CHARMS: an evidence-based intervention helping care homes to promote movement and activity for residents
Many people living in care homes experience a range of physical and cognitive impairments. Movement and physical activity interventions, delivered in the most appropriate ways and tailored to an individual’s preferences, needs and abilities, can help to improve some of their experience; maintain residents’ existing functional abilities; and contribute to their overall quality of life.
Whilst the benefits of increased activity and the dangers of inactivity are both well recognised, providing increased opportunities for movement can be challenging for care homes. Beliefs about the appropriateness of physical activity, pressures on staff time, lack of resources, and resident willingness to engage can all inhibit the delivery of interventions to prompt physical activity. Standardised approaches take no account of the different resources available to individual care homes or the needs of individual residents and, as a result, can be difficult for care homes to deliver and/or sustain.
In a project funded by the Healthcare Management Trust (‘HMT’) and led by Prof. Alison Bowes, researchers from the University of Stirling have been working with care homes to develop an evidence-based approach to promote physical activity appropriate for both a care home and its residents.
The project, which is now nearing completion, systematically developed and tested an intervention to promote movement. To initially understand current levels of activity and barriers to increasing opportunities for movement the research team carried out a series of interviews in five different care homes. This helped the team to understand what care home managers, staff and residents think about movement and physical activity: its value and its importance in the everyday life of the home and its residents. At the same time, the team carried out a review of the scientific and academic literature to bring together the most up-to-date research evidence around physical activity for older people, identifying the kinds of physical, psychological and social benefits which different types of activity can bring and the different factors known or suspected to affect the success of an intervention.
The collected evidence was examined to identify factors which may inhibit movement or physical activity in care homes, considering which factors can potentially be changed, and describing how any changes would bring about an increase in movement or activity. The research team identified 20 potentially modifiable factors that contributed to low levels of movement which could be grouped into: care home provider/staff; resident; environmental and policy/system. These led to the development of five ‘theories of change’, i.e. descriptions of what factors could be changed and how the changes might affect levels of movement or activity for care home residents.
The team then worked with care home staff, residents and relatives in six homes to co-produce, test and refine ‘CHARMS’, an approach to increasing opportunities for activity in care homes which is adaptable to and transferable between care homes. CHARMS, a name suggested by one of the care home workers involved in the co-creation activities, is short for ‘Care Homes Achieving Realistic Movement Strategies’ is a ‘toolkit’ of resources incorporating the theories of change developed during the project. The CHARMS tools can be used by individual care homes to identify areas where they could improve, produce their own action plan for increasing activity, and monitor progress.
Feedback from care homes involved in testing the CHARMS approach has highlighted the potential positive results of the intervention. The next step is to carry out a trial of CHARMS in a larger number of care homes. The research team is currently seeking funding for this larger trial and is also working on a website to host resources to support care homes who want to use the CHARMS approach. The website will contain further information about CHARMS, downloadable CHARMS resources, other activity-related links, and ideas and examples from the care homes involved in the CHARMS tests and is expected to go ‘live’ by late Spring 2019.
~ Dr Alison Dawson, Research Fellow