12.08.2019
The ROAM II Study is an exciting research study sponsored
by Nottinghamshire Healthcare NHS Foundation Trust and funded by the Abbeyfield
Research Foundation.
Primary research
question: Can an
outdoor programme to improve the quality of
resident outdoor engagement be co-produced with staff, residents and
relatives in UK care homes?
What’s happened since April 2019?
In the last update, we reported that we had been consulting with care
homes to develop the ROAM II study protocol and were awaiting ethical review. This
took place at the end of April with the London - Camden and Kings Cross
research ethics committee (REC). Anita Astle MBE, who is the Managing Director
of Wren Hall Nursing Home and a Co-Researcher for the study, also attended the review (thanks Anita!). We suspect that care home
managers are not routinely invited to attend REC reviews but this was an extremely
valuable experience. We were able to address the panel’s questions from a research
and practice perspective and also express our worry about how some
of the governance requirements/processes might impact on the engagement of
those living and working in the study care homes.
We are pleased to announce that we received a ‘Favourable Opinion’ from
the REC at the end of May. The following week, we began recruiting residents,
family carers and care home workers in three care homes in the East Midlands.
Recruitment – progress so far
A guiding principle in Appreciative Action Research is to include as many
people in the study setting as possible. Therefore, we are approaching all eligible
residents and care staff in the selected households. We also want to recruit a
proportion of family carers who visit regularly. Overall, we are aiming to
invite 115 care home workers, 81 residents and 24 family carers to take part (220
in total).
As care home recruitment rates tend to fall between 40-60%, we do not
expect to recruit 220 participants. However, due to the participatory nature of
the study, we feel it is important to achieve buy-in and engagement from over
half of those we approach to take part. To this end, we have set a minimum
target of 50% for each type of participant – but we are working very hard to win
a small majority by the time recruitment closes!
Recruitment challenges
We are delighted that we have almost achieved our minimum target for staff
recruitment. However, whilst many staff have expressed that residents should
have increased opportunities to get outside, some have said that they do not
feel they have time to take part in the research. From the outset, we asked
managers and team leaders to attend staff recruitment sessions so that they
could reassure staff about time and workload - where this has happened, recruitment
has worked well! We know from the research literature that lack of time is
described as a major barrier to supporting residents outside, so we are paying
close attention to this narrative.
With regard to resident recruitment, there is a small shortfall in the setting with the highest number of eligible resident
participants. As the majority of these lack capacity to provide informed
written consent, we opted to write to their relatives, as Personal Consultees, with
the study information and Advice forms. This was partly due to the challenge of
arranging recruitment visits for the numbers involved. Unfortunately, there has
been a poor response to the recruitment packs and we received some informal
feedback that the documentation was too lengthy/detailed. To be able to
approach these Personal Consultees again, we were advised by the REC to submit
a substantial amendment and are currently awaiting the outcome of this.
On a positive note, where we have conducted recruitment sessions in-person
and been able to provide verbal explanations alongside the study information
sheets, there have been relatively few problems. So there has been a big lesson
learned in terms of how to use study documentation to engage those in the care
home setting. Whilst we did consult with the care homes about the information
sheets, there are clearly issues for us to consider next time. Amongst the
study team, this has sparked an interest in doing some quality improvement work
focusing on accessibility/utility of study documentation in care home research.
Watch this space….
What’s happening next?
We are continuing
to work hard to exceed the minimum recruitment targets and where possible, we are
collecting baseline measures. In one care home, data collection for the
‘Discovery’ phase has begun and three residents have been interviewed about
their outdoor engagement (what works well and what do you want to happen more
of the time?). In the research literature, first-hand accounts from UK care
home residents about outdoor use are scarce, so it will be exciting to publish
these findings later on.
The final,
year-one quarterly blog update will be posted by September 30th,
2019. By this time, we are hoping to have begun the outdoor engagement quality
improvement work in each care home, so please watch this space for a progress
update.
Whatever
your role, please join in the discussion about working with UK care homes to
improve the quality of resident outdoor engagement via our twitter feed: @ROAM IIStudy
Lead
Investigator: Amanda King
(Research
Occupational Therapist)
Telephone:
07769366313
Co-applicants: Professor Pip Logan, Associate
Professor Adam Gordon and Dr Neil Chadborn (University of Nottingham)
