The questionnaire was designed specifically to make it quick and easy for CH
managers to fill in. It was hoped that this would maximise the response rate. The aim was to elicit as much information as possible with minimal effort needed from the respondents to complete the questionnaire. Therefore, a brief, focused questionnaire comprised of only eight questions on one page was developed. To address the
research questions the topics prioritised to be covered by the questionnaire were: admission criteria of CHs in relation to CB; the instances and types of CB the CHs experience; the types of treatments or therapies (NPIs) used to manage BPSD; and the
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prescription levels of antipsychotic medications. To view the survey questionnaire see Appendix B.
The demographic data already available from the sample information comprised of: CH name, address, telephone number, registration, ownership, specialism and how many residents they could accommodate. This reduced the need for a lot of
demographic data to be sought within the questionnaire. To enable accurate
knowledge of resident numbers, the first question asked CH managers for the number of residents they were currently looking after. Individual CH names were added to this question on each questionnaire before printing. The question read: How many
residents does ‘CH name’ currently have? The individualisation of surveys was a laborious process, yet it was useful since it enabled the returned questionnaires to be identified and negated the need for an extra question asking for the CH name. The personalisation may also have contributed to CH managers generating a more favourable opinion of the questionnaire.
The questionnaire went through several drafts during its development. Questions were reworded, reordered, and restructured. Consultations with my supervisory team enabled a satisfactory stage to be reached with the questionnaire development. A pre-test, in the form of a stakeholder consultation, was then conducted to inform the development of the questionnaire before the final design was accepted. Personal contacts were used to arrange meetings with the managers of two very sheltered accommodation establishments. These settings provide domiciliary care to many people on one site; each occupant receives the care they need in their own flat within the larger building. To be eligible to live in very sheltered accommodation each
occupant has to receive a minimum of 4 hours care a week. The managers of these settings were not eligible to be included in the survey sample; therefore using them to test the questionnaire would not affect the global survey sample in anyway. However, their role within these settings is very similar to the CH manager role and if they found the questions to be acceptable it was likely that CH managers would too.
The stakeholders read through the survey and offered comments on its structure, on the nature of the issues it covered and on the perceived ease that the questions could
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be answered. The feedback was mostly positive; stating that the topic was a ‘problem that needs looking at’ and that the questionnaire was ‘easy to fill in’. There was surprise from 1 manager at the amount of therapies and treatments available for BPSD (the options in the multiple-response question). There was some debate between the two about the stigma of antipsychotic use and whether CH managers would report accurately on antipsychotic prescription levels. One stakeholder thought that there ‘may be a stigma over antipsychotic use,’ whereas, the other thought there ‘shouldn’t be stigma of antipsychotic use as GPs prescribe, not managers.’ These divergent views allude to one limitation of the self completion survey method; it is impossible to verify the information supplied by respondents. Whether respondents would give a socially acceptable answer to the question about antipsychotic
prescription levels is unknown and an issue that would be better explored by the case study method. Yet, as explained in chapter 3, a medication mapping phase for this study was unfeasible, leaving the prevalence of antipsychotic prescriptions in CHs an important issue to explore with the survey.
Due to the availability of the CH addresses, but not emails, in the directories from which the sample was derived postal surveys were chosen over email or internet surveys. Telephone surveys were considered, but dismissed due to the time
consuming nature of contacting n=747 CHs, the availability of managers at the time of the phone call, and the requirement of immediate responses, which could inhibit the possibility of checking answers with other staff members. As the case studies would be conducted directly after the survey phase no follow ups were sent out to non- responding CHs. Other postal survey studies to CHs, without follow ups, have obtained response rates of between 35 – 38% (Purandare et al., 2004; Rodriguez et al., 2007). It was hoped that the survey in this study would attain similar levels to these, although CHs can be a particularly difficult group to gain high response rates from. For example, one study by Gage et al targeted CHs with a self completion internet questionnaire about integrated working between CHs and other agencies; they only gained a 15.8% response rate (Gage et al., 2012).
The final questionnaire design included open, closed and multiple-response questions. The questionnaire was comprised of 3 dichotomous (yes or no) closed questions
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asking whether the CHs were currently looking after PWD, whether they admitted people with CB to the CH and whether they had experienced an episode of CB in the last week. Three further questions were open ended asking for a numerical response; these asked about the number of residents currently in the CH, the number of
residents currently prescribed antipsychotic medications and if so how many were prescribed a PRN medication. One question asked about the treatments and therapies used within the CH and offered listed multiple-response choices with an additional free text option if other responses were relevant (a list of the non-pharmacological interventions included with brief definitions can be found in Appendix A). Finally, 1 question was of an open style asking for three free text responses of experienced behaviours that were perceived as difficult to manage. Therefore, in all, information about caring for PWD, antipsychotic use, perceived difficult behaviours and
interventions used within the home to manage difficult behaviour was sought. A cross-sectional design was employed to gain a snapshot of the status quo in CHs in autumn 2011.