G-EAT - German Environmental Audit Tool
Development of an instrument for the assessment of dementia-sensitive environmental design in nursing homes under inclusion of the perspective of people with dementia
Project Overview
| Duration: | since 2019 |
| Funding: | DZNE Witten |
| Project Management: | Dr. Bernhard Holle |
| Project Coordination and Staff: | Anne Fahsold, M.Sc. Kathrin Schmüdderich (2019-2020) |
Background
The importance of the built environment in the care and lives of people with dementia in long-term residential care has been recognised for several decades and is increasingly being addressed in dementia-related health care research. If the physical environment is well adapted to the needs of the residents, e.g. if the nursing home has a familiar design or if environmental elements support orientation, this can help to maintain everyday competence. This goes hand in hand with improving quality of life. Internationally, particularly in English-speaking countries, various principles for the implementation of dementia-sensitive design in health and care facilities have been developed in the past on the basis of the current state of research, which should guide the planning of new buildings, but are also used by providers as part of refurbishment projects. Building on this, there already exist a number of established tools for recording the characteristics of dementia-sensitive environmental features from the English-speaking world, which are also used for recording in studies. The relevance of recording the factor "built environment" for health research in Germany results, among other things, from the implications of the "DementiaMonitor" study at the DZNE Witten, AG Care Structures. A standardised, reliable and valid instrument for assessing the sensitivity of the built environment in residential long-term care to dementia is not yet available in Germany, although an instrument has already been adapted, although its psychometric quality proved to be inadequate (cf. Institute for Gerontology at the University of Heidelberg, 2006).
Project aims
From the research needs described above, the following overarching objectives have been identified and will be addressed in various sub-studies of the G-EAT project line. As a first step, the Australian "Environmental Audit Tool - High Care" was adapted to specific cultures and scientifically tested in order to assess the situation of the built environment and to make dementia-specific adaptations. As part of the G-EAT project, the tool will be further developed for specific cultures. The aim is to actively involve residents with dementia in German nursing homes. The project also aims to identify the needs of nursing homes and their staff in terms of environmental adaptations that can be included into day-to-day activities for the residents, taking into account existing staff resources.
Methods
1. Translation and adaptation of the Environmental Audit Tool - High Care
The adaptation of the original tool was carried out in a multi-step process based on the recommendations of the World Health Organization (1998). The translation and adaptation process involves both scientific experts and potential users from residential long-term care. The translation of the instrument was carried out by employees of DZNE. For linguistic validation colleagues with experience in translation processes were consulted. For the cultural adaptation, focus group interviews with long-term care practitioners were conducted and the Content Validity Index of G-EAT was calculated. Open questions from the existing process as well as an insight into the application of the instrument in Australia were clarified through a consultation at the University of Wollongong (Dementia Training Australia). Finally, the German language version of the instrument was reviewed by an Australian linguistics with regard to its equivalence to the Environmental Audit Tool -High Care.
2. Testing the feasibility of the G-EAT
Following the Australian approach, the instrument can be used by both researchers and practitioners. In order to identify information needs in the use of the G-EAT for both user groups and to be able to make adaptations, the instrument was evaluated regarding its feasibility in several living units. Thereby, the focus was on the duration of completing the form, integrating the assessment into the everyday life of the residents (prevention of disturbances) as well as the understanding of the respective questions of the G-EAT.
3. Interrater reliability testing of the G-EAT
The subsequent psychometric testing was carried out on 40 different living units in nursing homes in North Rhine-Westphalia. Two DZNE employees and two staff members working in the facility applied the instrument to one living unit per participating facility. After participation, all institutions received the results of the G-EAT in order to be able to discuss the strengths and weaknesses discovered in their built environment.
Expected Results
Following the completed phases 1 and 2 of the project, an adapted version of the EAT-HC, the German Environmental Audit Tool, now exists. The tool has already been applied in 40 living units in Germany area in the context of the interrater reliability test. In addition to the evaluation of interrater reliability, additional information was added to selected questions to simplify the G-EATs application for its users. The current analysis of the interrater reliability will provide further information about the possibility of scientific and practice-oriented application of the G-EAT in German residential long-term care. Also these results will form the basis for the further development of the instrument.
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