Abstract
Aims:
i) Develop and test a theory-based diagnostic instrument to assess barriers and facilitators accurately and prospectively; and ii) survey barriers and facilitators to the delivery of skin hygiene care in care homes.
Background:
There is an ageing population and an increasing number of people residing in care homes. As skin ages it become vulnerable to dryness, itching, cracks, and tears. These are experienced by many older people and cause discomfort, compromised quality of life, skin breakdown, increased dependency, longer hospital stays, and greater financial and human costs. These problems can be prevented through adequate skin hygiene care, however despite best practice guidance, concordance may be sub-optimal.
Methods:
Barriers and facilitators identified from a literature review and pilot study were categorised in a Delphi survey of experts (psychology or skin health) (n=8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n=38), construct validity (n=235), and test-retest reliability (n=11). Barriers and facilitators were surveyed in round two.
Results:
A 29-item valid and reliable instrument resulted (χ2/df=1.539, RMSEA=0.047, CFA=0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, high workload, and difficulties meeting often unrealistic expectations of relatives. A key facilitator was knowledge of how to perform effective skin hygiene care.
Conclusions:
This study identified a comprehensive list of barriers and facilitators to skin hygiene care including barriers previously unreported.
Relevance to clinical practice:
Efforts to improve care tend to be based on information giving. However, our work illustrates that barriers other than knowledge need to be addressed. Use of the SHELL-CH Index will allow identification of barriers and facilitators in local contexts and this understanding will support the development of interventions tailored according to need.