Abstract
BackgroundResearch has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool.MethodsSecondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality.ResultsRegression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (ρ = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (ρ = 0.25), the DEAP total score (ρ = 0.56), and the Mini Nutritional Assessment- Short Form (ρ = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (ρ = 0.53), staff Person Directed Care score (ρ = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (ρ = −0.26) and protein intake (ρ = −0.24). The homelikeness and functionality scales were also associated with one another (ρ = 0.26).ConclusionThe construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms.Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016.
Highlights
Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC)
A literature review identified seven therapeutic goals of dining spaces in LTC [13]. These were translated into observable items that are typically static in a dining room that were included on Dining Environment Audit Protocol (DEAP) [14]: general description of the physical space; a drawing of the layout; and ratings on adequacy of lighting, presence of glare, length of pathways, clutter, capacity for staff supervision, use of restraints and potential for resident opinions on comfort of space to be accommodated, and types of seating arrangements [13]
Dementia care units often promote safety of residents and as evidenced in this study, items such as an unsecured stove, were rare in these dining rooms. While these findings suggest that the homelike summary scale of the DEAP has construct validity, the adjusted R2 for the homelikeness model suggests that some variance in this scale was unexplained by DEAP variables
Summary
Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). DEAP is the first standardized environmental assessment specific to the physical aspects of the dining room and is based on the concept of competence-press and how the physical environment can support or produce barriers for psychosocial participation for residents [13]. A literature review identified seven therapeutic goals (e.g. orientation) of dining spaces in LTC [13] These were translated into observable items that are typically static in a dining room that were included on DEAP [14]: general description of the physical space (e.g. number of tables and chairs); a drawing of the layout; and ratings on adequacy of lighting, presence of glare, length of pathways, clutter, capacity for staff supervision, use of restraints and potential for resident opinions on comfort of space (e.g. temperature, lighting) to be accommodated, and types of seating arrangements [13]. Both scales range from 1 to 8 where a higher score indicates a greater degree of homelikeness or functionality [12, 13]
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