The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol

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While depression can be attributable to many causes, it may be associated with organisational culture and quality of care in nursing homes. Person-centredness is espoused in the regulatory standards of many nursing homes and has informed cultures. However, systematic reviews of the impact of person-centred practices on depression have yielded mixed results and the prevalence of depression among older adults in nursing homes remains high. This realist review protocol gives details about the background to this study and how the authors intend to carry out a realist review. The review aims to gather evidence as to whether person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes, how, why, for whom and in what contexts? Method This protocol details a theory-driven realist review. The review will follow the four-step design as follows: define the scope of the review, search for and appraise evidence, extract and synthesize findings and develop narrative. Evidence will be gathered in the form of context, mechanisms and outcomes (CMOs) from both published and unpublished sources and grey literature to test and refine initial programme theories with the collaboration of an expert panel. Findings will be reported according to RAMESES publication guidelines and will be shared with stakeholders. Conclusion It is anticipated that the review detailed in this protocol will outline theories and give insight that can explain whether or not, in what way, how and why person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes and provide guidance for the embedding of person-centred cultures in nursing homes. The review was registered with PROSPERO in July 2024 (CRD4202456825). 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HRB Open Res 2025, 8 :30 ( https://doi.org/10.12688/hrbopenres.14052.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] Tope Omisore https://orcid.org/0000-0002-3204-0133 1 , Seán Paul Teeling https://orcid.org/0000-0002-4102-7280 1-3 , Timmy Frawley https://orcid.org/0000-0002-2108-005X 1,3 , Mary Butler 4 , David Edvardsson 5 Tope Omisore https://orcid.org/0000-0002-3204-0133 1 , Seán Paul Teeling https://orcid.org/0000-0002-4102-7280 1-3 , [...] Timmy Frawley https://orcid.org/0000-0002-2108-005X 1,3 , Mary Butler 4 , David Edvardsson 5 PUBLISHED 10 Feb 2025 Author details Author details 1 Centre for Interdisciplinary Research, University College Dublin School of Nursing Midwifery and Health Systems, Dublin, Leinster, Ireland 2 Centre for Person-Centered Practice Research, Division of Nursing,, Queen Margaret University, School of Health Sciences, Edinburgh, Scotland, UK 3 Centre for Interdisciplinary Research, Education and Innovation in Health Systems, University College Dublin, Dublin, Ireland, Ireland 4 St. Brendan's Community Nursing Unit, Health Service Executive, Ballinasloe, County Galway, Ireland 5 School of Nursing and Midwifery, La Trobe University, GS Building,, Bandura, Australia Tope Omisore Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Writing – Original Draft Preparation Seán Paul Teeling Roles: Conceptualization, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Timmy Frawley Roles: Conceptualization, Supervision, Writing – Review & Editing Mary Butler Roles: Methodology, Validation David Edvardsson Roles: Methodology, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Ageing Populations collection. Abstract Background Depression is highly prevalent among older adults in nursing homes and living in nursing homes has been reported to be associated with depression. While depression can be attributable to many causes, it may be associated with organisational culture and quality of care in nursing homes. Person-centredness is espoused in the regulatory standards of many nursing homes and has informed cultures. However, systematic reviews of the impact of person-centred practices on depression have yielded mixed results and the prevalence of depression among older adults in nursing homes remains high. This realist review protocol gives details about the background to this study and how the authors intend to carry out a realist review. The review aims to gather evidence as to whether person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes, how, why, for whom and in what contexts? Method This protocol details a theory-driven realist review. The review will follow the four-step design as follows: define the scope of the review, search for and appraise evidence, extract and synthesize findings and develop narrative. Evidence will be gathered in the form of context, mechanisms and outcomes (CMOs) from both published and unpublished sources and grey literature to test and refine initial programme theories with the collaboration of an expert panel. Findings will be reported according to RAMESES publication guidelines and will be shared with stakeholders. Conclusion It is anticipated that the review detailed in this protocol will outline theories and give insight that can explain whether or not, in what way, how and why person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes and provide guidance for the embedding of person-centred cultures in nursing homes. The review was registered with PROSPERO in July 2024 (CRD4202456825). READ ALL READ LESS Keywords Realist review protocol, older adults, nursing home, person-centred cultures, depression. Corresponding Author(s) Tope Omisore ( [email protected] ) Close Corresponding author: Tope Omisore Competing interests: No competing interests were disclosed. Grant information: Health Research Board [R20038]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Omisore T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Omisore T, Teeling SP, Frawley T et al. The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :30 ( https://doi.org/10.12688/hrbopenres.14052.1 ) First published: 10 Feb 2025, 8 :30 ( https://doi.org/10.12688/hrbopenres.14052.1 ) Latest published: 10 Feb 2025, 8 :30 ( https://doi.org/10.12688/hrbopenres.14052.1 ) Introduction Depression (which could refer to depressive disorder or depressive symptoms) 1 is common among older adults 2 , 3 . According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) depressive symptoms among older adults include inability to sleep and concentrate, tiredness, desire to die, pain, weight loss, constipation, feeling of worthlessness, psychomotor retardation, depressed mood and loss of interest in activities that used to give pleasure, with the predominance of somatic symptoms 4 . Globally, depression among older adults is recognised as a public health concern, encompassing major depressive disorder and depressive symptoms 1 , 5 . The prevalence and incidence of depression among older adults in nursing homes are significantly higher than they are among community-dwelling older adults 6 , 7 . See Table 1 for comparison of incidence and prevalence of depression among older adults in nursing homes and in the community. Table 1. Comparison of incidence and prevalence of depression among older adults in nursing homes and in the community. Prevalence and incidence of depression Older adults in nursing homes Older adults in the community Prevalence of depressive symptoms 80% 3 35% 8 Prevalence of major depressive disorder 19% 13 Up to 5% 14 Incidence of depressive symptoms 90% 15 27% 16 Incidence of major depressive disorder 14% 15 7% 14 Depression among older adults in nursing homes There are different types of residential care facilities that exist in different countries depending on the needs of the older adults. A nursing home is a type of residential care facility. Many definitions and terms for a nursing home exist in the literature ( Table 2 ) such as skilled nursing facility, subacute care facility, care home, geriatric hospital 8 . The definition of a nursing home that aligns with this study is that of long-term care facility where an older adult receives nursing care in addition to assistance with activities of daily living for twenty hours a day for an indefinite period (). An end-of-life care may also be provided. Table 2. Terms and definitions of nursing homes internationally. Terms Definitions Hospice home Provides end of life care to older adults Geriatric hospital Provides transitional care to older adults post-acute hospital admission Care home Assistance is provided with ADLs but no licensed professional on site Assisted living facility Provides accommodation and board to the older adults in addition to assistance with ADLs Skilled nursing facility Provides transitional care to older adults after acute hospital discharge Rehabilitation hospital Provides physiotherapy, occupational therapy and speech therapy to restore functional abilities Long term care facility Provides accommodation and assistance with ADLs to older adults as well as chronic disease management Subacute care facility Provides step down care including physiotherapy, speech and occupational therapy post- acute hospital admission. Source 17 A recent observational longitudinal cohort study 9 with a sample size of over 1200 older adults found that the rate of admission to a long-term care facility was not associated with severe disability or co-morbidity but rather with moderate disability and a lack of social support. This is in contrast to the belief that all the older adults in nursing homes live with severe disability. Depression among older adults in nursing homes is associated with poor well-being, poor quality of life, high mortality rates, increased use of acute care services, cognitive and functional declines and poor recovery from other morbidities 10 – 12 . The higher prevalence and incidence are concerning given the projected increase in older adults needing nursing home care globally 18 , 19 . In addition, pharmacotherapy is effective only for a subset of depressed older adults, particularly those with mild to moderate depression and those with dementia do not respond well to pharmacotherapy 20 – 23 . Depression in nursing homes has multifaceted causes including social, psychological, and biological factors. Though no single factor is solely responsible for depression 1 , 2 , Staff training, organisational culture, and quality of care in nursing homes significantly influence depression among older adults 15 , 24 – 26 . The American Geriatric Society and the American Association for Geriatric Psychiatry stress the importance of nursing home culture in fostering good mental health care 26 . Given these prevalence and incidence rates of depressive symptoms and major depressive disorder among older adults in nursing homes 3 , 8 , 13 , exploring effective care strategies becomes imperative. The World Health Organization advocates for person-centred approaches to care, emphasising individual needs and preferences 27 . Person-centredness and person-centred cultures Recognised as a multidimensional concept 28 , person-centredness is considered a gold standard approach to care for older adults globally 27 , 29 , influencing international health policies 30 , 31 . It is distinct from patient-centredness, which focuses on medical decision-making, by placing emphasis on organisational cultures in nursing homes that promote independence, social engagement, and respect for older adults' dignity, preferences, and choices 32 , 33 . Person-centredness in care refers to an approach that prioritises the individuality and personhood of older adults 32 , 34 . It emphasises building relationships based on strengths and values, respecting individuals’ preferences and promoting their well-being 35 , 36 . Kitwood's seminal work in dementia care laid the foundation for models such as the VIPS Model 37 and the person-centred nursing framework 36 , which advocate for personalised care and improvements in the physical and social environment of nursing homes 38 , 39 . Person-centred cultures are beliefs, values and concepts that foster the personhood of a service user in a healthcare setting 40 and are necessary for delivery of person-centred care 28 , 40 . Person-centred cultures are cultures that promote the independence of older adults, demonstrate respect for the choices, preferences and autonomy of the older persons, their social engagement and a culture of staff training and development 34 – 36 . Person-centred cultures in nursing homes In developed countries, nursing homes are required to adhere to person-centred cultures as part of regulatory standards to ensure effective care delivery and enhance the quality of life for older adults 41 , 42 . These cultures promote the independence, social engagement, dignity, preferences, and choices of older adults, supported by staff training and development 33 , 35 . In the Republic of Ireland, compliance with person-centred cultures is a major condition for nursing home registration 30 . Despite this, depression remains prevalent among older adults in nursing homes worldwide 15 , 23 , 43 , with studies showing mixed outcomes regarding the impact of person-centred care on depression. While some studies reported reduced depressive symptoms 44 – 46 , others found no effect 47 . Implementing person-centred care also faces challenges 48 , and the contextual complexities of nursing homes may influence the responses of staff and residents, which systematic reviews might not capture 49 . Given the multidimensional nature of health policies and interventions in complex systems, a theory-driven realist review is needed to explain the mixed outcomes of person-centred cultures concerning depression management among older adults in nursing homes 49 , 50 . This approach explores the contextual factors that enable or constrain interventions in the nursing home setting 50 . Use of realist review Studying healthcare policies or interventions is challenging due to their complexity and impact on different aspects of the health system 49 . Realist review, a theory-driven and explanatory form of systematic review grounded in critical realism, is useful for exploring such interventions 49 , 51 . Critical realism posits that reality exists independently of human knowledge, not all aspects are visible, reality is layered, causality is multidirectional, and multiple methodologies and scientific theories are needed to understand it 52 – 55 . It holds that the interconnectedness of social elements allows for theory development about social phenomena 56 . Realist review begins and ends with theory, aiming to develop, test, and refine theories by explaining the relationship among contexts (C), mechanisms (M), and outcomes (O) of an intervention 49 , 50 . It thus provides insights to foster policy or intervention implementation through mechanism transfer 49 , 50 . According to Pawson 57 , context refers to conditions enabling or hindering an intervention's mechanism, including personal, interpersonal, organisational, institutional, and infrastructural factors. Mechanism denotes the resources provided by an intervention and stakeholder responses, while outcome represents the intended or unintended consequences 57 . Realist review answers "what works, how, why, and in what contexts?" by being cyclical, involving stakeholders, using diverse evidence sources, and being theory-driven 58 . Stakeholder involvement ensures relevance and transferability of findings. Realist review has been applied widely in healthcare research 59 , 60 . Protocol The aim of the realist review outlined in this protocol is to identify from available evidence (both published and unpublished, and grey literature) if person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes, how, for who, why and in what contexts? The research questions guiding this review are: Do person-centred cultures contribute to the aetiology and management of depression among older adults in nursing homes, how, for whom, in what contexts and why? What are the facilitators and barriers of developing person-centred cultures that may contribute to the aetiology and management of depression among older adults in nursing homes in Ireland? In what contexts do specific mechanisms facilitate or hinder nursing home staffs’ understanding of the development of person-centred cultures, and how does this understanding influence the management of depressive symptoms among older adults? Methods The development of candidate programme theories (CPTs) in a realist review involves constructing frameworks to analyse the causal mechanisms through which interventions produce outcomes in specific contexts 59 . This process entails mapping out potential mechanisms that explain how the intervention works, drawing on insights from a scoping review of existing literature, expert knowledge, and preliminary data to form hypotheses about these mechanisms 61 . This review will be reported using RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards) standards 50 and the framework to be followed for the design of this review is the four-step framework 62 : 1. Define the scope of the review 2. Search for and appraise the evidence 3. Extract and synthesize findings 4. Develop narrative 1. Define the scope of the review To define the scope of the review, we have convened two groups: local reference groups from nursing homes ensuring relevance and practical applicability 63 , and an expert panel in person-centred practice, mental health, and realist research guiding theory adjudication and advising on emerging literature 60 , 64 . Collaborating with the expert panel, we identified research questions and clarified the review purpose, focusing on depression and person-centred cultures in nursing homes. Formal theories to review will include self-determination theory 65 , Lewisohn's theory of depression 66 , social cognitive theory 67 , and the person-centred nursing framework 36 . These theories explore intrinsic motivation, social environment reinforcement, and structural components of person-centred care. The expert panel will refine, confirm, or refute generated candidate programme theories (CPTs) 59 (please, see additional material 1 for the CPTs), leading to refined IPTs guiding literature searches. 2. Search for and appraise the evidence The search for evidence will be guided by the research question and the developed IPTs, with an iterative and ongoing process throughout the review 50 , 67 . Any alterations will be documented for transparency. Search methods will include the snowball approach and forward and backward citation tracking 50 . A search strategy (please, see additional file 2), developed using the PICO framework with support from a university information specialist, will be adapted across databases. In the PICO framework, P stands for the population (older adults), I for the intervention (person-centred cultures), C for comparison, and O for outcome (development or amelioration of depression). The following electronic databases will be used: CINAHL, PubMed/Medline, EMBASE, PsycINFO, Scopus, Cochrane databases and repositories, andWeb of Science.. These databases index articles on health and social care. Grey literature sources will include Google, Health Service Executive, and National Health Service guidelines on person-centredness, and hand-searching of references. Search terms will be derived from key literature on person-centredness and depression and the initial programme theories. Using various data sources, including unpublished data, is beneficial in realist reviews 50 . Only studies involving older adults (age 60 and above) in nursing homes from 1990 (the approximate start of the person-centred movement) will be included 39 . Inclusion and exclusion criteria are detailed in Table 3 Table 3. Inclusion and Exclusion Criteria. Item Inclusion Exclusion Population Older adults (60 years and above) living in nursing homes (nursing homes as described before) Any study population different from nursing home, i.e. hostels Language Written in English Any other language different from English Timeframe From 1990 till September 2024 Outside this time frame Study design All study designs that are relevant that have produced findings that can contribute to theory building and testing Studies whose findings cannot contribute to theory development and testing Type of evidence Published and unpublished evidence that can contribute to theory development and testing Any evidence that cannot contribute to testing development and testing Geographic location Any location None Search results will be imported into Covidence an online software for managing and screening systematic search results which is freely available to staff and students of the University College Dublin. Rayyan is an alternative that is freely available. Two reviewers (TO and SPT) will first screen titles and abstracts, followed by full-text screening. An additional team member (TF) will act as an arbitrator in case of disagreements. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 67 will be used to guide the reporting of the screening and inclusion of documents. Endnote software which is freely available to staff and students of the University College Dublin, will be used to record the references from search results and any additional references included during the review. Zotero is an alternative which is freely available. In realist reviews, both academic and non-academic data sources are used to build robust theories 62 . Unlike other reviews that use predefined criteria to assess evidence quality, realist reviews focus on whether evidence contributes to theory development and testing 62 , 68 . Evidence quality is assessed based on relevance, richness, and rigour 69 . Relevance refers to data's ability to aid theory building or testing, while richness pertains to the explanatory power of the data. A distinction has been made between conceptual richness and contextual thickness of an evidence 69 . The conceptual richness pertains to theoretical explanations of how an intervention works, and contextual thickness, which describes the relationship of the intervention to the broader context. Thus, data can be relevant without being rich, and assessing data for relevance and richness helps manage data during realist reviews 70 . Rigour pertains to the methodological approach used to generate the data 62 Pawson and Wong advise that realist reviewers should not be overly rigid about rigour, as even methodologically weak data can provide valuable insights 62 , 68 . This review will use the framework by Dada and colleagues 70 to guide the assessment of relevance, richness, and rigour (Please, see Figure 1 ) and relevance, richness and rigor criteria are listed in Table 4 . Figure 1. Framework of applying relevance, richness and rigor in realist review 69 , reproduced with permission, license number 5880420875929. Table 4. Criteria for relevance, richness and rigor. Relevance Richness Rigor Include: 1. Population: include any study involving older adults (60 years and above) living in nursing homes (nursing homes as described before). 2. Language: include any study written in English. 3. Time frame: any study from 1990 till December 2024 4. Study designs: All study designs that are relevant that have produced findings that can contribute to theory building and testing except reviews or metanalysis. 5. Type of evidence: published and unpublished evidence that can contribute to theory development and testing. 6. Location: any location. Exclude: 1. Any study population different from nursing home, i.e. hostels. 2. Studies whose findings cannot contribute to theory development and testing. 3. Any other language different from English 4. Outside this time frame High : any document that can make many contributions to theory refinement in terms of mechanisms, contexts and outcomes. There is a rich description of the mechanism and or the contexts to develop, refine and refute the PTs Moderate: Makes 1 0r 2 contributions to theory development. Regardless of rigor, there is a contribution to PTs development. Low : Makes a little contribution to theory development. There is a little description of potential contexts, mechanisms and outcomes that result to theory development. None: though relevant to the review, the document makes no contributions to theory development. No description of the mechanism, context or outcome relevant to theory development. The rigor or trustworthiness of the data source and the coherence of the theory will be considered to contextualise the contributions of the evidence by asking the following questions: Are the methods used credible? If not, use other data to support the data. At the level of the PTs, are the theories coherent and simple? The advice from the expert panel will also be used to assess the rigor of the data and the coherence of the PTs. No document will be excluded based on rigor. Adapted from 70 3. Extract and synthesise findings An excel extraction table into which data will be extracted will be developed and it will be pretested before use 71 . Data extraction will be carried out by one reviewer (TA) and will be independently verified by another reviewer (SPT)). A realist ‘lens’ will be applied to the included data to extract data in the form of contexts, mechanisms and outcome in alignment with the research aim and the initial programme theories. Data extraction will be carried out independently by two reviewers and the two resulting tables will be amalgamated after verification by another reviewer. The realist review will follow the approach to analysis and synthesis outlined by Rycroft-Malone and colleagues 58 as follows: 1. Organisation of extracted data into evidence tables 2. Theming by individual reviewers 3. Comparison of reviewers’ themes for a specific article and formulation of chains of inference from the identified themes 4. Linking of the chains of inference, and tracking and linking of articles 5. Hypotheses formulation (mechanism, context, outcome chains). Retroductive theorising will be used to synthesise data 55 , 71 – 73 . This method systematically formulates and tests theories about an intervention or social programme by uncovering its underlying mechanisms 73 . Retroduction involves an iterative cycle of inductive reasoning, deductive reasoning, and abduction 74 . Unlike abduction, which explains phenomena for pragmatic understanding, retroduction sheds light on causality 56 . The populated data extraction forms will be imported into NVivo14 , which is freely available to staff and students of the University College Dublin, and coded according to a codebook informed by the IPTs and data extraction 75 . Each IPT will be a "node" in NVivo, and the extracted CMOCs will be linked to the relevant IPT-node, with notes describing how the data informs the adjudication and refinement of initial programme theories 68 . Each review stage may be revisited to ensure data and theory saturation. 4. Develop narratives At this stage, the stakeholders will be involved in the review of evidence gathered from the review. Initial programme theories (IPT) will be tested and refined or refuted, conclusion will be drawn and recommendations made that will inform a subsequent realist evaluation. Dissemination of findings and next steps The outcomes of the realist review will follow RAMESES reporting guidelines 49 , and will be disseminated through peer-reviewed journal publication, conference presentations to healthcare and academic audiences, and engagement with key stakeholders. Additionally, findings will be integrated into a PhD thesis. This review sets the foundation for a subsequent realist evaluation involving healthcare staff working in nursing homes, who will contribute to the further development of IPT relating to the contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes. This realist review protocol has been registered by PROSPERO (registration number is CRD42024568251) Conclusion Findings from this realist review will give understanding on the implementation of person-centredness and the embedding of person-centred cultures in nursing homes and provide explanation on the mechanisms through which person-centred cultures contribute to aetiology and management of depression among olde adults in nursing homes. To the best of our knowledge, this is the first realist review to look at the contributions of person-centred cultures to the aetiology and management of depression among older adults in nursing homes. It is anticipated that findings from the review detailed in this protocol will contribute to knowledge on how to improve the wellbeing and mental health of older adults in alignment with World Health Organisation’s Decade of Healthy Ageing 2021–2030 75 and comprehensive mental health action plan 2013–2030 76 . Systematic review registration This realist review protocol has been registered by PROSPERO (registration number is CRD42024568251). Ethics Ethical approval is not needed because this study is a review of published literature and no data collection will take place. Consent to participate This is a protocol paper, so consent is not applicable. Data availability Underlying data No data are associated with this article. Extended data Figshare: The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol. https://doi.org/10.6084/m9.figshare.c.7460071 77 . This project contains following extended data: - CANDIDATE PROGRAMME THEORIES CPTs.docx - PUBMED SEARCH STRATEGY FOR A REALIST REVIEW PROTOCOL.docx - PRISMA-P-SystRev-checklist person-centred culture.do Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guidelines Figshare: PRISMA-P checklist for “The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol”. https://doi.org/10.6084/m9.figshare.27080146 78 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Author contributions Omisore, T. Conceptualization, Data Curation, Formal Analysis, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing. Teeling, SP. Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing. Frawley, T. Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing. Butler, M. 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Omisore T, Teeling SP, Frawley TH: The contributions of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol. figshare. 2025. Collection http://www.doi.org/10.6084/m9.figshare.c.7460071.v1 78. Omisore T, Teeling SP, Frawley T: PRISMA-P-Syst Rev-checklist for a realist review protocol.docx additional file 3. figshare. Dataset (83). 2024. https://figshare.com/articles/dataset/PRISMA-P-Syst_Rev-checklist_for_a_realist_review_protocol_docx/27080146?file=49340104 Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Centre for Interdisciplinary Research, University College Dublin School of Nursing Midwifery and Health Systems, Dublin, Leinster, Ireland 2 Centre for Person-Centered Practice Research, Division of Nursing,, Queen Margaret University, School of Health Sciences, Edinburgh, Scotland, UK 3 Centre for Interdisciplinary Research, Education and Innovation in Health Systems, University College Dublin, Dublin, Ireland, Ireland 4 St. Brendan's Community Nursing Unit, Health Service Executive, Ballinasloe, County Galway, Ireland 5 School of Nursing and Midwifery, La Trobe University, GS Building,, Bandura, Australia Tope Omisore Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Project Administration, Writing – Original Draft Preparation Seán Paul Teeling Roles: Conceptualization, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Timmy Frawley Roles: Conceptualization, Supervision, Writing – Review & Editing Mary Butler Roles: Methodology, Validation David Edvardsson Roles: Methodology, Validation Competing interests No competing interests were disclosed. Grant information Health Research Board [R20038]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 10 Feb 2025, 8:30 https://doi.org/10.12688/hrbopenres.14052.1 Copyright © 2025 Omisore T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Omisore T, Teeling SP, Frawley T et al. The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :30 ( https://doi.org/10.12688/hrbopenres.14052.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 10 Feb 2025 Views 0 Cite How to cite this report: Doyle C. Reviewer Report For: The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :30 ( https://doi.org/10.21956/hrbopenres.15431.r45880 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-30/v1#referee-response-45880 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Feb 2025 Colleen Doyle , National Ageing Research Institute, Melbourne, Victoria, Australia; Edith Cowan University School of Psychology and Social Science (Ringgold ID: 204613), Joondalup, Western Australia, Australia; Swinburne University of Technology Faculty of Health Arts and Design (Ringgold ID: 444935), Hawthorn, Victoria, Australia Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15431.r45880 This is a protocol for a realist review examining the relationship between person-centred care and prevalence of depression in nursing homes for older adults. The paper describes well the anticipated methodology to be used, including a brief description of person-centredness ... Continue reading READ ALL This is a protocol for a realist review examining the relationship between person-centred care and prevalence of depression in nursing homes for older adults. The paper describes well the anticipated methodology to be used, including a brief description of person-centredness and other key concepts of depression and realist review methodologies. The paper is well written and refers to recent relevant research in the area. the proposed methods for the review are sound. One addition that may strengthen the paper is a further discussion of the issue of depression in people with cognitive impairment given that a large number of people in nursing homes have at least some degree of cognitive impairment. the choice of realist review methodology is a good one as it will provide greater understanding of any relationship found between care culture and mental health. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: aged care, depression, dementia, mental health, evaluation of health services I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Doyle C. Reviewer Report For: The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :30 ( https://doi.org/10.21956/hrbopenres.15431.r45880 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-30/v1#referee-response-45880 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 10 Feb 25 read Colleen Doyle , National Ageing Research Institute, Melbourne, Australia; Edith Cowan University School of Psychology and Social Science (Ringgold ID: 204613), Joondalup, Australia; Swinburne University of Technology Faculty of Health Arts and Design (Ringgold ID: 444935), Hawthorn, Australia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Doyle C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Feb 2025 | for Version 1 Colleen Doyle , National Ageing Research Institute, Melbourne, Victoria, Australia; Edith Cowan University School of Psychology and Social Science (Ringgold ID: 204613), Joondalup, Western Australia, Australia; Swinburne University of Technology Faculty of Health Arts and Design (Ringgold ID: 444935), Hawthorn, Victoria, Australia 0 Views copyright © 2025 Doyle C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a protocol for a realist review examining the relationship between person-centred care and prevalence of depression in nursing homes for older adults. The paper describes well the anticipated methodology to be used, including a brief description of person-centredness and other key concepts of depression and realist review methodologies. The paper is well written and refers to recent relevant research in the area. the proposed methods for the review are sound. One addition that may strengthen the paper is a further discussion of the issue of depression in people with cognitive impairment given that a large number of people in nursing homes have at least some degree of cognitive impairment. the choice of realist review methodology is a good one as it will provide greater understanding of any relationship found between care culture and mental health. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise aged care, depression, dementia, mental health, evaluation of health services I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Doyle C. Peer Review Report For: The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :30 ( https://doi.org/10.21956/hrbopenres.15431.r45880) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-30/v1#referee-response-45880 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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