The Development and Reliability of the Singaporean Environmental Assessment Tool (SEAT) for Facilities Providing High Levels of Care for People Living With Dementia

Abstract

Background: This article describes the development of the Singapore Environmental Assessment Tool (SEAT), a culturally appropriate, usable, reliable, and valid assessment tool designed to evaluate the extent to which the built environment in Singaporean aged care facilities is able to support the provision of high levels of care to people living with dementia. Methods: A multistage sequential mixed methods approach was carried out involving 16 raters in Stage 1 and six raters in Stage 2 using a culturally adapted English version of the Environmental Audit Tool–High Care (EAT-HC) in eight nursing homes. The first stage captured qualitative data on cultural sensitivities and usability of the tool. The SEAT was improved based on the findings, and in the second stage, the usability and psychometric properties of the modified tool were again assessed. Usability was determined by data collected via the System Usability Scale and the Questions to Assess Barriers and Facilitators survey. Psychometric properties were examined by the calculation of percentage agreement, item-level interrater agreement was measured using Fleiss’s κ, and Cronbach’s α was used to measure the internal consistency of the subscale scores. Results: The culturally adapted SEAT was found to have an acceptable level of usability and moderate level of reliability among subscales. Conclusion: The study indicated that the tool is reliable and valid when completed by users with knowledge of dementia-enabling environments. For the tool to be used with confidence education in the application of principles of design to the design of environments for people living with dementia is recommended prior to its use.

Feasibility, Interrater Reliability and Internal Consistency of the German Environmental Audit Tool (G-EAT)

“…Similar findings are reported by Sun and Fleming (2021) for the Singaporean version. To address this challenge, the author included additional items for the areas of palliative care, technology and spirituality in the Singapore Environmental Assessment Tool [20].…”

“…Brennan et al (2021) report for the adapted Japanese version (EAT-HC-JV) that cultural design elements such as foot baths or a tea ceremony room cannot be depicted with the original list of items [21]. Similar findings are reported by Sun and Fleming (2021) for the Singaporean version. To address this challenge, the author included additional items for the areas of palliative care, technology and spirituality in the Singapore Environmental Assessment Tool [20].…”

“…Background information was added to describe the meaning of the question in more detail. This necessity is also pointed out by Sun (2021) and Brennan and colleagues (2021), who emphasize the different literacy levels of staff of facilities using the instrument to collect data [38]. Even for other instruments that depict the built environment, additional information is provided in manuals to address the difficulties of this difficult-to-capture construct [39][40][41].…”

“…[13]. In accordance with the adapted versions of the EAT-HC for Singapore [20] and Japan [21], a multistep translation process of the instrument for the German context took place according to the guidelines of the World Health Organization (1998) [22]. Potential users of the future instrument from dementia-related health care research and dementia care were involved in the process.…”

The Role of the Built Environment on the Quality of Life for Residents in Long-Term Care Facilities in Asia: A Scoping Review

“…On the other hand, cultural reflection in the environmental features was found in nursing home settings through comparative case studies ( Lee et al, 2017 ; Lu & Wang, 2014 ), indicating that built environment reflected the residents’ sociocultural preferences or needs ( Chuang & Abbey, 2009 ; Lee et al, 2017 ; Sun & Fleming, 2021 ). For instance, there are notable differences between built environment characteristics of nursing units in China and the United States, including physical configuration, room occupancy, and quality of social spaces ( Lu & Wang, 2014 ).…”