Optimising footcare interventions for older adults living in care homes (OPINIONS)

Background: Foot problems are very common in older adults and are associated with pain, increased risk of falls, and poor health outcomes. Within care homes, care staff have an important role in the identification and prevention of foot problems yet have no training in footcare. To address this, we want develop a Programme Grant for Applied Research (PGfAR ) to co-create and evaluate an education intervention for care home staff to improve knowledge in footcare. Aims and objectives: The aim of this programme development grant (PDG) is to undertake developmental work to describe current footcare practices across the care home sector and identify the optimal parameters for designing a carer-led footcare education intervention. Three inter-linked developmental work packages (DWPs) will be undertaken. The objectives are to: • DWP1: (i) describe current knowledge and practices for screening and identification of footcare needs in care homes. (ii) explore care home staff perceptions of footcare knowledge and practice(s). (iii) understand system-level barriers and facilitators to supporting care staff to develop new knowledge. • DWP2: (iv) use data collected about current care practices and gaps to develop a logic model outlining how our intervention is designed to work and improve foot health outcomes for older adults in care homes. • DWP3: (v) identify care home staff, care home residents and their families to form a public involvement group within our PGfAR. (vi) develop a multi-sector, multi-disciplinary stakeholder group to support development of our intervention and knowledge mobilization in the PGfAR. (vii) assemble the team needed to deliver the PGfAR. Methods: DWP1 (observational work to inform programme development) will adopt a multi-method approach and: (1) undertake a cross-sectional, multi-informant survey of 200+ care home staff, health professionals and national stakeholders across the UK; (2) augment survey findings by qualitative contextual data through interviews with up to 20 care home staff and 10 care home residents and/or their family representative. DWP2 (methodological work to inform intervention development) will involve the triangulation of findings from DWP1 to develop programme theory and construct the logic model. DWP3 (public and multisector stakeholder engagement) will recruit participants from DWP1 and from existing networks to assemble a public involvement group and a multi-sector stakeholder group. Timelines for delivery: The project will run for 18 months; DWP1 from months 0 - 12, DWP2 from months 10 – 17, and DWP3 will run throughout the project. Embedded within this timeline will be the development of the PGfAR application. Knowledge mobilization, dissemination and Impact: We will transfer study findings to all partners with the delivery of accessible and tailored outputs. We will empower stakeholders through active involvement and positive advocacy for improving foot health in older adults. We will engage with professional and national networks to support dissemination. Research inclusion: The development of our application has involved people living in care homes, care home managers, care staff, and health and social care professionals working across care settings. This has helped us to understand that care staff feel there are “ambiguities” and “fear” with footcare, and that care staff want to feel better informed.