Enriching opportunities for people living with dementia: The ...

372 D. J. Brooker & R. J. WoolleyMethodsThe literature reviewThe published literature was reviewed throughoutthe development of the programme. Searches weremade of relevant databases such as Medline,CINAHL and Cochrane with regard to key termssuch as dementia, activity/occupation, therapy, andlong-term care/homes. Similarly, key journals werehand searched. Further references were followed upfrom articles obtained.The Expert Working Group (EWG)This group guided the development of the EnrichedOpportunities Programme. It was a four-way forumfor discussion and action between the research team,the practitioners (key operational staff) in the fourpractice development sites, family carers and a groupof thirty experts from a variety of professional,therapy and training perspectives in dementia care.Collectively, this forum was known as the ExpertWorking Group (EWG). All members were invitedto use their expertise from practice and research inorder to shape the Enriched OpportunitiesProgramme from a theoretical ideal into a usableintervention within long-term care. An initial twodayresidential meeting of the Expert WorkingGroup was held and the recordings of presentationsand ensuing discussions of this first meeting weretranscribed to help guide the project (Brooker &Woolley, 2003). A further five EWG meetings wereheld in this advisory capacity over the course of thedevelopment. All meetings were recorded and notesmade for analysis. Between times, individual membersof the EWG provided training and mentorshipto the four practice development sites.Action researchThe remit of the research was to capture theprocesses and outcomes of the EnrichedOpportunities Programme on people with dementia,their family carers and staff in the four study sites.The evaluation adopted a case study design(Robson, 1993) combining qualitative and quantitativeresearch methods and action research. Thecase in this evaluation can broadly be viewed as theinnovation i.e. the development of the EnrichedOpportunities Programme. Action research wasintegral to the case study approach, as the innovationrequired action with collaboration between theresearchers and practitioners and the EWG inorder to achieve both the developmental andresearch objectives.Four practice development sites participated;three dementia specialist nursing homes and oneextra care housing scheme. All three nursing homeswere registered EMI homes. In total, 127 peopleresiding within these nursing homes participatedin the programme. The extra care housing schemepractice development site had apartments for86 tenants with 18 tenants participating in theprogramme. A fuller description of the facilitiesand outcomes of the intervention in the nursinghomes are reported in a companion paper (Brookeret al., 2007).A series of focus groups were held for staff,relatives and volunteers. Thirty staff focus groups,seven relatives groups and six volunteer groups wereheld in all, ranging in size from 3 to 12 participants.In addition to obtaining general feedback, the aimof the groups was to help draw out ideas that hadbeen effective in promoting well-being and toexplore remaining obstacles to change. Notes werewritten afterwards, and each focus group meetingwas recorded then transcribed for analysis.‘Locksmiths’ and practice development sitemanagers were interviewed individually at threepoints to help capture the processes and enhanceunderstanding of their roles. A semi-structuredinterview schedule was followed so that similarquestions were asked at each site at parallel researchstages, but issues specific to each could be followedup. The interviews were recorded and subsequentlytranscribed for analysis purposes.In addition, in-depth case studies were completedon five residents in each of the nursing homes.In the extra care housing scheme, in-depth casestudies were undertaken on all of the tenants whohad participated. The Locksmith, staff members,relatives and wherever possible the participantthemselves were involved individually in this process.The transcripts from the focus groups andinterviews were read and re-read on a number ofoccasions by the authors. These were analysed toidentify the perceptions around four broad themesand to develop sub-themes from these:1. how people felt about the EnrichedOpportunities Project2. what life was like for residents/tenants3. what were identified as barriers to leading anenriched life4. what was identified as facilitating leading anenriched lifeThe qualitative data was analysed as a whole anddifferences and similarities between the study siteswere explored. The results were then discussed withthe project team and the EWG. Two in-depthreports were produced to set out the experience asa whole – one focusing on the nursing home sitesand one on the extra care housing scheme.ResultsEnriched Opportunities for People with Dementiahad as its premise that elevated well-being for peoplewith dementia is desirable and, that given the rightconditions, is obtainable and sustainable. It was