Introduction
Materials and methods
FUTURE WORKSHOP I |
Step 1 – Collecting potential actions & discussing in small groups Following a brainstorming session about potential PA-promoting offers with all participants, small groups discussed favoured actions together with researchers to consider different perspectives. |
Step 2 – Cataloguing actions Actions were catalogued and organised by opportunities, resources, commitments, and goals for promoting PA. |
Step 3 – Favouring & considering actions in detail As homework, participants collected actions they wanted to implement in daily home routine and considered actions in detail to present to the expert team. |
FUTURE WORKSHOP II |
Step 4 – Planning actions Actions prioritised were systematically planned following the SMART concept [37] – including specification, measurability, acceptance, realisability and timing (further details below). |
Step 5 – Creating goal attainment scaling 1.0 To assess success later, each action was assessed according to GAS [36]. Therefore, participants set expected goals by phrasing action success in 1 sentence (GAS = 0). The expert team determined positive and negative gradations (GAS = -2, -1, + 1, +2) retrospectively using field notes from workshops, then submitted them to homes for confirmation. Additionally, participants decided whether individual counselling for residents should be offered by a team of experts in their homes within the next weeks. |
INDIVIDUAL COUNSELLING I + II |
Step 6 – Developing individual activity schedules Individual counselling I was structured according to the 5 A concept [38] (further details below) and aimed to integrate PA opportunities, including actions developed in future workshops, into individual daily resident lives based on individual PA motives and goals [39]. Relatives supported cognitively impaired residents during individual counselling and in implementing the activity schedule. |
Step 7 – Handling barriers After 6 weeks, individual counselling II was scheduled with residents and relatives to handle possibly arising barriers and to reflect activities scheduled together. |
EVALUATION WORKSHOP |
Step 8 – Implementing-supervising Implementing actions into everyday life was supervised by the project team over 6 months between future workshops I + II by providing support when problems arose. Within 6 months, homes integrated actions into organisational structures and daily routines [40]. Responsible persons sent implementation protocols regularly. Evaluation questionnaires were surveyed after 3 and 6 months. |
Step 9 – Revising goal attainment scaling 2.0 In the evaluation workshop, actions developed during future workshop I + II were evaluated according to a 5-level GAS. Actions were rated in different areas (social, neighbourhood, green care, infrastructure, employees & caregivers, individual activity behaviour, and specifications of the nursing home) based on the GAS of future workshop II. To design the GAS lower threshold, rating scales were reformulated into statements (-2 = much worse than expected; -1 = worse than expected; 0 = as expected; +1 = better than expected; +2 = much better than expected). |
Step 10– Goal Attainment Scaling 3.0 Individual counselling was rated according to GAS, as well evaluated the success of the 2 sessions. Success was not evaluated for each resident but for the counselling approach in the home. |
Specification | Describing the action |
---|---|
Measurability | Defining success |
Acceptance | Consenting the team |
Realisability | Planning implementation |
Timing | Starting the action |
Assess | Identifying personal activity goals [39] and considering individual needs and nursing home social-infrastructural conditions |
Advise | Advising from PA experts about needs |
Agree | Agreeing upon goals by recording individual activities in resident activity schedules |
Assist | Providing support for changing behaviour, such as action or coping plans) |
Arrange | Arranging a follow-up meeting 6 weeks later to handle barriers |
Results
PA-related actions and dimensions in participating nursing homes
Activities of Daily Living | Structured Activities | Activity-Friendly Environment |
---|---|---|
Directly • Flower Tubs • Raised Beds • Household Activities Indirectly • Daily Check | Directly • Musical Offers • Rituals • Bowling • Individual PA Promotion Indirectly • Expanded Exercise Opportunities • Individual Counselling • Evening for Relatives • Recruiting Volunteers Staff Training | Directly • Walking Exercises • Excursions • Strolls • Interactive Bike • Barefoot Trail Indirectly • PA Patrons • Animals • Open Day • Furnished Terrace |
Success of implemented PA-promoting actions
Much worse than expected | Worse than expected | As successful as expected | More successful than expected | Much more successful than expected | Not evaluated | |
---|---|---|---|---|---|---|
social | 3 | 1 | 1 | 3 | ||
neighbourhood | 1 | 4 | 1 | 1 | ||
green care | 1 | 3 | 1 | 1 | ||
infrastructure | 3 | |||||
employees & caregivers | 1 | 1 | 2 | |||
individual activity behaviour | 1 | 4 | 3 | 3 | ||
specification of the nursing home | 3 | 12 | ||||
Total | 7 | 3 | 23 | 9 | 9 | 3 |
Much worse than expected | Worse than expected | As successful as expected | More successful than expected | Much more successful than expected | Not evaluated | |
---|---|---|---|---|---|---|
Home 1 (periphery) | 1 | 1 | 4 | 2 | 2 | |
Home 2 (periphery) | 3 | 1 | 2 | |||
Home 3 (periphery) | 4 | 1 | ||||
Home 4 (urban) | 1 | 6 | ||||
Home 5 (periphery) | 1 | 1 | 1 | 3 | 2 | |
Home 6 (urban) | Dropped Out | |||||
Home 7 (urban) | 1 | 3 | 2 | |||
Home 8 (periphery) | 3 | 1 | 2 | 2 | 3 | 1 |
In total | 7 | 3 | 23 | 9 | 9 | 3 |
Much worse than expected | Worse than expected | As successful as expected | More successful than expected | Much more successful than expected | Number of residents with individual counselling | |
---|---|---|---|---|---|---|
Home 1 (periphery) | x | 6 | ||||
Home 2 (periphery) | no individual counselling | |||||
Home 3 (periphery) | no individual counselling | |||||
Home 4 (urban) | x | 2 | ||||
Home 5 (periphery) | x | 6 | ||||
Home 6 (urban) | dropped out | |||||
Home 7 (urban) | x | 4 | ||||
Home 8 (periphery) | no individual counselling | |||||
Total | 18 |