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

Anne Fahsold,Bernhard Holle,Rebecca Palm,Hilde Verbeek,Kathrin Schmüdderich

doi:10.3390/ijerph19031050

Abstract

Dementia-specific environmental design has the potential to positively influence capabilities for daily living and quality of life in people with dementia living in nursing homes. To date, no reliable instrument exists for systematically assessing the adequacy of these built environments in Germany. This study aimed to test the adapted version of the Environmental Audit Tool—High Care (EAT-HC)—the German Environmental Audit Tool (G-EAT)—with regard to its feasibility, interrater reliability and internal consistency. The G-EAT was applied as a paper-pencil version in the German setting; intraclass correlation coefficients at the subscale level ranged from 0.662 (III) to 0.869 (IV), and 42% of the items showed at least substantial agreement (Cohen’s kappa ≥ 0.60). The results indicate the need to develop supplementary material in a manual that illustrates the meaning of the items and practical implications regarding dementia-specific environmental design. Furthermore, the intersectionality of built and physical environments must be considered when interpreting G-EAT results in future research and applications to residential long-term care practice.

Highlights

Forty nursing homes in the federal state of North Rhine-Westphalia participated in the interrater reliability study
From the testing described in this paper, the German Environmental Audit Tool exists in a modified version and may be applied in health care research
The usability and quality of the results for long-term care practitioners must be further evaluated with respect to the relevance of environmental design for practice and regarding the inclusion of this group in data collection

Summary

Introduction

80.2% of the 4,127,605 people in need of care in Germany receive support at home from relatives (64.0%) and outpatient services (29.7%) [1], residential long-term care is an irreplaceable pillar of the German care system. A total of 14,494 nursing homes provided 877,162 full-time long-term care places in 2019 [2]. Identified that 51.8% (95%-CI 50.4–53.3) [3] of nursing home residents are diagnosed with dementia. The number of residents living with mild cognitive impairments or undiagnosed dementia cannot be quantified, but it is estimated to be much higher. Residential long-term care facilities in Germany differ in various respects, including in terms of their size, the number of full-time long-term care places offered and their living concepts. The majority of nursing homes provide care in integrative living units where people with and without dementia live together. Nursing homes in Germany are often organized in living units—most with 2–3 per facility—but their characteristics are not clearly defined and vary across facilities

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