Learning Lessons in the Design and Delivery of Care Home Research

Learning Lessons in the Design and Delivery of Care Home Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning Lessons in the Design and Delivery of Care Home Research Annabelle Long, Garry Meakin, Paul Leighton, Adam L Gordon, Caroline Rick This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6844598/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Care homes for older adults pose a unique set of challenges for research. Despite having high healthcare needs, this population are often excluded from clinical research, in part due to the challenges of this care context. This study identifies barriers, facilitators and potential solutions to performing research in care homes for older adults and reaches a consensus on the relative importance of these approaches. The study consisted of three parts: a survey, qualitative interviews and Delphi exercise. The survey was designed to gather views from a wide range of stakeholders including care home staff, managers and researchers alongside residents and family members. It was initially distributed in the East Midlands and then the wider UK, A purposive sample of those who took part in the survey were interviewed to explore challenges surrounding research in care homes in greater depth. Finally, an e-Delphi was conducted with statements constructed by the study team using themes gathered from the first two stages. 63 participants responded to the survey. Most rated resident characteristics including cognitive and physical abilities as important considerations when running studies. They thought it less important that care staff had experience in research, but did have experience of the tasks that may be involved in conducting research. Eight people were included in qualitative interviews which identified 5 key themes including barriers and facilitators to research involvement, the need for care home research, reasons for participation and some potential solutions. From these themes 24 statements were developed including: facilitators to care home research; inclusion in research and potential solutions.19 participants took part in Round One of the Delphi with 15 continuing to Round Two. Consensus was reached on 23 out of the 24 statements. Care home research is different to that conducted in hospitals and other community settings. Researchers need to be flexible, fit in with the routines of the homes and value contributions from care home staff, with a specific focus on developing relationships with staff and managers. Time is needed to develop these relationships and may need to be a focus even before project commencement. Care Homes Older People Clinical Research Mixed methods Figures Figure 1 Figure 2 Background Care homes for older adults pose a unique set of challenges for researchers conducting clinical studies, including randomised controlled trials.( 1 ) This underserved population, despite having high healthcare needs, are often not included in clinical research, in part due to the challenges of conducting research in this context. This exclusion limits what we can learn from both homes and those who live and work in them.( 2 , 3 ) Care homes play a vital role in public health and care infrastructure, supporting people with complex needs, but they are also the place residents call ‘home’. ( 1 ) Care homes are sufficiently different from other settings in which care is delivered, meaning there are context-sensitive research questions that must be addressed by research conducted in situ, rather than by using research findings extrapolated from other settings. Examples include how infectious diseases are managed due to the influence of multiple immunocompromised individuals cohabiting;( 4 ) and how aspects of health and care delivery are structured to take account of the context-specific arrangements around care.( 5 ) There are specific challenges associated with conducting research in care homes.( 6 ) Complexity theory has been used as a way of explaining these( 7 ) but, in reality, these settings are no more or less complex than other health and social care organisations where research is conducted. Rather many of the difficulties stem from the fact that care homes are predominantly research naive, that they are neither contracted nor reimbursed for participation in research, and because they exist outside the governance infrastructure that regulates and indemnifies research in hospitals and community healthcare. The leadership and culture of a care home can have a positive or negative effect on the success of research. ( 8 ) Managers who are resistant to the necessary changes in routine associated with research can act as a barrier ( 9 – 11 ), and it takes time to build relationships with managers and staff to produce successful research delivery. ( 12 , 13 ) Where an intervention aligns with existing care home culture and, by consequence, is acceptable to staff and residents and fits with current routines, it is more likely to be successful. ( 14 ) Care homes where staff are very task-focused and overly concerned with risk management, or where management feel that specific research implies criticism of current practices, are less likely to be successful research partners. ( 15 – 18 ) The PROTECT-CH trial was set up during the COVID-19 pandemic as a UK-wide platform clinical trial to evaluate prophylactic treatments for COVID-19 in care home residents. During set-up, several barriers were encountered along with different methods of facilitating care home involvement. ( 19 ) There was no easily accessible central register of care homes to recruit from, and those that were registered on databases did not always have up-to-date contact details. Many care homes were owned by large chain providers, with individual managers unable to take part in research without authorisation from chain management. The ownership of care homes by commercial enterprises and charities, rather than local authorities or the NHS, also meant that the governance processes in place for health research, including having the appropriate insurances in place for research activity, did not automatically transfer to social care. Those issues discovered during the PROTECT-CH trial have been experienced by other research groups ( 20 , 21 ). This highlights the need for practical guidelines to support research infrastructure and delivery in care homes. Here we set out to identify the barriers and facilitators to performing research in adult care homes, to identify potential solutions to improving access and participation and to achieve consensus on the relative importance of these approaches. Methods This study consisted of three sequential parts, a survey, qualitative interviews and e-Delphi study. The survey was initially advertised in the East Midlands but widened to the whole of the UK. Qualitative interviews took place in the East Midlands. The e-Delphi included views of people across the UK. Survey Study Population All care home managers, staff, residents and family members, alongside researchers who had undertaken research in care homes, were eligible to participate. Sample Size A sample size was not calculated but we expected to receive between 50 and 80 survey responses based upon similar previous research. Survey Design A survey was developed by the research team for this study based upon findings from the PROTECT-CH study. A web-based online version was developed using MS Forms. Ethical approval was obtained from the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref No: 124–0224). A copy of the survey is available as a supplementary file. Data Collection The survey link was sent to the Enabling Research in Care Homes network for East Midlands (ENRICH EM) to distribute amongst their list of research-ready care homes. The survey was also promoted at ENRICH regional and national meetings and in ENRICH newsletters. Local networks known to the study team were used to promote the survey via email using a QR code and survey link. A poster was designed, including the QR code and link, and distributed to care homes by ENRICH for display in public areas to promote the survey to residents and family members. The survey initially had a slow local response so it was agreed with the funders that it could be promoted nationally to improve the response. Social media was also used to promote the study to a wider audience. We had a limited response from residents of care homes. To enable residents to access the survey more easily, a researcher (AL) went to two care homes to gather responses using a tablet computer. Clicking on the survey link introduced the researchers and potential participants to the study and explained the purpose of the survey. Participants consented to the study by clicking past the introduction page and starting the survey. At the end of the survey participants were offered the opportunity to enter a prize draw to win a £50 Amazon voucher. They were also asked at this point if they would be interested in participating in the next interview and e-Delphi stages of the research. Data Analysis Data from MS Forms was downloaded onto an Excel sheet. MS Forms also provided basic descriptive statistics for the completed survey responses. Survey responses were examined throughout the data collection period for any differences in opinions that could be explored during subsequent interviews. Free text responses were gathered, entered into NVivo, and analysed thematically with the interview data. Semi-Structured Interviews. Study Population A purposive sample of people who answered the survey and provided consent to be contacted were asked to participate in focus groups or semi-structured interviews. Participant information sheets were provided to those registering interest. Participants were given a minimum of 24 hours to consider involvement, and informed consent was collected from each participant prior to the interview. A topic guide was produced to support discussions based on concepts that had emerged from the survey. A copy of the topic guide is available as a supplementary file. Sample We aimed to get a selection of people who had and had not been involved in research from all groups (family, residents, staff, managers, researchers) and a variety of age ranges. From 63 survey responses just over half (52%) did not wish to participate in the interviews with 11% not responding to a subsequent invitation to an interview. Data Analysis. Interviews were transcribed verbatim and fully anonymised by an external transcriber. These were then checked using audio files (AL) to ensure the accuracy of the transcription. Transcription files were then uploaded onto NVivo 14. One researcher, (AL) coded the first six interviews using a thematic, inductive yet flexible coding process. During a gap in data collection, these codes were analysed to ensure no duplicate or similar codes were present and those found were amalgamated. A second researcher (CR) coded two interviews independently to ensure the robustness of the coding process. Coding then continued for the remaining interviews. Codes were rechecked at the end of data collection and duplicate or similar codes were combined. Free text survey responses were coded alongside the interview data. Modified e-Delphi The Delphi technique is a method used to generate a consensus within a group. ( 22 ) Traditionally the first round has open questioning which is used to identify the focus of the process. However, modifications are considered appropriate and in this modified e-Delphi we used themes gathered from the first two stages of the study, instead of having a round of open questioning, to identify the focus. Statements for the formal consensus process were developed in discussion with the study team until agreement was reached. ( 23 ) Study Population All participants who took part in the survey and who agreed to be contacted to take part in further stages of the study were included. A QR code was also created to invite researchers/methodologists who were present at the International Clinical Trials Methodology Conference held in Edinburgh in October 2024, where the initial findings of the study were presented, to take part. Sample Size A sample size was not calculated but we aimed to get between 50 and 70 responses to the e-Delphi survey. Survey Design A survey was designed by the research team for this study using statements that were constructed from the key themes that arose through the survey and interview stages of the study. One researcher (AL) developed an initial set of statements that were discussed by the research team, until agreement was reached for the final set of 24 statements. A copy of the survey is available as a supplementary file. Data Collection The survey link was emailed to all participants of the original survey who had left contact details for this stage of the study. Clicking on the survey link introduced the researcher and the study to potential participants and explained the purpose of the survey. Participants consented to the study by clicking past the introduction page and starting the survey. At the end of the survey participants were offered the opportunity to enter a prize draw to win a £30 Amazon voucher. They were also asked to leave their details if they would be willing to participate in the next round. Participants were given two weeks to complete each round with a reminder email sent at one week. If the participant had not completed the round at this point, they were excluded from further rounds. An upper limit of three rounds was set to ensure retention of participants and reduce sample fatigue. ( 22 – 24 ) Each survey consisted of a series of structured statements asking for responders to rate their level of agreement using a five-point Likert scale (strongly agree – strongly disagree). Statements were grouped into sections with an open response question at the end of each section used to allow participants to comment on the statements in that section. As Delphi is an iterative process, it was necessary to analyse and review the findings of each round and revise the survey for the following round. For round two a summary of the scoring was presented which included the percentage level of agreement for each statement along with a summary of the comments. This provided participants with a context to inform their scoring to the revised survey. For any statement which reached consensus the scoring was presented, but participants were asked to not rescore in the following round. If consensus was reached but comments indicated minor modification for clarity, this was completed but participants were not asked to rescore. If consensus was not reached but comments indicated modification, statements were modified to reflect these comments, and the statement was presented back in the following round for rescoring and comments. Statements that had not reached consensus, but no comments were provided to indicate modification, were presented back to participants for rescoring as they were, but participants were given the opportunity to provide open text comments to explain their scoring. There has been no universally accepted level for defining consensus in a Delphi. Studies that have used this process have used a range of proportion of agreement from 51–100%. ( 22 , 23 ) A predefined consensus level is an indicator of good quality Delphi research. ( 23 ) A consensus threshold of 70% was set for this study as it was consistent with other similar research using a Delphi technique. ( 23 , 25 – 27 ) Data Analysis Data from MS Forms was downloaded onto an Excel sheet. MS Forms also provided basic descriptive statistics for the completed survey responses. Open survey responses were examined throughout the data collection period for any comments that indicated modifications to the statements in the following round. Free text responses were gathered and fed back to participants in subsequent rounds. These were also used to modify statements in the next round as appropriate. Results Survey There were 63 responses to the survey. Respondents varied in age (range 18–85) and sex with the majority being female (n = 57). There were a wide range of stakeholders who responded to the survey with 20 participants identifying as a manager or director of a care home. Experience ranges from 1–45 years working in the sector. Insert Table 1 Here Table 1 Distribution of Participant Roles Current Role Number of Participants (%) Care Home Manager (Single) 15 ( 24 ) Care Home Manager/Director (Chain) 5 ( 8 ) Care Home Owner 1 ( 2 ) Care Home Staff Member 12 ( 19 ) Family member of Care Home Resident 9 ( 14 ) Care Home Resident 4 ( 6 ) Academic Researcher 2 ( 3 ) Clinical or Academic Researcher 2 ( 3 ) Other 13 ( 21 ) Participants were asked to rate the importance of specific resident characteristics including cognitive and physical abilities when considering running a trial in a care home. The majority of respondents thought that these characteristics were important. However, when it came to the characteristics of family members including location and work status respondents thought these were less important. Most respondents did not think that it was important that care home staff had experience in research. However, they did think it was important that they had experience of the tasks that may be involved in the study. Insert Table 2 Here Table 2 Percentage Rating of Residents, Family Members and Staff Characteristics Characteristics Very Unimportant (%) Unimportant (%) Not Sure (%) Important (%) Very Important (%) Residents Cognitive Abilities 8 4 8 44 36 Multi morbidity 8 12 12 40 28 Frailty 8 8 8 48 28 Help with ADL’s 8 12 8 44 28 Sensory Impairment 8 4 8 48 32 Family Members Geographical Location 8 32 20 36 4 Physical or Cognitive Impairments 12 0 24 48 16 Work Full Time 12 28 8 44 8 Staff Experience of Research 8 56 8 24 4 Specific Research Training 16 0 20 40 24 Electronic Care Records 4 8 24 48 16 Dispensing and recording medication 4 0 20 44 32 Survey results revealed no consensus as to the importance of payment to either organisations or individual staff. However, most respondents did feel that it was appropriate to recognise the contributions of staff. Insert Fig. 1 Here The survey provided examples of tasks that staff may undertake with appropriate training and there was broad agreement that these suggested tasks were appropriate. Insert Fig. 2 Here Interviews Eight participants consented to take part in an interview. Most interviews took place online (n = 7) and participants included care home managers (n = 2) staff members (n = 2), family members (n = 2) and researchers (n = 2). Insert Table 3 Here Table 3 Participants’ demographics Pseudonym Role Gender Age Level of Experience Research Experience INT01 Care Home Owner Female 56–70 35 yrs Yes INT02 Care Home Staff Member Female 41–55 2 yrs Yes INT03 Care Home Staff Member Male 18–25 2 yrs No INT04 Care Home Manager Male 56–70 14 yrs Yes INT05 Family Member Female 56–70 n/a No INT06 Family Member Female 56–70 n/a Yes INT07 Academic Researcher Female 26–40 7 Yes INT08 Academic Researcher Female 56–70 10 Yes Themes Data analysis identified five key themes: barriers to research involvement, facilitators to research involvement, need for care home research, why people participate and potential solutions. Barriers to Research Involvement All groups identified that research could be time-consuming and not necessarily a high priority for the care home. “I think a lot of care homes or care home managers might find oh I don’t want to do that because they think it’s going to be too much work…oh we've enough to do” (INT04) “Research is not a priority in care homes amongst all their competing activities” (SVY33 – survey free text response) Researchers identified that governance in this area can be more complex and may be both time-consuming and act as a barrier to care homes wanting to be involved in studies. “...there was a lot of issues around the governance and having the systems to be appropriate to those settings” (INT07) “Easier processes, ethics etc to involve care homes would facilitate it as well” (SVY39) Recruitment can be more complex in a care home environment as many residents have reduced capacity. There may be a need to involve a family member to gain consultee advice which may not be straightforward. “I guess at that point I did realise…it was all difficult in terms of the recruitment” (INT07) “Sometimes difficult when residents have complex needs to involve them” (SVY44) Staff and family members also reported a lack of opportunities to take part in research studies which had limited their involvement. “...in finding the care home for my dad, we went round lots and lots of different care homes looking at them and I never saw …on noticeboards...never seen anything about research trials or anything like that” (INT05) “I have put the home forward for research, but never taken part yet” (SVY23) Facilitators to Research Involvement Despite some barriers to involvement in research, participants were able to identify several facilitators to involvement in a study. Many participants commented that it was important to have buy-in for the research from the whole care home team, including those working in roles ancillary to care. Studies where all staff were motivated ‘flowed’ better than those where participation was directed by managers. “I would really reiterate how important it is to include every level of staff, including your domestic staff because they very often have quite an influence on the coalface” (INT06) “It's good for staff to see how they can help shape services” (SVY 44) Alongside this, it was also important to have a management that is receptive to research. This can be a key factor when you have a group of care homes managed by the same company. “I think you need to have receptive management because if something just comes as a leaflet in the post it’s easily dismissed as like almost like a cold call and it finishes in the bin” (INT02) “I was one of the first homes what took part in research because I took part in it my boss then said can you get the other homes on it as well” (INT04) Equally as important was the involvement of residents' families with the study. Ensuring that family members were informed and on board was a key part of getting residents involved. “families bring a different perspective to the fore and are required to assist sometimes their loved ones and give support” (SVY28) “Clinical trials need to allow sufficient time to discuss with family members as appropriate and allow opportunity for family members who live away or work to engage with the process” (SVY32) Training was thought to be an important facilitator both in making staff aware of the benefit of research to their day-to-day work and in offering them opportunities to develop. “I think it’s useful for them to have some knowledge of research, to understand the importance of it, after all, you’re going in the home and disrupting the home while you’re doing your research.” (INT08) “absolutely they should be trained…because you’re not going to get buy-in if they don’t understand the rationale, if they don’t understand what the study’s about, if they don’t understand what the end goal is ...” (INT06) Financial incentives were thought to be of some benefit both to the care home and the individuals involved. However, some participants felt that it was important that the staff were acknowledged for their involvement and that didn’t necessarily need to be financial. “it's a thank you or an acknowledgement for what you’ve done” (INT01) “Flexibility may be needed as care homes may want different things e.g. vouchers, a sum towards the home's activity budget, CPD opportunities, backfill” (SVY38) Need for Care Home Research Participants generally agreed that there was a need for care home research to take place for things to move forward, especially as this population is increasing over time. Care homes were seen to be different to hospitals and primary care, primarily because the research was happening in someone’s home and not a workplace. “there’s a general lack of understanding of the needs of care homes and care home residents. There’s a perception that they're the equivalent of hospitalised patients and it’s not, it’s people’s homes” (INT01) “it’s so different to doing research in the hospital environment or in the community to be honest” (INT08) Alongside this social care research was not seen as equitable to NHS research in terms of funding or support. “I guess that’s another sort of maybe barrier or reason why it can be challenging in terms of that understanding of research and awareness of research…the investment hasn’t been the same across social care generally I guess, to support staff and people to understand the importance of research or engage with research in the same way” (INT07) “I’ve always come from a health background, a health position. So, I guess it’s that recognition…actually we probably need to start challenging that thinking actually that I guess that’s, in terms of the integration of health and social care, where could things sit…” (INT07) All participant groups highlighted the importance of inclusion in research for residents and family members as well as the care home staff. “It’s important to ensure that care home research can include all care home residents to make sure the research findings are applicable and useful” (SVY32) “it doesn’t matter whether people have got a cognitive impairment, whether they're physically disabled, whether they can't speak, we can still do the research, there’s processes that we can adopt so that we can do the research” (INT01) “It’s difficult to think that research could be done about care homes without involving the people who work there or the people who are the residents there” (INT05) Why People Participate There were a variety of reasons why people participated in research from interest and learning opportunities to making sure that they were offering the best care to their residents. Some staff and researchers thought that taking part in research offered learning and development opportunities. “the more we know, the more we educate ourselves, the better trained we are, the more we can help them, the residents” (INT03) “being part of the trial may provide the staff members with an insight into something new” (INT05) Managers and staff felt that participating in research enabled homes to be at the forefront of improving care not only for the residents that they look after now but also for future generations. “If there are any improvements that can be provided to those standards of care here in UK” (INT03) “without trials a lot of opportunities to improve practice would be missed” (SVY28) “More research we do improves outcomes for current and future residents” (SVY10) Some participants commented on the altruistic nature of taking part in research and felt that by helping others now you may be helped in the future. “I'm just automatically driven to be involved because there’s an opportunity to learn. Even if you learn actually it doesn’t make a difference” (INT01) “we've decided to take part and to help out, so in return we can be helped out when we need to” (INT02) It was also noted by some participants that there were regulatory benefits to taking part in research. “apparently, CQC likes the home to be involved in research and give feedback and receive feedback” (INT02) “…with the CQC’s new single assessment framework, there are three quality restatements in the 34 that relate to monitoring and evaluation, and research engagement, and implementing research evidence” (INT06) Potential Solutions One of the important themes that came out was potential solutions to the key barriers and facilitators that were identified. Care home managers and staff identified that research worked well when researchers were able to fit in with the routines of the home. They commented that researchers need to be aware that the resident's care will always be the first priority of the care home staff, and flexibility is important when working with care homes. “we've got staff available for them so if they need anything, you know, getting the information and that…the teams what have been coming in, I must admit they’ve been fantastic, it’s never been a ‘oh can you get me this or that or you're holding me up’ it’s our pace…because obviously my residents come first before that”( INT04) “my experience is you have to be incredibly flexible as a researcher” (INT08) There needs to be good relationships between researchers and care homes. It needs to be appreciated that it takes time to develop those relationships and that it is often done better face-to-face. Participants also thought that it was important to develop networks and collaborate with other research organisations to help with these relationships. “I think from my experience the time needed to build those relationships is quite important. And they’re not always allocated in the funding…the actual, building the relationships and understanding...they’re not always able to be accounted for in the research plan” (INT07) “I think that’s one of the important things to get there, to build network, to build connections with care homes, because I don’t think cold calls and emails would help” (INT03) Some participants stated that sometimes some of the best ideas come from the staff and residents themselves. They also commented that it can be difficult to motivate people to take on ideas that have come from management. “give them a platform to share their ideas because they’re the ones right on the coalface who very often are very creative and innovative. Give them the opportunity.” (INT06) “it’s better when it comes from the grassroots, from the floor because good ideas that cascade down just fall on an umbrella and dissipate very often...if it comes from the floor and it’s nurtured and it’s encouraged and staff feel that their opinions matter, their views, their suggestions are listened to and they work together to find solutions or to try new ideas” (INT06) Many participants recognised that care staff were often undervalued for the work that they do and that it was important to recognise the value of care home staff as part of the research team. “Researchers need to balance their ask of care workers and their own activity - use care workers to the maximum effect and save the other tasks for the research team” (SVY14) “I think that’s probably a broader societal view...and probably links with the lack of recognition for the staff in those settings and the lack of pay and training and all the rest” (INT07) Delphi Response rate From the 63 responses to the original survey, 31 participants agreed to contact for further participation in the study. These 31 participants were invited to take part through an email which contained the link to the consensus survey. 19 of these participants responded to Round One of the survey and 15 went on to complete Round Two. Participants The participants who took part in the consensus represented a range of stakeholders including seven managers of care homes, three care home staff members, three academics who worked in the care home space, three family members, one participant in senior management position, one practice development manager and one membership organisation lead. Summary of the rounds The results for each round are presented in Table 2 which presents an overview of the scoring for each round. Insert Table 4 Here Table 4 Summary of Responses Total Number of Statements for scoring Statements that reached consensus (< 70%) and accepted Statements that did not reach consensus and were modified Statements that did not reach consensus and were rescored. Statements that did not reach consensus and were removed Round 1 24 18 (75%) 4 2 0 Round 2 6 5 (66%) 0 0 1 In Round One, 18 statements were accepted, four were modified in line with free text comments that were provided to improve clarity and understanding. Two statements did not reach consensus, but there were no free text comments to suggest any changes. These were sent out for rescoring with the original wording. In Round Two, five statements were accepted. One statement did not reach consensus and the free text comments did not have a consensus. This statement was removed. Summary of results Consensus was reached on 23 statements relating to the themes developed through the early stages of the study. All statements that reached consensus are presented in Table 3 within these themes. Insert Table 5 Here Table 5 Accepted Statements Theme Statement % agreement When consensus reached Need for Research in Care Homes Research is important in care homes as they are different to hospitals 100 Round 1 Research is important in care homes as without it opportunities to improve care and move practice forward would be missed 94.8 Round 1 Research has wider benefits for residents and care home staff which need to be clearly articulated and understood 94.7 Round 1 The governance of research in care home settings is complex and may discourage some settings from taking part. 73.3 Round 2 Facilitators to Research Involvement For research to be successful in a care home environment there need to be buy in from the whole care team 73.7 Round 1 Receptive management is key to a care home being involved in research 94.7 Round 1 Face-to-face contact from researchers would increase care home involvement in research. 78.6 Round 2 It is important to provide training to give care home staff an understanding of general research principles 89.4 Round 1 Training needs to be specific to each trial and undertaken only as necessary 78.9 Round 1 Research offers care home staff an opportunity to develop and learn new knowledge and skills 94.7 Round 1 It is important to recognise the contribution of care home staff to the research and reward them for their contribution. 92.9 Round 2 Inclusion in Research To ensure that research is meaningful for the target population, all care home residents should be given the opportunity to be involved in research. 85.8 Round 2 There needs to be defined processes to ensure all care home residents can be involved in research 73.7 Round 1 Research protocols need to ensure that sufficient time is allowed to recruit using multiple methods and allow access to information in a variety of ways 94.7 Round 1 Researchers need to think creatively about how to involve care home residents in research 94.8 Round 1 Potential Solutions For research to be successful researchers need to be flexible, fit in with the routines of the home and recognise the value of the care home staff 84.2 Round 1 There needs to be more collaboration between care homes and other research agencies (such as universities) to develop and maintain good working relationships 89.5 Round 1 There needs to be defined principles on payment for care home research to ensure equity with equivalent research taking place in the NHS 84.3 Round 1 It is important to embed research into all care home activities including induction, training and staff meetings for staff to appreciate the importance and benefit of research 84.2 Round 1 Time is needed to develop good relationships between staff and researchers, and this should be part of any funding application which involves research in care homes 89.4 Round 1 Researchers need to improve the implementation of research into practice to aid staff and residents’ understanding of its importance 100 Round 1 Researchers need to make better use of available technology to improve the research process in care homes 73.3 Round 2 Developing ideas in collaboration with care home staff and residents would ensure that research undertaken is important and relevant to those people involved 94.7 Round 1 One statement was removed during the process due to not reaching consensus and the analysis of the free text responses in round two which is presented below in Table 4 . Insert Table 6 Here Table 6 Removed Statements Theme Statement % agreement Outcome Facilitators to Research Involvement Paying a care home chain to be involved in research is appropriate to ensure involvement 53.3 Removed following Round 2 Discussion Summary of Findings This study aimed to identify the barriers and facilitators to performing research in care homes for older people and to identify potential solutions for improving access and participation. A survey examined the characteristics that were important to consider when undertaking research in a care home, the importance of payment to both individuals and organisations and the type of tasks which might be appropriate for care home staff to undertake. In depth interviews were carried out with eight participants to explore these concepts further. Five key themes were identified including barriers to research involvement, facilitators to research involvement, need for care home research, why people participate and potential solutions. From these themes, 24 statements were developed which covered four main areas which would look to identify potential solutions to improving access and participation to research in care homes including: the need for care home research; facilitators to care home research; inclusion in research and potential solutions. Consensus was reached on 23 statements drawing from a broad range of stakeholders including those working in care homes, researchers and family members of those living in care homes. Comparison with Other Studies The governance of research in care homes can be complex and it may discourage some care homes from taking part. During the PAAD study, care homes felt overwhelmed by the tasks that were required, and staff didn't necessarily understand the importance of following a set protocol. Managers felt the study added to staff’s already busy workload and overburdened them with the study documentation. Their solutions included ensuring that study processes were easy for staff to understand and complete and embedding their own staff into care homes for data collection. ( 28 ) Similarly, the PACE study found that by seeking feedback on the study information forms and data collection forms from those who were using them helped relieve some of that tension. ( 29 ) There have been several previous studies that have looked at the facilitators to conducting research in care homes. Having receptive management, alongside buy in from the whole care team was thought to be key to care home involvement in research. Care home managers who appreciate the benefits of research are often more willing to allow staff and residents to take part. ( 29 ) Those who could demonstrate that research was a valid part of their daily work also benefited from greater engagement. ( 32 ) Whilst engaging with staff and residents on how the study could benefit them can help create buy in from across the whole care home. ( 33 – 35 ) During the COVID pandemic, contact with care homes was severely reduced, and many participants in our study thought that the resumption of face-to-face contact with researchers could act to increase care home involvement in research – although the extent to which this has happened as the health and social care system continues to struggle to recover post-pandemic is unclear. This finding mirrors studies which have highlighted the importance of regular communication between the research teams and care home staff. Good and consistent communication is needed to build optimal working relationships, but this takes time that isn't always available within a research project. ( 30 , 31 ) Training for care home staff was thought to be an important factor during the initial survey, and this also came through in the interview study. Several participants thought that training could help outline the benefit of research for staff and offer further opportunities for professional development. Few studies have discussed the need or benefit of training, not just in the processes of one study, but general research principles. Care organisations feel that training should focus on ensuring staff are compliant with mandatory training and may not consider that research training is relevant to care home staff. ( 32 ) However, providing care home staff an opportunity to develop and learn new skills may make them feel more valued and highlight the importance of their work. ( 2 , 6 ) Ritchie et al highlighted that high care home staff turnover was a systemic barrier to care home research and including research training during the induction of care home staff may facilitate more general knowledge in the workforce. ( 6 ) Skills for Care, recognising that demographic changes mean we will need more social care workers in the future and that we do not have enough social care workers now, with a current vacancy rate of over 8%, have led the development of a workforce strategy which aims both attract and retain people in the workforce emphasising both fair pay and training as part of this strategy. ( 33 ) Both the survey and the interviews have highlighted the importance of recognising the contribution of staff in the research process but there is no clear description of how to go about doing this in Skills for Care guidance. Financial incentives have been suggested in previous work ( 34 , 35 ) but responses in this study suggested this may not always be appropriate. Other ways of recognising the contribution of the staff may include gifts in kind, providing refreshments and training. ( 35 ) Communication between researchers and the care homes to establish how best to achieve this would be useful to do in the early stages of planning a research study. Strengths and Limitations This study had certain strengths and limitations. It would have been preferable to have more participants in all three stages of the study. In the survey we were aiming for 50 to 80 respondents, and we had 63 responses which was within our expected range. We were aiming for 10 to 20 respondents at interview stage and were only able to recruit 8. However, we were able to interview participants from all our stakeholder groups aside from residents, who have prevalent cognitive impairment and whom it is often difficult to recruit to interview studies. We were aiming for 50 to 70 respondents for the Delphi, but this was not achieved with 19 respondents in Round One and 15 respondents in Round 2. However, initially we had planned to complete a nominal group process with around 8 participants (2 care home managers, 2 care home staff members, 2 researchers and 2 family members) but we were unable to organise a suitable time for everyone to meet. Although we did not achieve high numbers, we did get a representative sample of the stakeholder groups within the Delphi. Despite the challenges, there are several strengths to the study. It achieved its overarching goal to bring together the learnings from previous research to help future researchers, care home teams, and residents benefit from these hard-won lessons. While many of these exemplars have been published, they have been done individually on a project-by-project basis, making their impact harder to judge. Synthesising these findings in collaboration with the research community, care home staff, and residents/families has allowed ideas to be contrasted and evaluated. This study has tried to take this learning to develop guidelines that can be usefully shared in the care home research environment. Another strength of the study it that it followed a three-stage process modelled on the James Lind Priority Sharing Partnership. A survey was completed taking the views from a wide range of stakeholders including care home staff, managers and researchers as well as residents and family members. These results were then refined and developed further through semi-structured interviews that also included a wide range of stakeholders. Finally, the themes that came through these stages were used to develop the statements for the Delphi which gained responses from a wide range of stakeholders building a consensus for future guidelines. The study team also worked in collaboration with both the funders and key stakeholders to reduce barriers to involvement in the study including expanding the initial survey to allow a national response, using both traditional and social media to promote the survey widely and a researcher going into care homes in person with a tablet computer to increase access for residents living in care homes. Implications and Future Research Several solutions were suggested in this study. Researchers need to be flexible and fit in with routines of the home and recognise value of care home staff. Although we concentrated on training for care home staff, it was recognised in the Delphi study that researchers themselves may benefit from training on how care home's function. Indeed, care homes themselves have identified the need for training for inexperienced researchers. ( 36 ) In all three stages of this study, it was suggested that more collaboration both with research agencies and care homes, as well as between the researchers, staff and residents, would ensure the research that is carried out is what the key stakeholders need and want. Partnerships such as the James Lind Alliance have been set up with the sole purpose of finding out what the research priorities are, but on a national scale. Smaller collaborations between local universities and care homes may help identify research that is relevant on a local level. ( 37 ) Both the University of Maastricht and in the UK the University of Leeds have living lab collaborations with local care homes which work to address research priorities identified by those living and working in long term care. These relationships have taken time to develop but are now sustainable partnerships that work to improve care, increase knowledge and innovation. ( 38 , 39 ) The interviews in this study suggest that whereas research in NHS settings is considered routine, in care settings it may be seen as a luxury or something that is nice to have. Since its inception in 2006 the NIHR has funded social care research, but it added ‘care’ to its name in 2022 to emphasise this commitment, recognising that research in this area is less well established. ( 40 ) Whilst healthcare all sits under the umbrella of the NHS, social care is more fragmented and overseen by around 150 local authorities. Not only that but it is delivered by many different organisations, alongside families, friends and local communities. This makes the planning and delivery of social care research more difficult. Alongside this, clinicians who work in NHS settings are likely to have been introduced to research as part of their training and see it as part of their role. People working in social care are less likely to have been provided with research training and may not see this as part of their job. The NIHR has put social care research on an equal footing to health and is working to increase research capacity in the social care workforce. ( 41 ) However, it has only been two years since this commitment was made, and this study would suggest there is still a way to go. Care home research is unique in that it is carried out in a place that is both someone’s home as well as a workplace and a ‘care institution’. It is also different to NHS institutions where research is carried out more often. For this to be successful it is important to develop relationships with the staff and managers. Time is needed to develop these relationships, and that time is often needed before the project and the funding starts. If relationships have developed on previous projects, researchers may end up frequently using the same care homes, potentially leading to a less diverse view with the same people are involved in several projects. This may also result in ‘research fatigue’ from the staff and the residents if they are being asked to regularly give their time. Alongside this the high turnover within care homes can mean that relationships may be short-lived and frequently renewed as management and staff change. Conclusions There is a need for care home research as they are home to some of the most vulnerable in society whose frailty and multiple morbidities requires healthcare tailored to their complex needs. They are unique in offering a care infrastructure alongside a social environment that would not normally be considered as part of a research study. These differences suggest that research should be conducted in situ, rather than by using findings extrapolated from other settings. For care home research to be successful it is important to develop relationships with staff and managers. Researchers need to be flexible, fit in with the routines of the home and recognise the value of care home staff. Time is needed to develop these relationships which is often needed before the project starts and both care homes and universities could benefit from developing longer time collaborations to allow this to take place. Declarations Ethics approval and consent to participate: Ethical approval was obtained from the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref No: 124-0224). Written consent was obtained for all participant at all three stages of the study. This study adheres to all of the ethical principles in the Declaration of Helsinki regarding the collection of data on human subjects. Consent for publication: Not applicable – all identifiable information has been removed, and participants have been anonymised. Availability of data and materials: All data generated and analysed during this study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: This study was funded by the Clinical Research Network East Midlands. The funders had no influence or control on the planning, conduct, or reporting of the study. Authors Contributions: AL: Study design, ethical approval, recruitment, data collection, data analysis, manuscript writing. GM: Study design, data analysis, manuscript editing ALG: Study conception, study design, data analysis, manuscript editing PL: data analysis, manuscript editing. CR: Study conception, study design, data analysis, manuscript editing All authors read and approved the final manuscript. Acknowledgements: We are very grateful to all the care home managers, staff and residents alongside all other health care professionals and family members who participated in this study for sharing their experience and time. References Peryer G, Kelly S, Blake J, Burton JK, Irvine L, Cowan A, et al. Contextual factors influencing complex intervention research processes in care homes: A systematic review and framework synthesis. Age and Ageing. Volume 51. Oxford University Press; 2022. Law E, Ashworth R. Facilitators and Barriers to Research Participation in Care Homes: Thematic Analysis of Interviews with Researchers, Staff, Residents and Residents’ Families. J Long-Term Care. 2022;2022:49–60. Law E, Ashworth R, Killin L, Connelly P. Motivating and constraining factors for research participation in Scottish care homes. Nurs Residential Care. 2021;23(4):1–7. Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241. Logan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A et al. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ. 2021;375. Ritchie LA, Gordon AL, Penson PE, Lane DA, Akpan A. Stop and Go: Barriers and Facilitators to Care Home Research. J Frailty Aging. 2023;12(1):63–6. Simpson KM, Porter K, McConnell ES, Colón-Emeric C, Daily KA, Stalzer A et al. Tool for evaluating research implementation challenges: A sense-making protocol for addressing implementation challenges in complex research settings. Implement Sci. 2013;8(1). Bunn F, Goodman C, Corazzini K, Sharpe R, Handley M, Lynch J et al. Setting priorities to inform assessment of care homes’ readiness to participate in healthcare innovation: A systematic mapping review and consensus process. Int J Environ Res Public Health. 2020;17(3). Wenborn J, Challis D, Head J, Miranda-Castillo C, Popham C, Thakur R, et al. Providing activity for people with dementia in care homes: A cluster randomised controlled trial. Int J Geriatr Psychiatry. 2013;28(12):1296–304. Rantz MJ, Zwygart-Stauffacher M, Hicks L, Mehr D, Flesner M, Petroski GF, et al. Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. J Am Med Dir Assoc. 2012;13(1):60–8. Luckett T, Chenoweth L, Phillips J, Brooks D, Cook J, Mitchell G, et al. A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: Perceptions of palliative care planning coordinators and other health professionals in the IDEAL study. Int Psychogeriatr. 2017;29(10):1713–22. Ballard C, Orrell M, YongZhong S, Moniz-Cook E, Stafford J, Whittaker R, et al. Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: a factorial cluster-randomized controlled trial by the Well-Being and Health. Am J Psychiatry. 2015;173(3):252–62. Livingston G, Barber J, Marston L, Stringer A, Panca M, Hunter R, et al. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. Lancet Psychiatry. 2019;6(4):293–304. Greenspan SL, Nace D, Perera S, Ferchak M, Fiorito G, Medich D, et al. Lessons learned from an osteoporosis clinical trial in frail long-term care residents. Clin Trails. 2012;9(2):247–56. Brooker DJ, Latham I, Evans SC, Jacobson N, Perry W, Bray J, et al. FITS into practice: Translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging Ment Health. 2016;20(7):709–18. Ellard DR, Thorogood M, Underwood M, Seale C, Taylor SJ. Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation. 2014. Stein-Parbury J, Chenoweth L, Jeon YH, Brodaty H, Haas M, Norman R. Implementing Person-Centered Care in Residential Dementia Care. Clin Gerontol. 2012;35(5):404–24. Hall S, Longhurst S, Higginson IJ. Challenges to conducting research with older people living in nursing homes. BMC Geriatr. 2009;9(1). Gordon AL, Rick C, Juszczak E, Montgomery A, Howard R, Guthrie B, et al. The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure. Age Ageing. 2022;51(3):afac052. Lam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K et al. Challenges of conducting research in long-term care facilities: A systematic review. BMC Geriatr. 2018;18(1). Jenkins C, Smythe A, Galant-Miecznikowska M, Bentham P, Oyebode J. Overcoming challenges of conducting research in nursing homes. Nurs Older People. 2016;28(5):16. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008–15. Robinson KR, Leighton P, Logan P, Gordon AL, Anthony K, Harwood RH et al. Developing the principles of chair based exercise for older people: A modified Delphi study. BMC Geriatr. 2014;14(1). Mullen PM. Delphi: Myths and reality. J Health Organ Manag. 2003;17(1):37–52. Van Steenkiste BC, Jacobs JE, Verheijen NM, Levelink JH, Bottema BJAM. A Delphi technique as a method for selecting the content of an electronic patient record for asthma. Volume 65. International Journal of Medical Informatics; 2002. Wells C, Kolt GS, Marshall P, Bialocerkowski A. The Definition and Application of Pilates Exercise to Treat People With Chronic Low Back Pain: A Delphi Survey of Australian Physical Therapists. Phys Ther. 2014;94(6):792–805. Aloraibi S, Gladman J, Godfrey D, Booth V, Robinson K, Lunt E et al. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study. BMC Geriatr. 2021;21(1). Hood K, Nuttall J, Gillespie D, Shepherd V, Wood F, Duncan D, et al. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): A prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes. Health Technol Assess (Rockv). 2014;18(63):1–84. Collingridge Moore D. Talk to the people who know-consulting widely before starting care home research [Internet]. 2015 Apr [cited 2025 Jan 17]. Available from: https://enrich.nihr.ac.uk/casestudies/talk-to-the-people-who-know-consulting-widely-before-starting-care-home-research/ Rutherford A. Dementia Research – a care home perspective. [Internet] 2019 [cited 2025 Jan 17] Available from: https://enrich.nihr.ac.uk/casestudies/dementia-research-a-care-home-perspective/ Hart C, Alam S, Gibson K. Laying the foundations – what helps research in care homes to work well? [Internet]. 2015 Mar [cited 2025 Jan 20]. Available from: https://enrich.nihr.ac.uk/casestudies/laying-the-foundations-what-helps-research-in-care-homes-to-work-well/ Sabey A, Bray I, Gray S. Building capacity to use and undertake applied health research: establishing a training programme for the health workforce in the West of England. Public Health. 2019;167:62–9. Skills For Care. A workforce strategy for adult social care in England [Internet]. 2024 [cited 2025 Apr 25]. Available from: https://www.skillsforcare.org.uk/Workforce-Strategy/Overview/Executive-summary.aspx Scott A. Getting staff involved in research Background [Internet]. 2015. Available from: Goodman Claire. Doing ‘with’ rather than doing ‘to’ – working in partnership with care home staff [Internet]. 2015 Apr [cited 2025 Jan 20]. Available from: https://enrich.nihr.ac.uk/casestudies/doing-with-rather-than-doing-to-working-in-partnership-with-care-home-staff/ Davies SL, Goodman C, Manthorpe J, Smith A, Carrick N, Iliffe S. Enabling research in care homes: An evaluation of a national network of research ready care homes. BMC Med Res Methodol. 2014;14(1). Concannon TW, Meissner P, Grunbaum JA, McElwee N, Guise JM, Santa J, et al. A new taxonomy for stakeholder engagement in patient-centered outcomes research. J Gen Intern Med. 2012;27:985–91. Verbeek H, Zwakhalen SMG, Schols JMGA, Kempen GIJM, Hamers JPH. The Living Lab in Ageing and Long-Term Care: A Sustainable Model for Translational Research Improving Quality of Life, Quality of Care and Quality of Work. J Nutr Health Aging. 2020;24(1):43–7. Griffiths AW, Devi R, Cheetham B, Heaton L, Randle A, Ellwood A et al. Maintaining and improving mouth care for care home residents: A participatory research project. Int J Older People Nurs. 2021;16(5). National Institute for Health and Care Research. NIHR changes name to emphasise long-term commitment to social care research [Internet]. 2022 [cited 2025 Jan 24]. Available from: https://www.nihr.ac.uk/news/nihr-changes-name-emphasise-long-term-commitment-social-care-research National Institute for Health and Care Research. 5 things you didn’t know about social care research [Internet]. 2024 [cited 2025 Jan 24]. Available from: https://bepartofresearch.nihr.ac.uk/news-and-features/social-care-research Additional Declarations No competing interests reported. Supplementary Files FocusGroupTopicGuideEMCRNCareHomeStudy.docx LearninglessonsindesignanddeliveryofCareHomeresearchAsurveyamended.pdf LearningLessonsinDesignandDeliveryofCareHomeResearchaModifiedDelphiStudy.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers agreed at journal 27 Jul, 2025 Reviewers invited by journal 18 Jul, 2025 Editor assigned by journal 16 Jul, 2025 Editor invited by journal 24 Jun, 2025 Submission checks completed at journal 23 Jun, 2025 First submitted to journal 23 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6844598","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488346108,"identity":"4df8fb08-ffab-40aa-9070-81fe77400345","order_by":0,"name":"Annabelle Long","email":"data:image/png;base64,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","orcid":"","institution":"University of Warwick","correspondingAuthor":true,"prefix":"","firstName":"Annabelle","middleName":"","lastName":"Long","suffix":""},{"id":488346109,"identity":"e9403067-e3fc-4b74-8f1f-4c82ada52a5d","order_by":1,"name":"Garry Meakin","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Garry","middleName":"","lastName":"Meakin","suffix":""},{"id":488346110,"identity":"c4e1669b-d802-4247-b3ba-a14e3bb40170","order_by":2,"name":"Paul Leighton","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Leighton","suffix":""},{"id":488346111,"identity":"7b1c2091-5ded-46a7-a944-3c8d0e31393a","order_by":3,"name":"Adam L Gordon","email":"","orcid":"","institution":"Queen Mary University of London","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"L","lastName":"Gordon","suffix":""},{"id":488346112,"identity":"83a1bd58-4a42-4a5b-9009-a71d194acba3","order_by":4,"name":"Caroline Rick","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Rick","suffix":""}],"badges":[],"createdAt":"2025-06-07 20:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6844598/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6844598/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87347864,"identity":"6dce5cc3-5b2b-41b5-84b2-e45f69770ef7","added_by":"auto","created_at":"2025-07-23 02:49:31","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":278256,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePercentage ratings of appropriateness for previous methods of payment in research studies\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/25c6f516a298df1ca5c90344.jpeg"},{"id":87346888,"identity":"78177ac0-c8bd-4f8b-b146-1467c080f755","added_by":"auto","created_at":"2025-07-23 02:33:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38936,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePercentage ratings of appropriateness of tasks for care home staff to complete with appropriate training\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/1aa2d9f4dd570966d3c0d6ef.png"},{"id":87348560,"identity":"b4e7595f-eb59-4ac8-adaa-5d7fe658cd96","added_by":"auto","created_at":"2025-07-23 02:57:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1546165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/6fcdb6c8-582d-4f78-a29e-fbde852fbdbe.pdf"},{"id":87346881,"identity":"fd00ae6c-18c9-4dab-97bd-f5cdeafa4c61","added_by":"auto","created_at":"2025-07-23 02:33:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20919,"visible":true,"origin":"","legend":"","description":"","filename":"FocusGroupTopicGuideEMCRNCareHomeStudy.docx","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/25c85c33aed32e03c4d0f32a.docx"},{"id":87347745,"identity":"38d46ec1-1f08-4ab8-bb2a-9ced7d2b2b07","added_by":"auto","created_at":"2025-07-23 02:41:31","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":272991,"visible":true,"origin":"","legend":"","description":"","filename":"LearninglessonsindesignanddeliveryofCareHomeresearchAsurveyamended.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/4dcb87bedd8b798ec411e5dc.pdf"},{"id":87346890,"identity":"4c6e1398-e484-4fc0-83bc-a1a934b51044","added_by":"auto","created_at":"2025-07-23 02:33:31","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":361150,"visible":true,"origin":"","legend":"","description":"","filename":"LearningLessonsinDesignandDeliveryofCareHomeResearchaModifiedDelphiStudy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6844598/v1/933a7aa4994f6000529ce0cb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Learning Lessons in the Design and Delivery of Care Home Research","fulltext":[{"header":"Background","content":"\u003cp\u003eCare homes for older adults pose a unique set of challenges for researchers conducting clinical studies, including randomised controlled trials.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) This underserved population, despite having high healthcare needs, are often not included in clinical research, in part due to the challenges of conducting research in this context. This exclusion limits what we can learn from both homes and those who live and work in them.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Care homes play a vital role in public health and care infrastructure, supporting people with complex needs, but they are also the place residents call \u0026lsquo;home\u0026rsquo;. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCare homes are sufficiently different from other settings in which care is delivered, meaning there are context-sensitive research questions that must be addressed by research conducted in situ, rather than by using research findings extrapolated from other settings. Examples include how infectious diseases are managed due to the influence of multiple immunocompromised individuals cohabiting;(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and how aspects of health and care delivery are structured to take account of the context-specific arrangements around care.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThere are specific challenges associated with conducting research in care homes.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Complexity theory has been used as a way of explaining these(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) but, in reality, these settings are no more or less complex than other health and social care organisations where research is conducted. Rather many of the difficulties stem from the fact that care homes are predominantly research naive, that they are neither contracted nor reimbursed for participation in research, and because they exist outside the governance infrastructure that regulates and indemnifies research in hospitals and community healthcare.\u003c/p\u003e\u003cp\u003eThe leadership and culture of a care home can have a positive or negative effect on the success of research. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Managers who are resistant to the necessary changes in routine associated with research can act as a barrier (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and it takes time to build relationships with managers and staff to produce successful research delivery. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Where an intervention aligns with existing care home culture and, by consequence, is acceptable to staff and residents \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eand\u003c/span\u003e fits with current routines, it is more likely to be successful. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Care homes where staff are very task-focused and overly concerned with risk management, or where management feel that specific research implies criticism of current practices, are less likely to be successful research partners. (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe PROTECT-CH trial was set up during the COVID-19 pandemic as a UK-wide platform clinical trial to evaluate prophylactic treatments for COVID-19 in care home residents. During set-up, several barriers were encountered along with different methods of facilitating care home involvement. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) There was no easily accessible central register of care homes to recruit from, and those that were registered on databases did not always have up-to-date contact details. Many care homes were owned by large chain providers, with individual managers unable to take part in research without authorisation from chain management. The ownership of care homes by commercial enterprises and charities, rather than local authorities or the NHS, also meant that the governance processes in place for health research, including having the appropriate insurances in place for research activity, did not automatically transfer to social care.\u003c/p\u003e\u003cp\u003eThose issues discovered during the PROTECT-CH trial have been experienced by other research groups (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This highlights the need for practical guidelines to support research infrastructure and delivery in care homes. Here we set out to identify the barriers and facilitators to performing research in adult care homes, to identify potential solutions to improving access and participation and to achieve consensus on the relative importance of these approaches.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study consisted of three sequential parts, a survey, qualitative interviews and e-Delphi study. The survey was initially advertised in the East Midlands but widened to the whole of the UK. Qualitative interviews took place in the East Midlands. The e-Delphi included views of people across the UK.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSurvey\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eStudy Population\u003c/h2\u003e\u003cp\u003eAll care home managers, staff, residents and family members, alongside researchers who had undertaken research in care homes, were eligible to participate.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eA sample size was not calculated but we expected to receive between 50 and 80 survey responses based upon similar previous research.\u003c/p\u003e\n\u003ch3\u003eSurvey Design\u003c/h3\u003e\n\u003cp\u003eA survey was developed by the research team for this study based upon findings from the PROTECT-CH study. A web-based online version was developed using MS Forms. Ethical approval was obtained from the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref No: 124\u0026ndash;0224). A copy of the survey is available as a supplementary file.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe survey link was sent to the Enabling Research in Care Homes network for East Midlands (ENRICH EM) to distribute amongst their list of research-ready care homes. The survey was also promoted at ENRICH regional and national meetings and in ENRICH newsletters. Local networks known to the study team were used to promote the survey via email using a QR code and survey link.\u003c/p\u003e\u003cp\u003eA poster was designed, including the QR code and link, and distributed to care homes by ENRICH for display in public areas to promote the survey to residents and family members.\u003c/p\u003e\u003cp\u003eThe survey initially had a slow local response so it was agreed with the funders that it could be promoted nationally to improve the response. Social media was also used to promote the study to a wider audience.\u003c/p\u003e\u003cp\u003eWe had a limited response from residents of care homes. To enable residents to access the survey more easily, a researcher (AL) went to two care homes to gather responses using a tablet computer.\u003c/p\u003e\u003cp\u003eClicking on the survey link introduced the researchers and potential participants to the study and explained the purpose of the survey. Participants consented to the study by clicking past the introduction page and starting the survey.\u003c/p\u003e\u003cp\u003eAt the end of the survey participants were offered the opportunity to enter a prize draw to win a \u0026pound;50 Amazon voucher. They were also asked at this point if they would be interested in participating in the next interview and e-Delphi stages of the research.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData from MS Forms was downloaded onto an Excel sheet. MS Forms also provided basic descriptive statistics for the completed survey responses. Survey responses were examined throughout the data collection period for any differences in opinions that could be explored during subsequent interviews.\u003c/p\u003e\u003cp\u003eFree text responses were gathered, entered into NVivo, and analysed thematically with the interview data.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSemi-Structured Interviews.\u003c/span\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003e A purposive sample of people who answered the survey and provided consent to be contacted were asked to participate in focus groups or semi-structured interviews. Participant information sheets were provided to those registering interest. Participants were given a minimum of 24 hours to consider involvement, and informed consent was collected from each participant prior to the interview. A topic guide was produced to support discussions based on concepts that had emerged from the survey. A copy of the topic guide is available as a supplementary file.\u003c/p\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eWe aimed to get a selection of people who had and had not been involved in research from all groups (family, residents, staff, managers, researchers) and a variety of age ranges. From 63 survey responses just over half (52%) did not wish to participate in the interviews with 11% not responding to a subsequent invitation to an interview.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis.\u003c/h2\u003e\u003cp\u003eInterviews were transcribed verbatim and fully anonymised by an external transcriber. These were then checked using audio files (AL) to ensure the accuracy of the transcription. Transcription files were then uploaded onto NVivo 14. One researcher, (AL) coded the first six interviews using a thematic, inductive yet flexible coding process. During a gap in data collection, these codes were analysed to ensure no duplicate or similar codes were present and those found were amalgamated.\u003c/p\u003e\u003cp\u003eA second researcher (CR) coded two interviews independently to ensure the robustness of the coding process.\u003c/p\u003e\u003cp\u003eCoding then continued for the remaining interviews. Codes were rechecked at the end of data collection and duplicate or similar codes were combined. Free text survey responses were coded alongside the interview data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eModified e-Delphi\u003c/h2\u003e\u003cp\u003eThe Delphi technique is a method used to generate a consensus within a group. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Traditionally the first round has open questioning which is used to identify the focus of the process. However, modifications are considered appropriate and in this modified e-Delphi we used themes gathered from the first two stages of the study, instead of having a round of open questioning, to identify the focus. Statements for the formal consensus process were developed in discussion with the study team until agreement was reached. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStudy Population\u003c/h2\u003e\u003cp\u003eAll participants who took part in the survey and who agreed to be contacted to take part in further stages of the study were included. A QR code was also created to invite researchers/methodologists who were present at the International Clinical Trials Methodology Conference held in Edinburgh in October 2024, where the initial findings of the study were presented, to take part.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSample Size\u003c/h2\u003e\u003cp\u003eA sample size was not calculated but we aimed to get between 50 and 70 responses to the e-Delphi survey.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSurvey Design\u003c/h2\u003e\u003cp\u003eA survey was designed by the research team for this study using statements that were constructed from the key themes that arose through the survey and interview stages of the study. One researcher (AL) developed an initial set of statements that were discussed by the research team, until agreement was reached for the final set of 24 statements. A copy of the survey is available as a supplementary file.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eThe survey link was emailed to all participants of the original survey who had left contact details for this stage of the study.\u003c/p\u003e\u003cp\u003eClicking on the survey link introduced the researcher and the study to potential participants and explained the purpose of the survey. Participants consented to the study by clicking past the introduction page and starting the survey.\u003c/p\u003e\u003cp\u003eAt the end of the survey participants were offered the opportunity to enter a prize draw to win a \u0026pound;30 Amazon voucher. They were also asked to leave their details if they would be willing to participate in the next round.\u003c/p\u003e\u003cp\u003eParticipants were given two weeks to complete each round with a reminder email sent at one week. If the participant had not completed the round at this point, they were excluded from further rounds.\u003c/p\u003e\u003cp\u003eAn upper limit of three rounds was set to ensure retention of participants and reduce sample fatigue. (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eEach survey consisted of a series of structured statements asking for responders to rate their level of agreement using a five-point Likert scale (strongly agree \u0026ndash; strongly disagree). Statements were grouped into sections with an open response question at the end of each section used to allow participants to comment on the statements in that section.\u003c/p\u003e\u003cp\u003eAs Delphi is an iterative process, it was necessary to analyse and review the findings of each round and revise the survey for the following round.\u003c/p\u003e\u003cp\u003eFor round two a summary of the scoring was presented which included the percentage level of agreement for each statement along with a summary of the comments. This provided participants with a context to inform their scoring to the revised survey.\u003c/p\u003e\u003cp\u003eFor any statement which reached consensus the scoring was presented, but participants were asked to not rescore in the following round. If consensus was reached but comments indicated minor modification for clarity, this was completed but participants were not asked to rescore. If consensus was not reached but comments indicated modification, statements were modified to reflect these comments, and the statement was presented back in the following round for rescoring and comments.\u003c/p\u003e\u003cp\u003eStatements that had not reached consensus, but no comments were provided to indicate modification, were presented back to participants for rescoring as they were, but participants were given the opportunity to provide open text comments to explain their scoring.\u003c/p\u003e\u003cp\u003eThere has been no universally accepted level for defining consensus in a Delphi. Studies that have used this process have used a range of proportion of agreement from 51\u0026ndash;100%. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) A predefined consensus level is an indicator of good quality Delphi research. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) A consensus threshold of 70% was set for this study as it was consistent with other similar research using a Delphi technique. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData from MS Forms was downloaded onto an Excel sheet. MS Forms also provided basic descriptive statistics for the completed survey responses. Open survey responses were examined throughout the data collection period for any comments that indicated modifications to the statements in the following round.\u003c/p\u003e\u003cp\u003e Free text responses were gathered and fed back to participants in subsequent rounds. These were also used to modify statements in the next round as appropriate.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eSurvey\u003c/h2\u003e\u003cp\u003eThere were 63 responses to the survey. Respondents varied in age (range 18\u0026ndash;85) and sex with the majority being female (n\u0026thinsp;=\u0026thinsp;57). There were a wide range of stakeholders who responded to the survey with 20 participants identifying as a manager or director of a care home. Experience ranges from 1\u0026ndash;45 years working in the sector.\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Participant Roles\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Role\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Participants (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare Home Manager (Single)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare Home Manager/Director (Chain)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare Home Owner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare Home Staff Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily member of Care Home Resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare Home Resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Researcher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical or Academic Researcher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParticipants were asked to rate the importance of specific resident characteristics including cognitive and physical abilities when considering running a trial in a care home. The majority of respondents thought that these characteristics were important. However, when it came to the characteristics of family members including location and work status respondents thought these were less important. Most respondents did not think that it was important that care home staff had experience in research. However, they did think it was important that they had experience of the tasks that may be involved in the study.\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePercentage Rating of Residents, Family Members and Staff Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery Unimportant\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnimportant (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Sure\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eImportant (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVery Important\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidents\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive Abilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMulti morbidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrailty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHelp with ADL\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSensory Impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Members\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographical Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical or Cognitive Impairments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Full Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStaff\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperience of Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecific Research Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElectronic Care Records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDispensing and recording medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSurvey results revealed no consensus as to the importance of payment to either organisations or individual staff. However, most respondents did feel that it was appropriate to recognise the contributions of staff.\u003c/p\u003e\u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe survey provided examples of tasks that staff may undertake with appropriate training and there was broad agreement that these suggested tasks were appropriate.\u003c/p\u003e\u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eInterviews\u003c/h2\u003e\u003cp\u003e Eight participants consented to take part in an interview. Most interviews took place online (n\u0026thinsp;=\u0026thinsp;7) and participants included care home managers (n\u0026thinsp;=\u0026thinsp;2) staff members (n\u0026thinsp;=\u0026thinsp;2), family members (n\u0026thinsp;=\u0026thinsp;2) and researchers (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; demographics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePseudonym\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRole\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLevel of Experience\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eResearch Experience\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare Home Owner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35 yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare Home Staff Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare Home Staff Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare Home Manager\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamily Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamily Member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic Researcher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINT08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic Researcher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eThemes\u003c/h2\u003e\u003cp\u003eData analysis identified five key themes: barriers to research involvement, facilitators to research involvement, need for care home research, why people participate and potential solutions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eBarriers to Research Involvement\u003c/h2\u003e\u003cp\u003eAll groups identified that research could be time-consuming and not necessarily a high priority for the care home.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think a lot of care homes or care home managers might find oh I don\u0026rsquo;t want to do that because they think it\u0026rsquo;s going to be too much work\u0026hellip;oh we've enough to do\u0026rdquo;\u003c/em\u003e (INT04)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Research is not a priority in care homes amongst all their competing activities\u0026rdquo;\u003c/em\u003e (SVY33 \u0026ndash; survey free text response)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResearchers identified that governance in this area can be more complex and may be both time-consuming and act as a barrier to care homes wanting to be involved in studies.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;...there was a lot of issues around the governance and having the systems to be appropriate to those settings\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Easier processes, ethics etc to involve care homes would facilitate it as well\u0026rdquo;\u003c/em\u003e (SVY39)\u003c/p\u003e\u003cp\u003eRecruitment can be more complex in a care home environment as many residents have reduced capacity. There may be a need to involve a family member to gain consultee advice which may not be straightforward.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I guess at that point I did realise\u0026hellip;it was all difficult in terms of the recruitment\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes difficult when residents have complex needs to involve them\u0026rdquo;\u003c/em\u003e (SVY44)\u003c/p\u003e\u003cp\u003eStaff and family members also reported a lack of opportunities to take part in research studies which had limited their involvement.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;...in finding the care home for my dad, we went round lots and lots of different care homes looking at them and I never saw \u0026hellip;on noticeboards...never seen anything about research trials or anything like that\u0026rdquo;\u003c/em\u003e (INT05)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have put the home forward for research, but never taken part yet\u0026rdquo;\u003c/em\u003e (SVY23)\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eFacilitators to Research Involvement\u003c/h2\u003e\u003cp\u003eDespite some barriers to involvement in research, participants were able to identify several facilitators to involvement in a study.\u003c/p\u003e\u003cp\u003eMany participants commented that it was important to have buy-in for the research from the whole care home team, including those working in roles ancillary to care. Studies where all staff were motivated \u0026lsquo;flowed\u0026rsquo; better than those where participation was directed by managers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I would really reiterate how important it is to include every level of staff, including your domestic staff because they very often have quite an influence on the coalface\u0026rdquo;\u003c/em\u003e (INT06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It's good for staff to see how they can help shape services\u0026rdquo;\u003c/em\u003e (SVY 44)\u003c/p\u003e\u003cp\u003eAlongside this, it was also important to have a management that is receptive to research. This can be a key factor when you have a group of care homes managed by the same company.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think you need to have receptive management because if something just comes as a leaflet in the post it\u0026rsquo;s easily dismissed as like almost like a cold call and it finishes in the bin\u0026rdquo;\u003c/em\u003e (INT02)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I was one of the first homes what took part in research because I took part in it my boss then said can you get the other homes on it as well\u0026rdquo;\u003c/em\u003e (INT04)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eEqually as important was the involvement of residents' families with the study. Ensuring that family members were informed and on board was a key part of getting residents involved.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;families bring a different perspective to the fore and are required to assist sometimes their loved ones and give support\u0026rdquo;\u003c/em\u003e (SVY28)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Clinical trials need to allow sufficient time to discuss with family members as appropriate and allow opportunity for family members who live away or work to engage with the process\u0026rdquo;\u003c/em\u003e (SVY32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTraining was thought to be an important facilitator both in making staff aware of the benefit of research to their day-to-day work and in offering them opportunities to develop.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think it\u0026rsquo;s useful for them to have some knowledge of research, to understand the importance of it, after all, you\u0026rsquo;re going in the home and disrupting the home while you\u0026rsquo;re doing your research.\u0026rdquo;\u003c/em\u003e (INT08)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;absolutely they should be trained\u0026hellip;because you\u0026rsquo;re not going to get buy-in if they don\u0026rsquo;t understand the rationale, if they don\u0026rsquo;t understand what the study\u0026rsquo;s about, if they don\u0026rsquo;t understand what the end goal is ...\u0026rdquo;\u003c/em\u003e (INT06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFinancial incentives were thought to be of some benefit both to the care home and the individuals involved. However, some participants felt that it was important that the staff were acknowledged for their involvement and that didn\u0026rsquo;t necessarily need to be financial.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;it's a thank you or an acknowledgement for what you\u0026rsquo;ve done\u0026rdquo;\u003c/em\u003e (INT01)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Flexibility may be needed as care homes may want different things e.g. vouchers, a sum towards the home's activity budget, CPD opportunities, backfill\u0026rdquo;\u003c/em\u003e (SVY38)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eNeed for Care Home Research\u003c/h2\u003e\u003cp\u003eParticipants generally agreed that there was a need for care home research to take place for things to move forward, especially as this population is increasing over time.\u003c/p\u003e\u003cp\u003eCare homes were seen to be different to hospitals and primary care, primarily because the research was happening in someone\u0026rsquo;s home and not a workplace.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;there\u0026rsquo;s a general lack of understanding of the needs of care homes and care home residents. There\u0026rsquo;s a perception that they're the equivalent of hospitalised patients and it\u0026rsquo;s not, it\u0026rsquo;s people\u0026rsquo;s homes\u0026rdquo;\u003c/em\u003e (INT01)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;it\u0026rsquo;s so different to doing research in the hospital environment or in the community to be honest\u0026rdquo;\u003c/em\u003e (INT08)\u003c/p\u003e\u003cp\u003eAlongside this social care research was not seen as equitable to NHS research in terms of funding or support.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I guess that\u0026rsquo;s another sort of maybe barrier or reason why it can be challenging in terms of that understanding of research and awareness of research\u0026hellip;the investment hasn\u0026rsquo;t been the same across social care generally I guess, to support staff and people to understand the importance of research or engage with research in the same way\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve always come from a health background, a health position. So, I guess it\u0026rsquo;s that recognition\u0026hellip;actually we probably need to start challenging that thinking actually that I guess that\u0026rsquo;s, in terms of the integration of health and social care, where could things sit\u0026hellip;\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll participant groups highlighted the importance of inclusion in research for residents and family members as well as the care home staff.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s important to ensure that care home research can include all care home residents to make sure the research findings are applicable and useful\u0026rdquo;\u003c/em\u003e (SVY32)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;it doesn\u0026rsquo;t matter whether people have got a cognitive impairment, whether they're physically disabled, whether they can't speak, we can still do the research, there\u0026rsquo;s processes that we can adopt so that we can do the research\u0026rdquo;\u003c/em\u003e (INT01)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s difficult to think that research could be done about care homes without involving the people who work there or the people who are the residents there\u0026rdquo;\u003c/em\u003e (INT05)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eWhy People Participate\u003c/h2\u003e\u003cp\u003eThere were a variety of reasons why people participated in research from interest and learning opportunities to making sure that they were offering the best care to their residents.\u003c/p\u003e\u003cp\u003eSome staff and researchers thought that taking part in research offered learning and development opportunities.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;the more we know, the more we educate ourselves, the better trained we are, the more we can help them, the residents\u0026rdquo;\u003c/em\u003e (INT03)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;being part of the trial may provide the staff members with an insight into something new\u0026rdquo;\u003c/em\u003e (INT05)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eManagers and staff felt that participating in research enabled homes to be at the forefront of improving care not only for the residents that they look after now but also for future generations.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If there are any improvements that can be provided to those standards of care here in UK\u0026rdquo;\u003c/em\u003e (INT03)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;without trials a lot of opportunities to improve practice would be missed\u0026rdquo;\u003c/em\u003e (SVY28)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;More research we do improves outcomes for current and future residents\u0026rdquo;\u003c/em\u003e (SVY10)\u003c/p\u003e\u003cp\u003eSome participants commented on the altruistic nature of taking part in research and felt that by helping others now you may be helped in the future.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I'm just automatically driven to be involved because there\u0026rsquo;s an opportunity to learn. Even if you learn actually it doesn\u0026rsquo;t make a difference\u0026rdquo;\u003c/em\u003e (INT01)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;we've decided to take part and to help out, so in return we can be helped out when we need to\u0026rdquo;\u003c/em\u003e (INT02)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIt was also noted by some participants that there were regulatory benefits to taking part in research.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;apparently, CQC likes the home to be involved in research and give feedback and receive feedback\u0026rdquo;\u003c/em\u003e (INT02)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;with the CQC\u0026rsquo;s new single assessment framework, there are three quality restatements in the 34 that relate to monitoring and evaluation, and research engagement, and implementing research evidence\u0026rdquo;\u003c/em\u003e (INT06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003ePotential Solutions\u003c/h2\u003e\u003cp\u003eOne of the important themes that came out was potential solutions to the key barriers and facilitators that were identified.\u003c/p\u003e\u003cp\u003eCare home managers and staff identified that research worked well when researchers were able to fit in with the routines of the home. They commented that researchers need to be aware that the resident's care will always be the first priority of the care home staff, and flexibility is important when working with care homes.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;we've got staff available for them so if they need anything, you know, getting the information and that\u0026hellip;the teams what have been coming in, I must admit they\u0026rsquo;ve been fantastic, it\u0026rsquo;s never been a \u0026lsquo;oh can you get me this or that or you're holding me up\u0026rsquo; it\u0026rsquo;s our pace\u0026hellip;because obviously my residents come first before that\u0026rdquo;(\u003c/em\u003eINT04)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;my experience is you have to be incredibly flexible as a researcher\u0026rdquo;\u003c/em\u003e (INT08)\u003c/p\u003e\u003cp\u003eThere needs to be good relationships between researchers and care homes. It needs to be appreciated that it takes time to develop those relationships and that it is often done better face-to-face. Participants also thought that it was important to develop networks and collaborate with other research organisations to help with these relationships.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think from my experience the time needed to build those relationships is quite important. And they\u0026rsquo;re not always allocated in the funding\u0026hellip;the actual, building the relationships and understanding...they\u0026rsquo;re not always able to be accounted for in the research plan\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that\u0026rsquo;s one of the important things to get there, to build network, to build connections with care homes, because I don\u0026rsquo;t think cold calls and emails would help\u0026rdquo;\u003c/em\u003e (INT03)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome participants stated that sometimes some of the best ideas come from the staff and residents themselves. They also commented that it can be difficult to motivate people to take on ideas that have come from management.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;give them a platform to share their ideas because they\u0026rsquo;re the ones right on the coalface who very often are very creative and innovative. Give them the opportunity.\u0026rdquo;\u003c/em\u003e (INT06)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;it\u0026rsquo;s better when it comes from the grassroots, from the floor because good ideas that cascade down just fall on an umbrella and dissipate very often...if it comes from the floor and it\u0026rsquo;s nurtured and it\u0026rsquo;s encouraged and staff feel that their opinions matter, their views, their suggestions are listened to and they work together to find solutions or to try new ideas\u0026rdquo;\u003c/em\u003e (INT06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMany participants recognised that care staff were often undervalued for the work that they do and that it was important to recognise the value of care home staff as part of the research team.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Researchers need to balance their ask of care workers and their own activity - use care workers to the maximum effect and save the other tasks for the research team\u0026rdquo;\u003c/em\u003e (SVY14)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that\u0026rsquo;s probably a broader societal view...and probably links with the lack of recognition for the staff in those settings and the lack of pay and training and all the rest\u0026rdquo;\u003c/em\u003e (INT07)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eDelphi\u003c/h2\u003e\u003cdiv id=\"Sec28\" class=\"Section4\"\u003e\u003ch2\u003eResponse rate\u003c/h2\u003e\u003cp\u003eFrom the 63 responses to the original survey, 31 participants agreed to contact for further participation in the study. These 31 participants were invited to take part through an email which contained the link to the consensus survey. 19 of these participants responded to Round One of the survey and 15 went on to complete Round Two.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe participants who took part in the consensus represented a range of stakeholders including seven managers of care homes, three care home staff members, three academics who worked in the care home space, three family members, one participant in senior management position, one practice development manager and one membership organisation lead.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSummary of the rounds\u003c/h3\u003e\n\u003cp\u003eThe results for each round are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e which presents an overview of the scoring for each round.\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Responses\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Number of Statements for scoring\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStatements that reached consensus (\u0026lt;\u0026thinsp;70%) and accepted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatements that did not reach consensus and were modified\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStatements that did not reach consensus and were rescored.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStatements that did not reach consensus and were removed\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn Round One, 18 statements were accepted, four were modified in line with free text comments that were provided to improve clarity and understanding. Two statements did not reach consensus, but there were no free text comments to suggest any changes. These were sent out for rescoring with the original wording.\u003c/p\u003e\u003cp\u003eIn Round Two, five statements were accepted. One statement did not reach consensus and the free text comments did not have a consensus. This statement was removed.\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSummary of results\u003c/h2\u003e\u003cp\u003eConsensus was reached on 23 statements relating to the themes developed through the early stages of the study. All statements that reached consensus are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e within these themes.\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAccepted Statements\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% agreement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWhen consensus reached\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeed for Research in Care Homes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch is important in care homes as they are different to hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch is important in care homes as without it opportunities to improve care and move practice forward would be missed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch has wider benefits for residents and care home staff which need to be clearly articulated and understood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe governance of research in care home settings is complex and may discourage some settings from taking part.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacilitators to Research Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFor research to be successful in a care home environment there need to be buy in from the whole care team\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReceptive management is key to a care home being involved in research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFace-to-face contact from researchers would increase care home involvement in research.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is important to provide training to give care home staff an understanding of general research principles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraining needs to be specific to each trial and undertaken only as necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch offers care home staff an opportunity to develop and learn new knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is important to recognise the contribution of care home staff to the research and reward them for their contribution.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion in Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo ensure that research is meaningful for the target population, all care home residents should be given the opportunity to be involved in research.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThere needs to be defined processes to ensure all care home residents can be involved in research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch protocols need to ensure that sufficient time is allowed to recruit using multiple methods and allow access to information in a variety of ways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearchers need to think creatively about how to involve care home residents in research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotential Solutions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFor research to be successful researchers need to be flexible, fit in with the routines of the home and recognise the value of the care home staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThere needs to be more collaboration between care homes and other research agencies (such as universities) to develop and maintain good working relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThere needs to be defined principles on payment for care home research to ensure equity with equivalent research taking place in the NHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is important to embed research into all care home activities including induction, training and staff meetings for staff to appreciate the importance and benefit of research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime is needed to develop good relationships between staff and researchers, and this should be part of any funding application which involves research in care homes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearchers need to improve the implementation of research into practice to aid staff and residents\u0026rsquo; understanding of its importance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearchers need to make better use of available technology to improve the research process in care homes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeveloping ideas in collaboration with care home staff and residents would ensure that research undertaken is important and relevant to those people involved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRound 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOne statement was removed during the process due to not reaching consensus and the analysis of the free text responses in round two which is presented below in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e Here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRemoved Statements\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% agreement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacilitators to Research Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePaying a care home chain to be involved in research is appropriate to ensure involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRemoved following Round 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec33\" class=\"Section2\"\u003e\u003ch2\u003eSummary of Findings\u003c/h2\u003e\u003cp\u003e This study aimed to identify the barriers and facilitators to performing research in care homes for older people and to identify potential solutions for improving access and participation.\u003c/p\u003e\u003cp\u003eA survey examined the characteristics that were important to consider when undertaking research in a care home, the importance of payment to both individuals and organisations and the type of tasks which might be appropriate for care home staff to undertake.\u003c/p\u003e\u003cp\u003eIn depth interviews were carried out with eight participants to explore these concepts further. Five key themes were identified including barriers to research involvement, facilitators to research involvement, need for care home research, why people participate and potential solutions.\u003c/p\u003e\u003cp\u003eFrom these themes, 24 statements were developed which covered four main areas which would look to identify potential solutions to improving access and participation to research in care homes including: the need for care home research; facilitators to care home research; inclusion in research and potential solutions.\u003c/p\u003e\u003cp\u003eConsensus was reached on 23 statements drawing from a broad range of stakeholders including those working in care homes, researchers and family members of those living in care homes.\u003c/p\u003e\u003cdiv id=\"Sec34\" class=\"Section3\"\u003e\u003ch2\u003eComparison with Other Studies\u003c/h2\u003e\u003cp\u003eThe governance of research in care homes can be complex and it may discourage some care homes from taking part. During the PAAD study, care homes felt overwhelmed by the tasks that were required, and staff didn't necessarily understand the importance of following a set protocol. Managers felt the study added to staff\u0026rsquo;s already busy workload and overburdened them with the study documentation. Their solutions included ensuring that study processes were easy for staff to understand and complete and embedding their own staff into care homes for data collection. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) Similarly, the PACE study found that by seeking feedback on the study information forms and data collection forms from those who were using them helped relieve some of that tension. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThere have been several previous studies that have looked at the facilitators to conducting research in care homes.\u003c/p\u003e\u003cp\u003eHaving receptive management, alongside buy in from the whole care team was thought to be key to care home involvement in research. Care home managers who appreciate the benefits of research are often more willing to allow staff and residents to take part. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Those who could demonstrate that research was a valid part of their daily work also benefited from greater engagement. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) Whilst engaging with staff and residents on how the study could benefit them can help create buy in from across the whole care home. (\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDuring the COVID pandemic, contact with care homes was severely reduced, and many participants in our study thought that the resumption of face-to-face contact with researchers could act to increase care home involvement in research \u0026ndash; although the extent to which this has happened as the health and social care system continues to struggle to recover post-pandemic is unclear. This finding mirrors studies which have highlighted the importance of regular communication between the research teams and care home staff. Good and consistent communication is needed to build optimal working relationships, but this takes time that isn't always available within a research project. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eTraining for care home staff was thought to be an important factor during the initial survey, and this also came through in the interview study. Several participants thought that training could help outline the benefit of research for staff and offer further opportunities for professional development. Few studies have discussed the need or benefit of training, not just in the processes of one study, but general research principles. Care organisations feel that training should focus on ensuring staff are compliant with mandatory training and may not consider that research training is relevant to care home staff. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) However, providing care home staff an opportunity to develop and learn new skills may make them feel more valued and highlight the importance of their work. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Ritchie et al highlighted that high care home staff turnover was a systemic barrier to care home research and including research training during the induction of care home staff may facilitate more general knowledge in the workforce. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eSkills for Care, recognising that demographic changes mean we will need more social care workers in the future and that we do not have enough social care workers now, with a current vacancy rate of over 8%, have led the development of a workforce strategy which aims both attract and retain people in the workforce emphasising both fair pay and training as part of this strategy. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) Both the survey and the interviews have highlighted the importance of recognising the contribution of staff in the research process but there is no clear description of how to go about doing this in Skills for Care guidance. Financial incentives have been suggested in previous work (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) but responses in this study suggested this may not always be appropriate. Other ways of recognising the contribution of the staff may include gifts in kind, providing refreshments and training. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) Communication between researchers and the care homes to establish how best to achieve this would be useful to do in the early stages of planning a research study.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThis study had certain strengths and limitations. It would have been preferable to have more participants in all three stages of the study. In the survey we were aiming for 50 to 80 respondents, and we had 63 responses which was within our expected range. We were aiming for 10 to 20 respondents at interview stage and were only able to recruit 8. However, we were able to interview participants from all our stakeholder groups aside from residents, who have prevalent cognitive impairment and whom it is often difficult to recruit to interview studies.\u003c/p\u003e\u003cp\u003eWe were aiming for 50 to 70 respondents for the Delphi, but this was not achieved with 19 respondents in Round One and 15 respondents in Round 2. However, initially we had planned to complete a nominal group process with around 8 participants (2 care home managers, 2 care home staff members, 2 researchers and 2 family members) but we were unable to organise a suitable time for everyone to meet. Although we did not achieve high numbers, we did get a representative sample of the stakeholder groups within the Delphi.\u003c/p\u003e\u003cp\u003eDespite the challenges, there are several strengths to the study. It achieved its overarching goal to bring together the learnings from previous research to help future researchers, care home teams, and residents benefit from these hard-won lessons. While many of these exemplars have been published, they have been done individually on a project-by-project basis, making their impact harder to judge. Synthesising these findings in collaboration with the research community, care home staff, and residents/families has allowed ideas to be contrasted and evaluated. This study has tried to take this learning to develop guidelines that can be usefully shared in the care home research environment.\u003c/p\u003e\u003cp\u003eAnother strength of the study it that it followed a three-stage process modelled on the James Lind Priority Sharing Partnership. A survey was completed taking the views from a wide range of stakeholders including care home staff, managers and researchers as well as residents and family members. These results were then refined and developed further through semi-structured interviews that also included a wide range of stakeholders. Finally, the themes that came through these stages were used to develop the statements for the Delphi which gained responses from a wide range of stakeholders building a consensus for future guidelines.\u003c/p\u003e\u003cp\u003eThe study team also worked in collaboration with both the funders and key stakeholders to reduce barriers to involvement in the study including expanding the initial survey to allow a national response, using both traditional and social media to promote the survey widely and a researcher going into care homes in person with a tablet computer to increase access for residents living in care homes.\u003c/p\u003e\n\u003ch3\u003eImplications and Future Research\u003c/h3\u003e\n\u003cp\u003eSeveral solutions were suggested in this study.\u003c/p\u003e\u003cp\u003eResearchers need to be flexible and fit in with routines of the home and recognise value of care home staff. Although we concentrated on training for care home staff, it was recognised in the Delphi study that researchers themselves may benefit from training on how care home's function. Indeed, care homes themselves have identified the need for training for inexperienced researchers. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn all three stages of this study, it was suggested that more collaboration both with research agencies and care homes, as well as between the researchers, staff and residents, would ensure the research that is carried out is what the key stakeholders need and want. Partnerships such as the James Lind Alliance have been set up with the sole purpose of finding out what the research priorities are, but on a national scale. Smaller collaborations between local universities and care homes may help identify research that is relevant on a local level. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Both the University of Maastricht and in the UK the University of Leeds have living lab collaborations with local care homes which work to address research priorities identified by those living and working in long term care. These relationships have taken time to develop but are now sustainable partnerships that work to improve care, increase knowledge and innovation. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe interviews in this study suggest that whereas research in NHS settings is considered routine, in care settings it may be seen as a luxury or something that is nice to have. Since its inception in 2006 the NIHR has funded social care research, but it added \u0026lsquo;care\u0026rsquo; to its name in 2022 to emphasise this commitment, recognising that research in this area is less well established. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) Whilst healthcare all sits under the umbrella of the NHS, social care is more fragmented and overseen by around 150 local authorities. Not only that but it is delivered by many different organisations, alongside families, friends and local communities. This makes the planning and delivery of social care research more difficult. Alongside this, clinicians who work in NHS settings are likely to have been introduced to research as part of their training and see it as part of their role. People working in social care are less likely to have been provided with research training and may not see this as part of their job. The NIHR has put social care research on an equal footing to health and is working to increase research capacity in the social care workforce. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) However, it has only been two years since this commitment was made, and this study would suggest there is still a way to go.\u003c/p\u003e\u003cp\u003eCare home research is unique in that it is carried out in a place that is both someone\u0026rsquo;s home as well as a workplace and a \u0026lsquo;care institution\u0026rsquo;. It is also different to NHS institutions where research is carried out more often. For this to be successful it is important to develop relationships with the staff and managers. Time is needed to develop these relationships, and that time is often needed before the project and the funding starts. If relationships have developed on previous projects, researchers may end up frequently using the same care homes, potentially leading to a less diverse view with the same people are involved in several projects. This may also result in \u0026lsquo;research fatigue\u0026rsquo; from the staff and the residents if they are being asked to regularly give their time. Alongside this the high turnover within care homes can mean that relationships may be short-lived and frequently renewed as management and staff change.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere is a need for care home research as they are home to some of the most vulnerable in society whose frailty and multiple morbidities requires healthcare tailored to their complex needs. They are unique in offering a care infrastructure alongside a social environment that would not normally be considered as part of a research study. These differences suggest that research should be conducted in situ, rather than by using findings extrapolated from other settings. For care home research to be successful it is important to develop relationships with staff and managers. Researchers need to be flexible, fit in with the routines of the home and recognise the value of care home staff. Time is needed to develop these relationships which is often needed before the project starts and both care homes and universities could benefit from developing longer time collaborations to allow this to take place.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref No: 124-0224). Written consent was obtained for all participant at all three stages of the study. This study adheres to all of the ethical principles in the Declaration of Helsinki regarding the collection of data on human subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026ndash; all identifiable information has been removed, and participants have been anonymised.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analysed during this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Clinical Research Network East Midlands. The funders had no influence or control on the planning, conduct, or reporting of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAL: Study design, ethical approval, recruitment, data collection, data analysis, manuscript writing.\u003c/p\u003e\n\u003cp\u003eGM: Study design, data analysis, manuscript editing\u003c/p\u003e\n\u003cp\u003eALG: Study conception, study design, data analysis, manuscript editing\u003c/p\u003e\n\u003cp\u003ePL: data analysis, manuscript editing.\u003c/p\u003e\n\u003cp\u003eCR: Study conception, study design, data analysis, manuscript editing\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are very grateful to all the care home managers, staff and residents alongside all other health care professionals and family members who participated in this study for sharing their experience and time.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePeryer G, Kelly S, Blake J, Burton JK, Irvine L, Cowan A, et al. Contextual factors influencing complex intervention research processes in care homes: A systematic review and framework synthesis. Age and Ageing. Volume 51. Oxford University Press; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaw E, Ashworth R. Facilitators and Barriers to Research Participation in Care Homes: Thematic Analysis of Interviews with Researchers, Staff, Residents and Residents\u0026rsquo; Families. J Long-Term Care. 2022;2022:49\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaw E, Ashworth R, Killin L, Connelly P. Motivating and constraining factors for research participation in Scottish care homes. Nurs Residential Care. 2021;23(4):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLogan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A et al. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ. 2021;375.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRitchie LA, Gordon AL, Penson PE, Lane DA, Akpan A. Stop and Go: Barriers and Facilitators to Care Home Research. J Frailty Aging. 2023;12(1):63\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimpson KM, Porter K, McConnell ES, Col\u0026oacute;n-Emeric C, Daily KA, Stalzer A et al. Tool for evaluating research implementation challenges: A sense-making protocol for addressing implementation challenges in complex research settings. Implement Sci. 2013;8(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBunn F, Goodman C, Corazzini K, Sharpe R, Handley M, Lynch J et al. Setting priorities to inform assessment of care homes\u0026rsquo; readiness to participate in healthcare innovation: A systematic mapping review and consensus process. Int J Environ Res Public Health. 2020;17(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWenborn J, Challis D, Head J, Miranda-Castillo C, Popham C, Thakur R, et al. Providing activity for people with dementia in care homes: A cluster randomised controlled trial. Int J Geriatr Psychiatry. 2013;28(12):1296\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRantz MJ, Zwygart-Stauffacher M, Hicks L, Mehr D, Flesner M, Petroski GF, et al. Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. J Am Med Dir Assoc. 2012;13(1):60\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuckett T, Chenoweth L, Phillips J, Brooks D, Cook J, Mitchell G, et al. A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: Perceptions of palliative care planning coordinators and other health professionals in the IDEAL study. Int Psychogeriatr. 2017;29(10):1713\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBallard C, Orrell M, YongZhong S, Moniz-Cook E, Stafford J, Whittaker R, et al. Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: a factorial cluster-randomized controlled trial by the Well-Being and Health. Am J Psychiatry. 2015;173(3):252\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLivingston G, Barber J, Marston L, Stringer A, Panca M, Hunter R, et al. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. Lancet Psychiatry. 2019;6(4):293\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreenspan SL, Nace D, Perera S, Ferchak M, Fiorito G, Medich D, et al. Lessons learned from an osteoporosis clinical trial in frail long-term care residents. Clin Trails. 2012;9(2):247\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrooker DJ, Latham I, Evans SC, Jacobson N, Perry W, Bray J, et al. FITS into practice: Translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging Ment Health. 2016;20(7):709\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEllard DR, Thorogood M, Underwood M, Seale C, Taylor SJ. Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation. 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStein-Parbury J, Chenoweth L, Jeon YH, Brodaty H, Haas M, Norman R. Implementing Person-Centered Care in Residential Dementia Care. Clin Gerontol. 2012;35(5):404\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall S, Longhurst S, Higginson IJ. Challenges to conducting research with older people living in nursing homes. BMC Geriatr. 2009;9(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGordon AL, Rick C, Juszczak E, Montgomery A, Howard R, Guthrie B, et al. The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure. Age Ageing. 2022;51(3):afac052.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K et al. Challenges of conducting research in long-term care facilities: A systematic review. BMC Geriatr. 2018;18(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJenkins C, Smythe A, Galant-Miecznikowska M, Bentham P, Oyebode J. Overcoming challenges of conducting research in nursing homes. Nurs Older People. 2016;28(5):16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson KR, Leighton P, Logan P, Gordon AL, Anthony K, Harwood RH et al. Developing the principles of chair based exercise for older people: A modified Delphi study. BMC Geriatr. 2014;14(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMullen PM. Delphi: Myths and reality. J Health Organ Manag. 2003;17(1):37\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Steenkiste BC, Jacobs JE, Verheijen NM, Levelink JH, Bottema BJAM. A Delphi technique as a method for selecting the content of an electronic patient record for asthma. Volume 65. International Journal of Medical Informatics; 2002.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWells C, Kolt GS, Marshall P, Bialocerkowski A. The Definition and Application of Pilates Exercise to Treat People With Chronic Low Back Pain: A Delphi Survey of Australian Physical Therapists. Phys Ther. 2014;94(6):792\u0026ndash;805.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAloraibi S, Gladman J, Godfrey D, Booth V, Robinson K, Lunt E et al. Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study. BMC Geriatr. 2021;21(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHood K, Nuttall J, Gillespie D, Shepherd V, Wood F, Duncan D, et al. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): A prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes. Health Technol Assess (Rockv). 2014;18(63):1\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCollingridge Moore D. Talk to the people who know-consulting widely before starting care home research [Internet]. 2015 Apr [cited 2025 Jan 17]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://enrich.nihr.ac.uk/casestudies/talk-to-the-people-who-know-consulting-widely-before-starting-care-home-research/\u003c/span\u003e\u003cspan address=\"https://enrich.nihr.ac.uk/casestudies/talk-to-the-people-who-know-consulting-widely-before-starting-care-home-research/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRutherford A. Dementia Research \u0026ndash; a care home perspective. [Internet] 2019 [cited 2025 Jan 17] Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://enrich.nihr.ac.uk/casestudies/dementia-research-a-care-home-perspective/\u003c/span\u003e\u003cspan address=\"https://enrich.nihr.ac.uk/casestudies/dementia-research-a-care-home-perspective/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHart C, Alam S, Gibson K. Laying the foundations \u0026ndash; what helps research in care homes to work well? [Internet]. 2015 Mar [cited 2025 Jan 20]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://enrich.nihr.ac.uk/casestudies/laying-the-foundations-what-helps-research-in-care-homes-to-work-well/\u003c/span\u003e\u003cspan address=\"https://enrich.nihr.ac.uk/casestudies/laying-the-foundations-what-helps-research-in-care-homes-to-work-well/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabey A, Bray I, Gray S. Building capacity to use and undertake applied health research: establishing a training programme for the health workforce in the West of England. Public Health. 2019;167:62\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSkills For Care. A workforce strategy for adult social care in England [Internet]. 2024 [cited 2025 Apr 25]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.skillsforcare.org.uk/Workforce-Strategy/Overview/Executive-summary.aspx\u003c/span\u003e\u003cspan address=\"https://www.skillsforcare.org.uk/Workforce-Strategy/Overview/Executive-summary.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScott A. Getting staff involved in research Background [Internet]. 2015. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.dendron.nihr.ac.uk/enrich\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoodman Claire. Doing \u0026lsquo;with\u0026rsquo; rather than doing \u0026lsquo;to\u0026rsquo; \u0026ndash; working in partnership with care home staff [Internet]. 2015 Apr [cited 2025 Jan 20]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://enrich.nihr.ac.uk/casestudies/doing-with-rather-than-doing-to-working-in-partnership-with-care-home-staff/\u003c/span\u003e\u003cspan address=\"https://enrich.nihr.ac.uk/casestudies/doing-with-rather-than-doing-to-working-in-partnership-with-care-home-staff/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavies SL, Goodman C, Manthorpe J, Smith A, Carrick N, Iliffe S. Enabling research in care homes: An evaluation of a national network of research ready care homes. BMC Med Res Methodol. 2014;14(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eConcannon TW, Meissner P, Grunbaum JA, McElwee N, Guise JM, Santa J, et al. A new taxonomy for stakeholder engagement in patient-centered outcomes research. J Gen Intern Med. 2012;27:985\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerbeek H, Zwakhalen SMG, Schols JMGA, Kempen GIJM, Hamers JPH. The Living Lab in Ageing and Long-Term Care: A Sustainable Model for Translational Research Improving Quality of Life, Quality of Care and Quality of Work. J Nutr Health Aging. 2020;24(1):43\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGriffiths AW, Devi R, Cheetham B, Heaton L, Randle A, Ellwood A et al. Maintaining and improving mouth care for care home residents: A participatory research project. Int J Older People Nurs. 2021;16(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Institute for Health and Care Research. NIHR changes name to emphasise long-term commitment to social care research [Internet]. 2022 [cited 2025 Jan 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nihr.ac.uk/news/nihr-changes-name-emphasise-long-term-commitment-social-care-research\u003c/span\u003e\u003cspan address=\"https://www.nihr.ac.uk/news/nihr-changes-name-emphasise-long-term-commitment-social-care-research\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Institute for Health and Care Research. 5 things you didn\u0026rsquo;t know about social care research [Internet]. 2024 [cited 2025 Jan 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bepartofresearch.nihr.ac.uk/news-and-features/social-care-research\u003c/span\u003e\u003cspan address=\"https://bepartofresearch.nihr.ac.uk/news-and-features/social-care-research\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Care Homes, Older People, Clinical Research, Mixed methods","lastPublishedDoi":"10.21203/rs.3.rs-6844598/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6844598/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCare homes for older adults pose a unique set of challenges for research. Despite having high healthcare needs, this population are often excluded from clinical research, in part due to the challenges of this care context. This study identifies barriers, facilitators and potential solutions to performing research in care homes for older adults and reaches a consensus on the relative importance of these approaches.\u003c/p\u003e\u003cp\u003eThe study consisted of three parts: a survey, qualitative interviews and Delphi exercise. The survey was designed to gather views from a wide range of stakeholders including care home staff, managers and researchers alongside residents and family members. It was initially distributed in the East Midlands and then the wider UK, A purposive sample of those who took part in the survey were interviewed to explore challenges surrounding research in care homes in greater depth. Finally, an e-Delphi was conducted with statements constructed by the study team using themes gathered from the first two stages.\u003c/p\u003e\u003cp\u003e63 participants responded to the survey. Most rated resident characteristics including cognitive and physical abilities as important considerations when running studies. They thought it less important that care staff had experience in research, but did have experience of the tasks that may be involved in conducting research.\u003c/p\u003e\u003cp\u003eEight people were included in qualitative interviews which identified 5 key themes including barriers and facilitators to research involvement, the need for care home research, reasons for participation and some potential solutions.\u003c/p\u003e\u003cp\u003eFrom these themes 24 statements were developed including: facilitators to care home research; inclusion in research and potential solutions.19 participants took part in Round One of the Delphi with 15 continuing to Round Two. Consensus was reached on 23 out of the 24 statements.\u003c/p\u003e\u003cp\u003eCare home research is different to that conducted in hospitals and other community settings. Researchers need to be flexible, fit in with the routines of the homes and value contributions from care home staff, with a specific focus on developing relationships with staff and managers. Time is needed to develop these relationships and may need to be a focus even before project commencement.\u003c/p\u003e","manuscriptTitle":"Learning Lessons in the Design and Delivery of Care Home Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 02:33:26","doi":"10.21203/rs.3.rs-6844598/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-18T07:08:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312477870824146705194845115387985156461","date":"2025-08-04T00:12:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298494709786846945797087299482348361542","date":"2025-07-27T09:34:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-18T14:22:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T04:17:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-24T08:02:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-23T14:51:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-23T14:46:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4bde956e-8314-4e57-bcdc-ea32541f381e","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-23T02:33:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 02:33:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6844598","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6844598","identity":"rs-6844598","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}