Cross-sectional study assessing the feasibility of measuring residents’ Quality of Life in English care homes and assessing the construct validity and internal consistency of measures completed by staff-proxy
Authors: Towers Ann-Marie , Rand Stacey , Allan Stephen , Webster Lucy , Palmer S , Carroll Rachael E , Gordon Adam L , Akdur Gizdem , Smith Nick , Burton Jenni , Killett Anne , Hanratty Barbara , Meyer J , Spilsbury Karen , Goodman Claire 
Published: May 2024

Objectives

To assess the feasibility of capturing older care home residents’ quality of life (QoL) in digital social care records (DSCRs) and the construct validity (hypothesis testing) and internal consistency (Cronbach’s Alpha) of four QoL measures.

Design

Cross-sectional data collected in wave one of the DACHA (Developing resourcesAnd minimum dataset forCareHomes’Adoption) Study, a mixed-methods pilot of a prototype minimum dataset (MDS) [1].Setting:Care homes (with or without nursing) registered to provide care for older adults (>65 years) and/or those living with dementia. All homes used a DSCR system from one of two suppliers..

Participants

Data were extracted for 748 residents. All permanent residents, aged 65 years or older, were eligible to participate, including those lacking capacity to consent. Temporary residents and residents in their last weeks of life were excluded.

Outcome measures and analysis

The English language versions of: ASCOT-Proxy-Resident, ICECAP-O, EQ-5D-5L proxy and the QUALIDEM were added to the DSCRs. As there have not been any previous studies of the structural validity of the English language version of the QUALIDEM, ordinal Exploratory Factor Analysis (EFA) was applied for this measure only. Feasibility (% missing by software provider and measure), % floor/ceiling effects (>15% at lower/upper end of the scales), convergent or divergent construct validity (criterion of >75% of hypotheses accepted) and internal consistency (Cronbach’s Alpha ≥.7) were assessed for all four measures.

Results

The ordinal EFA of QUALIDEM did not replicate the findings of previous research. A six factors (36 items) solution was proposed and used in all subsequent analyses. There were low rates of missing data (<5%) for all items, except ASCOT-Proxy-Resident Control (5.1%) and Dignity (6.2%) and QUALIDEM item 35 (5.1%). Ceiling effects were observed for the ASCOT-Proxy-Resident and two of the QUALIDEM subscales. None of the scales had floor effects. Cronbach’s alpha indicated adequate internal consistency (α≥.70) for the ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L proxy. There were issues with two QUALIDEM subscales. Construct validity for all measures was adequate.

Conclusions

The findings support the use of EQ-5D-5L, ASCOT-Proxy-Resident and the ICECAP-O in care homes for older people. Choice of measure will depend on the construct(s) of interest. More research is needed to establish the psychometric properties of the QUALIDEM in an English care home setting.

Strengths and limitations

This is the first time that quality of life measures have been piloted in routine data collection from care home digital social care records (DSCRs) in England.

Findings support previous research that resident self-report leads to high levels of missing data. We present new evidence that collecting data through staff-proxy instead is feasible.

Psychometric evidence supported the construct validity and internal consistency of the ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L-Proxy.

Missing demographic data held about residents in DSCRs meant that we were unable to describe, or assess the representativeness, of residents in the sample.

We did not ask staff to record whether they completed the measures alone or asked the opinions of residents, family members or colleagues before making their ratings.