A Swedish evaluation of an educational intervention in person-centred communication for nursing assistants in home care for older adults: The ACTION programme

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The study presents an educational intervention called ACTION (a person-centred CommunicaTION programme for nurse assistants (NAs) in home care for older adults). The aim was to evaluate the impact of the person-centred communication educational intervention for nursing assistants in home care for older adults. Methods Data were collected from both intervention and control groups using pre- and post-intervention surveys assessing person-centred care, empathy, job satisfaction, and communication self-efficacy. The intervention group also completed a programme evaluation with open-ended questions upon completing the educational modules. Results NAs participating in the intervention reported increased awareness of the importance of communication and valued acquiring practical tools to enhance their interactions with older adults. While quantitative measures showed no significant differences between groups, qualitative feedback highlighted improvements in reflective practices and self-confidence in communication skills. The intervention did not yield significant quantitative outcomes, yet it prompted valuable qualitative changes in NAs’ communication awareness and practices. These findings highlight the importance of considering contextual factors and providing ongoing support when implementing person-centred communication interventions in elder care. The evaluation shows both strengths and methodological limitations. While some positive qualitative changes were observed, the findings emphasise the need to include the perspectives of older adults and their relatives in future research. Conclusions In summary, this study demonstrates that while quantitative improvements may be limited, qualitative insights reveal the meaningful impact of educational interventions on person-centred communication for nursing assistants. Continued attention to contextual challenges and ongoing support can further enhance the quality of care for older adults in home settings. Trial registration ISRCTN64890826. Registered 10 January 2022, https:// www. isrctn. com/ ISRCT N6489 0826 Competence development Education intervention Home care Nursing assistant Older adults Person-centred communication Figures Figure 1 BACKGROUND The study introduces the ACTION programme, a person-centred communication educational intervention for nurse assistants (NAs) in home care for older adults. Home Care Services (HCS) differ internationally in structure, organisation, and funding. There is a global trend towards supporting ageing at home, due to rising institutional costs, the older adults’ preference for familiar environments, and demographic shifts [ 1 ]. A gap exists, however, between the theoretical understanding and practical implementation of person-centred care (PCC), largely due to organisational barriers such as low staffing levels, low caregiver motivation, limited recognition of efforts, and insufficient opportunities for continuous professional development [ 2 ]. In Sweden, NAs play a crucial role in the provision of HCS, particularly for older adults. Home care is an essential component of the Swedish welfare system, allowing older adults to continue living in their homes while receiving the health and social support they need. NAs form one of the largest occupational groups in Sweden’s healthcare sector, responsible for providing most of the direct health care and social services in home settings [ 3 ]. They perform a variety of tasks that require not only practical nursing skills but also interpersonal and communication competencies. NAs assist with daily living activities such as personal hygiene, dressing, and mobility, and also administer basic medical care, such as medication management and wound dressing. They are also expected to respect each older adult’s dignity and individuality while supporting their emotional and psychological well-being. However, NAs report facing challenges due to time constraints, rigid schedules, and lack of training [ 4 ]. Older adults have diverse needs, including physical, emotional, and existential concerns. These needs may be subtly expressed [ 5 ], requiring NAs to have communication skills to identify and address them. Their role is complex because older adults often present with frailty, cognitive decline, and chronic illnesses, all of which complicate communication and care. Additionally, nursing staff face conflicting demands from the healthcare system, organisational constraints, patients, and relatives, and struggle to balance personal values with professional obligations under time pressure [ 6 ]. These aspects further highlight the complexity of implementing interventions in healthcare settings, particularly in dynamic environments such as home care. Educational interventions on communication have demonstrated positive outcomes, including increased knowledge, improved communication skills, and enhanced job satisfaction among healthcare professionals [ 7 , 8 ]. However, the success of these programmes often depends on the implementation strategies employed and the contextual factors influencing them. The Medical Research Council’s guidance emphasises the importance of systematically planning, implementing, and evaluating complex interventions. This involves understanding the multifaceted nature of such programmes and their interaction with the local context [ 9 ]. Web-based and blended learning methods enhance flexibility and accessibility in training, and improve healthcare professionals' behaviours, patient outcomes, and adoption of new practices [ 10 – 13 ]. Education, whether individual or group-based, is described in a review as positively influencing nurses' attitudes, knowledge, perceived control, skills, and social norms, allowing them to adopt multifaceted strategies showing slight but non-significant advantages over single approaches in clinical practice [ 14 ]. Key enablers include management support, resource availability, and structured facilitation during the training process. Conversely, challenges such as high workloads, limited time for training, and variability in participants’ educational backgrounds and attitudes can hinder participation and programme completion [ 15 , 16 ]. The ACTION programme is a web-based educational intervention designed by parts of this research group to enhance the competence of NAs in person-centred communication while providing home care for older adults. It has been pilot-tested and evaluated in studies that provide insights into its implementation, feasibility, and outcomes [ 4 , 15 , 17 ]. The programme includes modules and in-person group supervision, and focuses on developing empathy, active listening, and tailored communication. It supports self-directed and reflective learning, allowing NAs to access content online through various devices. The programme encourages integrating personal experiences into learning and applying knowledge daily. Evaluations show it enhances NAs' communication skills and job satisfaction by fostering accomplishment and connection with older adults [ 4 , 15 , 17 ]. To gain a deeper insight into the significance of competence development in communication, this study aimed to evaluate an educational intervention focused on person-centred communication for NAs providing home care for older adults. METHODS Design This study has a two-group pre-test and post-test design, combining both quantitative and qualitative data and analyses. It is a part of a larger research initiative – the ACTION programme [ 18 ]. The programme was initiated in 2017 with a small-scale intervention [ 15 ]. The evaluations indicated a need for certain refinements but also demonstrated promising results, forming the foundation for the development of this scaled-up intervention. Setting and samples Fourteen home care team managers in Mid-Sweden were contacted by one of the co-authors regarding participation in the ACTION program. Eleven teams agreed to participate. Each team was randomly assigned to either an intervention or a control group. A total of 132 NAs agreed to participate, resulting in 79 NAs in the intervention group (70 women, nine men) and 53 in the control group (43 women, 10 men). However, not all enrolled NAs completed the education programme or the surveys, citing reasons such as challenging working conditions, stress, and heavy workloads. In the intervention group, approximately half ( n = 43) completed all educational modules and the evaluation form. Among these, 35 NAs completed both the pre- and post-surveys. In the control group, 44 NAs completed both the pre- and post-surveys (see Fig. 1). A description of the sample is presented in Table 1 . Table 1 Overview of participation in the intervention and control groups Group Intervention n = 43 Control n = 44 Sign Female, n (%) 33 (76.7) 34 (77.3) NS b Age, years; mean, SD (min- max) 43.2, 10.5 (26-61) 42.4, 13.6 (19-64) NS a Working experience in care of older adults, months; mean, SD (min-max) 14.2, 8.9 (2-36) 16.5, 11.4 (1-40) NS a Second language n (%) 10 (23.3) 10 (22.7) NS b a t -tests, b chi-square tests, NS = Not Significant Data collection To evaluate the effect of the intervention on NAs’ communication, data were collected through surveys using validated instruments, as well as responses from an evaluation of the education programme. The validated instruments included questions related to PCC [ 19 ], empathy [ 20 ], job satisfaction [ 21 ], and self-efficacy communication skills [ 22 ]. Furthermore, the surveys included demographic questions about sex, age, native language, and work experience in the care of older adults. The intervention group completed a baseline survey before the intervention and another survey six to eight weeks later. The control group completed the same pre- and post-surveys as the intervention group [ 18 ]. At the end of the education programme, the intervention group completed an evaluation. This evaluation consisted of open-ended questions and was administered as a final assignment in the last education module. The questions included were: 1 ) What do you think has been important and interesting about the communication education programme? 2) What new knowledge and ideas have you gained? 3) How do you think your way of communicating might have been affected after the education programme? and 4) Is there anything you felt was missing or that could be improved in the education programme? All data collection and participation in the ACTION programme took place during the NAs’ regular work hours, with time specifically allocated within their schedules to participate. Measures Person-Centred Care Assessment Tool The Person-Centred Care Assessment Tool (P-CAT) measures to what extent staff members rate the care provided as being person-centred. It uses 13 items, rated on a five-point Likert-type scale ranging from 1 (disagree completely) to 5 (agree completely), with scores from 13 to 65, where higher values indicate a higher degree of self-scored person-centredness [ 19 ]. Cronbach’s alpha was .642 and .639 across the two measurements. Jefferson Scale of Empathy The Jefferson Scale of Empathy (JSE) measures empathy in the context of health professions education and patient care and is designed for use with health professions students and practitioners [ 20 ]. The 20 items are on a five-point Likert-type scale ranging from 1 (disagree) to 7 (Strongly Agree), with scores from 20 to 140, where higher values indicate a higher degree of self-scored empathy (Cronbach’s alpha was .689 for survey 1, and .808 for survey 2). The scale consists of three factors: I Perspective-taking (ten items) (Cronbach’s alpha was .718 for survey 1, and .804 for survey 2): II Compassionate care (eight items) (Cronbach’s alpha was .537 for survey 1, and .704 for survey 2), and III: Walking in the patient’s shoes (two items) (Cronbach’s alpha was .641 for survey 1, and .659 for survey 2). The JSE was used in this study with permission from Thomas Jefferson University. Measure of Job Satisfaction Job satisfaction measures to what extent staff rate job satisfaction, with 37 items on a five-point Likert-type scale ranging from 1 (Very displeased) to 5 (Very pleased), with scores from 1 to 185, where higher values indicate a higher degree of job satisfaction. Cronbach’s alpha was .833 for survey 1, and .835 for survey 2. The question My clinical grading was excluded from the survey because it was not relevant to this group. The scale consists of five factors: I Personal satisfaction (ten items) (Cronbach’s alpha was .405 for survey 1, and .346 for survey 2), II: Satisfaction with workload (seven items) (Cronbach’s alpha was .358 for survey 1, and .137 for survey 2), III: Satisfaction with professional Support (nine items) (Cronbach’s alpha was .690 for survey 1, and .675 for survey 2), IV: Satisfaction with pay and prospects (eight items) (Cronbach’s alpha was .582 for survey 1, and .792 for survey 2), and V; Satisfaction with training (three items) (Cronbach’s alpha was .332 for survey 1, and .681 for survey 2). Self-Efficacy Questionnaire The Self-Efficacy Questionnaire (SE-12) measures the clinical communication skills of healthcare professionals [ 22 ]. The 12 items are on a 10-point Likert-type scale ranging from 1 (very uncertain) to 10 (very certain), with scores from 12 to 120, where higher values indicate a higher degree of self-scored clinical communication skills. Cronbach’s alpha was .862 and .878 across the two measurements. Analyses Quantitative analyses Descriptive statistics were analysed, using frequencies and percentages for categorical variables, and means and standard deviations (SD) for continuous variables. Group differences were examined using independent sample t-tests for continuous variables and chi-square tests for categorical variables. Age and working experience in care of older adults were analysed using t-tests, while gender and second language status were compared using chi-square tests. Quantitative analyses Descriptive statistics were employed, with frequencies and percentages calculated for categorical variables and means and standard deviations (SD) reported for continuous variables. Independent sample t-tests were employed to assess group differences in continuous variables, while chi-square tests were utilised for categorical variables. Age and experience in the care of older adults were analysed using t-tests, whereas gender and second language status were compared through chi-square tests. Analyses for nonparametric statistics were used as the data did not have normal distribution or homoscedasticity (equal variances). Therefore, the Mann-Whitney U test was used to investigate the changes between the intervention group and the control group concerning P-CAT, Empathy, Job satisfaction , and Clinical communication skills . A Wilcoxon Signed Rank Test was used to analyse the changes in the groups between the measures at baseline and the second survey. For the missing values, we imputed the average of the values of the other attributes of the test case [ 23 ]. All tests were two-tailed, and statistical significance was set at p ≤ .05. All analyses were conducted using IBM SPSS Statistics (Version 28.0; IBM SPSS, Armonk, NY, USA). Qualitative analysis Answers from the evaluation form were analysed following an inductive content analysis [ 24 ]. The texts were read several times to give the authors a thorough understanding of their content. Secondly, meaning units, such as words, sentences or sections related to the study aim, were identified in the text. With the analysis, meaning-bearing units were re-read to obtain a sense of the whole and become immersed in the data. Thereafter, the data was coded, grouped into categories and abstracted. The codes were then compared to identify similarities and differences, leading to the emergence of seven subcategories and three generic categories, which were ultimately synthesised into a main category (see Table 2 ) [ 24 ]. Table 2 Examples of the abstraction process Subcategories Generic categories Main category Good communication Non-verbal Inclusive communication The impact of communication Relationships Trust Building relationships Questions Listening Understanding Active listening Ethical considerations Ethical approval was obtained from the Swedish Ethical Review Authority (Dnr 2021–05233), in accordance with the principles of the Declaration of Helsinki [ 25 ]. Both managers and NAs at the home care units received oral and written information about the ACTION programme and the research, how data would be collected, handled, stored, and presented /published, and their rights as participants. All participants were guaranteed confidentiality and their right to withdraw their participation at any time, without consequences and with no need to state reasons. Written informed consent to participate was obtained from the NAs before any participation in the research programme. All data was coded and managed according to the General Data Protection Regulation (GDPR, 2016/679). In accordance with the ethical approval, only researchers have access to data and information about the participants. RESULTS The results were divided into two main sections: statistical answers from the surveys and answers from the evaluation forms. Results from the surveys In the NAs’ responses to questions regarding PCC (P-CAT), group comparisons showed no significant differences between the intervention and control groups at either baseline or follow-up (Table 3 ). Similarly, no significant differences were found in the questions regarding empathy (JSE) or communication skills (SE-12) (see Table 3 ). However, empathy increased for both groups between baseline and the second surveys, although the changes were not significant. Table 3 Data from the intervention group (IG) and control groups (CG) concerning Person-Centred Care Assessment Tool, Empathy, Working satisfaction , and Clinical communication skills Baseline Mean (SD) Median After Mean (SD) Median p-value P-CAT IG 52.9 (6.5) 53.0 52.3 (6.4) 51.0 .456 b P-CAT CG 51.5 (5.4) 51.0 51.0 (5.1) 50.0 .686 b p-value .165 a .281 a Empathy index (Factor I-III) IG 113.5 (12.3) 113.0 114.8 (14.4) 118.0 .497 b Empathy index (Factor I-III) CG 112.2 (11.6) 113.0 113.8 (13.1) 116.5 .364 b p-value .657 a .719 a I: Perspective-taking IG 60.1 (6.0) 60.0 60.3 (7.8) 62.0 .781 b I: Perspective-taking CG 58.8 (7.9) 60.0 58.1 (7.9) 58.0 .168 b p-value .638 a .084 a II: Compassionate care IG 41.9 (7.5) 41.0 42.9 (7.2) 43.0 .530 b II: Compassionate care CG 42.3 (6.3) 42.0 44.3 (7.7) 44.3 .039 b p-value .782 a .290 a III: Walking in the patient´s shoes IG 11.5 (2.7) 12.0 11.6 (2.2) 12.0 .838 b III: Walking in the patient´s shoes CG 11.1 (3.0) 12.0 11.4 (3.0) 13.0 .703 b p-value .828 a .687 a Job satisfaction index (V factors) IG 158.7 (16.6) 156.0 151.7 (14.1) 152.0 .012 b Job satisfaction index (V factors) CG 142.7 (19.1) 140.0 141.2 (18.2) 136.0 .266 b p-value < .001 a .002 a I: Personal IG , 45.3 (5.7) 44.0 44.5 (4.2) 44.0 .788 b I: Personal CG 41.8 (5.4) 41.0 40.7 (5.6) 41.0 .129 b p-value 016 a .002 a II : With workload IG 27.3 (4.6) 26.0 28.2 (3.8) 29.0 .102 b II: With workload CC 26.5 (4.8) 26.0 26.6 (4.3) 26.0 .987 b p-value .583 a .026 a III : Professional support IG 37.8 (3.9) 37.0 37.4 (4.2) 38.0 .881 b III : Professional support CC 36.6 (5.7) 36.5 36.9 (5.5) 36.5 .695 b p-value 406 a .570 a IV : Pay and prospects IG 30.9 (4.4) 31.0 27.1 (3.6) 27.0 < .001 b IV: Pay and prospects CC 23.4 (4.7) 22.5 23.2 (4.8) 23.0 .522 b p-value < .001 a < .001 a V: With training IG 17.5 (3.5) 17.0 14.4 (2.9) 14.0 < .001 b V: With training CC 14.3 (3.1) 14.0 13.8 (2.9) 14.0 .133 b p-value < .001 a 361 a Clinical communication skills IG 104.2 (7.8) 104.0 103.3 (9.0) 105.0 .694 b Clinical communication skills CG 101.0 (10.1) 100.5 101.6 (9.6) 102.5 .670 b p-value .219 a .540 a a Mann-Whitney U test, b Wilcoxon signed-rank test, bold = statistically significant P-CAT = Person-Centred Care Assessment Tool The job satisfaction decreased significantly in the intervention group from 158.7 (16.6) at baseline to 151.7 (14.1) in the second survey ( p = .012). Concerning factor I and factor II, there were significant differences; the intervention group had higher values at both measuring points ( p < .001 versus p = .002). The same logic applied for factor IV, Pay and prospect ( p < .001 versus p < . 001) (see Table 3 ). Impact of communication In the evaluation from the intervention group after the education programme, it became evident that the education had been useful and had raised awareness of the impact of communication. The NAs stated that the education had enhanced their awareness of the importance of communication. They also highlighted how the repetition of previous knowledge served as a valuable reminder of the significance of communication, but there were also some suggestions for the development of the educational design. Awareness of the Importance of Communication In the evaluation, communication was described as a fundamental and important part of care, and the ACTION programme was said to have helped increase the NAs' awareness of the importance of good communication. Communication is important, that has always been known, but through the course [ACTION program], I have realised how much more and in everything we do, say, and don't say, we are communicating (NA2). NAs described an increased awareness of communication as essential for creating trust, confidence, and establishing good relationships with the older adult. They also emphasised communication as crucial for enhancing their understanding of the older adult. One example of how to increase their understanding was through active listening. Communication training shows how important it is to listen actively and affirm the older adult (NA8). Many of the NAs said that the education programme had reminded them of the importance of taking the time to listen and not be hurried. They had also become more aware of the significance of actively showing, non-verbally, the other person that they were listening. It's about being more mindful of how I express myself and my posture. I'm more aware of listening properly, reading body language, and paying attention to the tone of voice and facial expressions (NA7). Some NAs also mentioned being reminded of the importance of asking the older adult questions during their visit. One participant also mentioned that the training had encouraged them to ask questions, even those that might feel uncomfortable. I have learned not to be afraid to ask difficult questions, to listen to the person, and to reflect on what someone is trying to convey with their verbal and non-verbal communication (NA22). Value of Repeating Knowledge The NAs described the education programme as an appreciated repetition of previous knowledge, and they valued being reminded of important communication principles. Some things I already knew, but I learned a lot as well. I will carry this with me both in my personal and professional life (NA34). Repetition was described as reinforcing and consolidating knowledge and served as a useful reminder of important information, even for those with prior experience who might discover gaps in their understanding. I thought I knew a lot about communication before, but I was wrong. I feel that I have grown from this education (NA13). Furthermore, the NAs stated that the education programme strengthened and validated previous knowledge and how they already communicated in their interactions with the older adults. What has been interesting about the training is that it has covered many things we do daily without really thinking about it when working with people. Through the videos and during the training, I have seen that what I do myself is included as examples or information, and that it works in everyday life with the clients (NA37). At the same time, I am proud of myself for the validations [through the education] that I have been very good at (NA38). Strengths and Areas for Development in the Education Design Based on the evaluation, the education programme was generally received positively by the NAs. Many stated that they did not find any specific content missing, and the group reflections and recorded lectures were considered useful. A podcast in the education field, about challenging communication and interacting with people with dementia, was noted as interesting and beneficial. I have found it interesting to listen to the podcasts. The latest one was particularly valuable, discussing how to listen and talk to those with dementia or who have other illnesses that can make it difficult to connect or find topics of conversation, and how to remain calm when talking to them (NA25). The discussions you had [in the podcast] and the suggestions on how to approach such situations were very helpful (NA3). The education programme was also described as providing useful new tools and ideas for communication. After the training, my way of communicating with the older adults has improved significantly. I try to use everything I learned as much as possible (NA8). It has been an educative training that has provided me with many new tools and ways of thinking to use when communicating, especially with older adults at my job (NA21). Specific examples of communication tools and strategies were also mentioned, such as: Mirroring, maintaining presence, using appropriate body language, and sustaining eye contact (NA13). Other examples included: Speaking clearly while maintaining calmness, eye contact, and good posture (NA19). Additionally, participants emphasized the importance of: Sitting down, not being afraid of silence, and recognizing that it is not always necessary to keep talking to maintain the conversation (NA33). The NAs also provided suggestions and identified areas for improvement. Although the training module specifically addressed communication strategies for managing aggressive or challenging situations, it was suggested that additional content on this topic would be beneficial. Furthermore, there was an expressed need for newly hired employees and substitutes to have ongoing access to the education programme, as it is considered essential for enhancing their communicative skills and interactions with the older adults in their care. I found it interesting to listen to this [education programme], and you can always learn something new… It would be great for newly hired nursing staff and substitutes to listen to this because I believe it could help many who do not have much experience in this field (NA3). Finally, it was noted that learning how the digital platform functions can be challenging, especially for individuals who have limited technological skills. DISCUSSION This study investigated the effects of a person-centred communication intervention on NAs working with older adults in home care settings. While the quantitative findings did not show significant differences between the intervention and control groups, the qualitative insights provided meaningful reflections on participants’ experiences and perceptions. The lack of changes in survey outcomes brings the study’s design into question. Overestimation by the intervention group could be a factor, as participants might have initially rated their communication skills highly, leading to a ceiling effect. Many NAs believed they had strong communication skills before the education programme, and this could explain the high baseline scores and the lack of significant post-intervention changes. Research participation has consequences for behaviours being investigated, although little can be known about the conditions under which NAs operate, their mechanisms of effects, or their magnitudes [ 26 ]. Similarly, the timing of the post-measurements might not have been optimal. It is plausible that the true benefits of such interventions require a longer time frame to manifest. Contextual factors such as staff shortages and time constraints may complicate the implementation of educational interventions. These challenges can create a work environment that might hinder NAs from effectively using communication techniques such as person-centred communication. The gap between PCC practices and theoretical knowledge often arises due to organisational issues, including insufficient staff ratios, lack of caregiver motivation and team cohesion, limited managerial recognition, and inadequate ongoing training and support [ 2 ]. Such barriers can reduce the quality of care for older individuals and limit NAs attention to the older adults. It is important to implement a tailored personal health plan and facilitate inter-professional teamwork and collaboration with older adults and their relatives, establishing a person-centred approach [ 27 ]. Though the quantitative results were inconclusive, the qualitative findings revealed improved self-awareness among NAs regarding communication techniques. The participants valued tools like mirroring, managing silence, and calmness, praising their practicality. The intervention fostered reflection on non-verbal cues and strengthened trusting relationships, enhancing interactions with older adults through mindful and effective communication practices. The participants noted that the education programme made them more aware of their expressions, body language, and tone when interacting with the older adults. They valued the reminder to ask questions, even if uncomfortable, to better understand the older adults’ needs. This aligns with previous research emphasising reflective practices in improving healthcare communication [ 7 , 8 ]. Interestingly, the intervention seemed to enhance NAs' ability to clearly articulate their understanding of effective communication. After the training, their responses to qualitative questions became more detailed and descriptive, indicating improved reflection and expression regarding communication practices. Qualitative methods can capture subtle changes of interventions that might not be immediately apparent in quantitative data, highlighting the value of subjective evaluations in understanding intervention impacts [ 28 ]. The fidelity of the intervention remains vital, as inconsistent attendance or lack of follow-up may affect practical implementation. Additionally, the participants noted challenges with navigating the digital platform used for the training, particularly for those with limited technological skills. This highlights the need for technological support and simplified instructions in future implementations to ensure accessibility for all staff members. This is in line with a review describing that technology is reshaping education by expanding the traditional learning environment and encouraging the development of digital programmes for cognitive growth [ 29 ]. Operational challenges, such as staff shortages and time constraints, were also mentioned as obstacles to fully integrating the new strategies into daily workflows. These factors not only influence the effectiveness of interventions but also underscore the complexities of working in care environments. The participants also emphasised the importance of extending access to the education programme to newly hired staff and substitutes. Providing training early in their careers could significantly enhance their communicative abilities and interactions with older individuals. The link between job competency and the intention to stay in the workplace was found to be significantly influenced by intrinsic and extrinsic job satisfaction. Considering the challenges of staff shortages and retention in long-term care settings, organisations should focus on strategies to boost employees’ intention to remain. One way to achieve this is by enhancing employees’ competency, as higher competency leads to improved care quality and increased extrinsic job satisfaction. Strengthening competency fosters both intrinsic and extrinsic job satisfaction, improving care standards, affirmation, personal achievement, and willingness to stay in long-term care roles [ 30 ]. Our results could help build a more robust foundation for PCC. The positive reflections from the participants demonstrate that even if measurable improvements were absent, the intervention contributed to meaningful shifts in self-awareness and communication practices. Strength and limitations This study contributes to the understanding of NAs’ experiences and evaluates an educational intervention aimed at improving person-centred communication in home care for older adults. Nevertheless, it has several limitations. First, some of the Cronbach’s Alpha ratings were low, for instance Satisfaction with workload , at .358 and .137, suggesting a low level of internal consistency among the items being measured, indicating that they may not be measuring the same underlying construct. Another limitation is the small number of participants. According to Graneheim et al., the value of research data is not determined by the number of participants, but by the richness and depth of the information collected [ 31 ]. We considered the data rich enough to be analysed. The trustworthiness of the results was ensured by thoroughly describing the participants, data collection procedures and the analysis steps. However, the Swedish context should be considered regarding transferability. The authors have different backgrounds in healthcare and social work which can strengthen understanding. However, the main problem of studying the effects of a person-centred communication intervention from the perspective of professionals is that it misses the main effects, hence the experiences of older adults. Therefore, we suggest intervention studies in which the opinions of older adults and their relatives about communication and PCC are included. Conclusions In conclusion, while the intervention did not produce significant quantitative changes, it facilitated meaningful qualitative reflections and shifts in the participants' communication practices. The study highlights the importance of addressing contextual factors, providing ongoing support, and tailoring interventions to the unique challenges of care settings. By doing so, future initiatives can better equip NAs with the skills and confidence needed to provide high-quality, PCC. The findings also suggest a need for better adjustments in scheduling to reduce stress and improve workflow. Ensuring that NAs have the time and resources to practice new communication techniques is essential for their successful implementation. Moreover, future studies should explore the integration of tailored personal health plans, inter-professional teamwork, and collaboration with older adults and their relatives. Additionally, ongoing education and support for newly hired staff and substitutes could help bridge gaps in experience and enhance the overall quality of care. Future studies should also investigate the experiences of older adults and their relatives regarding communication and person-centredness in interactions with nursing staff. Abbreviations ACTION A person-centred communication programme HCS Home care services NA Nurse assistant PCC Person-centred care Declarations Ethics approval and consent to participate This research was approved by the Swedish Ethical Review Authority (Dnr 2021–05233) and was conducted in accordance with the Declaration of Helsinki. All participants received verbal and written information about the study. A written informed consent was obtained before participation in the research, and all participants were informed about the research, how their personal data would be processed, their right to request information, and their right to withdraw at any time without consequences. All data were coded and handled in accordance with the General Data Protection Regulation [ 32 ]. Participant recruitment and the handling of data, i.e. storage, transmission, and accessibility, were outlined in alignment with legal frameworks and safety routines to uphold participant safety, privacy, and confidentiality. Access to data was limited only to researchers affiliated with the ACTION programme. Based on their prior research, conducted in similar settings, the researchers had experience of the complexities and ethical considerations necessary to ensure that data handling was carried out in a responsible and ethically sound way. Consent for publication All participants received information about the study, including how the findings would be reported and published. Written informed consent was obtained before their participation in the research. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Clinical trial number Not applicable. Funding Open access funding was provided by Mälardalen University. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution JH initiated this study and proposed the study design, which was developed in collaboration with BK, DL, and TG. The data were collected by JH and analysed by JH, BK, and DL. The study was drafted by all authors. All authors reviewed and edited the manuscript and approved the final draft. Acknowledgement We specially thank the participants who took part in the present study. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of the data and ethical considerations. References World Health Organization. The growing need for home health care for the elderly Home health care for the elderly as an integral part of primary health care services. 2015; Available from: https://applications.emro.who.int/dsaf/EMROPUB_2015_EN_1901.pdf . Cited 2025 Oct 08. Güney S, Karadağ A, El-Masri M. Perceptions and experiences of person-centered care among nurses and nurse aides in long term residential care facilities: A systematic review of qualitative studies. Geriatr Nurs. 2021;42(4):816–24. https://doi.org/10.1016/j.gerinurse.2021.05.007 . The Swedish National Board of Health and Welfare. Vård och omsorg för äldre. Lägesrapport 2024. [Health and social care of elderly. Situation report 2024]. 2024; Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2024-3-8991.pdf Gustafsson T, Maurin Söderholm H, Sundler AJ, Karlsson P, Lindberg E. Sometimes you need an eye-opener’: A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person‐centred communication. Nurs Open. 2023;10(7):4560–9. https://doi.org/10.1002/nop2.1702 . Sundler AJ, Ekwall A, Lundin S, Holmström IK. Communicative challenges in the home care of older persons–a qualitative exploration. J Adv Nurs. 2016;72(10):2435–44. https://doi.org/10.1111/jan.12996 . Rasoal D, Kihlgren A, Skovdahl K. Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach. BMC Geriatr. 2018;18:70. https://doi.org/10.1186/s12877-018-0756-9 . Ammentorp J, Sabroe S, Kofoed PE, Mainz J. The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy: A randomized controlled trial. Patient Educ Couns. 2007;66(3):270–7. https://doi.org/10.1016/j.pec.2006.12.012 . Wolderslund M, Kofoed PE, Ammentorp J. The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. Patient Educ Couns. 2021;104(6):1423–30. https://doi.org/10.1016/j.pec.2020.11.018 . Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. https://doi.org/10.1136/bmj.n2061 . Fontaine G, Cossette S, Maheu-Cadotte M, Mailhot T, Deschênes M-F, Mathieu-Dupuis G, et al. Evaluation of a web-based e-learning platform for brief motivational interviewing by nurses in cardiovascular care: a pilot study. J Med Internet Res. 2016;18(8):e224. https://doi.org/10.2196/jmir.5532 . Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300(10):1181–96. https://doi.org/10.1001/jama.300.10.1181 . Murphy J, Wootton S, Saxton J, Power E, Bridle C, Williams K, et al. Translating research into practice: evaluation of an e-learning resource for health care professionals to provide nutrition advice and support for cancer survivors. Nurse Educ Today. 2015;35(1):271–6. https://doi.org/10.1016/j.nedt.2014.11.003 . Sinclair PM, Kable A, Levett-Jones T. The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: a systematic review. Int J Nurs Stud. 2016;57:70–81. https://doi.org/10.1016/j.ijnurstu.2016.01.011 . Fontaine G, Cossette S, Gagnon MP, Mailhot T, Boyer L, Deschênes M-F, et al. Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis. Implement Sci. 2024;19(1):68. Gustafsson T, Sundler AJ, Maurin Söderholm H, Karlsson P, Lindberg E. Process evaluation of the ACTION programme: a strategy for implementing person-centred communication in home care. BMC Nurs. 2021;20:1–13. Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662–73. https://doi.org/10.1111/scs.12376 . Gustafsson T, Maurin Söderholm H, Sundler AJ, Karlsson P, Lindberg E. Communication in home care—A feasibility study of an educational intervention in self-efficacy and job satisfaction. Nurs Open. 2023;10(3):1375–82. https://doi.org/10.1002/nop2.1 . Höglander J, Gustafsson T, Maurin Söderholm H, Sundler AJ, Karlsson P, Lindberg E. Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol. BMC Geriatr. 2023;23(1):112. https://doi.org/10.1186/s12877-023-03842-4 . Sjögren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). Int Psychogeriatr. 2012;24(3):406–15. https://doi.org/10.1017/S1041610211001839 . Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, Veloski J, Magee M. The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educ Psychol Meas. 2001;61(2):349–65. https://doi.org/10.1177/00131640121971158 . Traynor M, Wade B. The development of a measure of job satisfaction for use in monitoring the morale of community nurses in four trusts. J Adv Nurs. 1993;18(1):127–36. https://doi.org/10.1046/j.1365-2648.1993.18010127.x . Axboe MK, Christensen KS, Kofoed PE, Ammentorp J. Development and validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication skills of health care professionals. BMC Med Educ. 2016;16:272. https://doi.org/10.1186/s12909-016-0798-7 . Saar-Tsechansky M, Provost F. Handling missing values when applying classification models. J Mach Learn Res. 2007;8:1625–57. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x . World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013. 310(20): pp. 2191–2194. Available from: https://jamanetwork.com/journals/jama/fullarticle/1760318/ Cited 2025 Oct 08. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267–77. https://doi.org/10.1016/j.jclinepi.2013.08.015 . Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs. 2021;42(1):213–24. https://doi.org/10.1016/j.gerinurse.2020.10.011 . Yadav D. Criteria for good qualitative research: A comprehensive review. Asia Pac Educ Res. 2022;31(6):679–89. https://doi.org/10.1007/s40299-022-00660-7 . Mhlongo S, Mbatha K, Ramatsetse C, Dlamini R. Challenges, opportunities, and prospects of adopting and using smart digital technologies in learning environments: An iterative review. Heliyon. 2023;9(6):e17134. https://doi.org/10.1016/j.heliyon.2023.e17134 . Chang YC, Yeh TF, Lai IJ, Yang CC. Job competency and intention to stay among nursing assistants: The mediating effects of intrinsic and extrinsic job satisfaction. Int J Environ Res Public Health. 2021;18(12):6436. https://doi.org/10.3390/ijerph18126436 . Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. https://doi.org/10.1016/j.nedt.2003.10.001 . General Data Protection. General Data Protection Regulation—GDPR. Available from: https://gdpr-info.eu/ . Cited 2025 Oct 08. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 24 Feb, 2026 Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviews received at journal 03 Jan, 2026 Reviews received at journal 02 Jan, 2026 Reviewers agreed at journal 29 Dec, 2025 Reviewers agreed at journal 24 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers invited by journal 17 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Editor invited by journal 11 Nov, 2025 Submission checks completed at journal 11 Nov, 2025 First submitted to journal 11 Nov, 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. 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15:27:47","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":140474,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7815093/v1/09fbc7f9bf0624301557de28.html"},{"id":98887698,"identity":"873c1e71-2798-4279-9031-1ee4769e300c","added_by":"auto","created_at":"2025-12-23 15:27:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":61786,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant flow and completion rates\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7815093/v1/110bf31b98918c4f626382ff.png"},{"id":107351033,"identity":"b3837019-4941-4888-bbcc-9fa65dad9fb1","added_by":"auto","created_at":"2026-04-20 16:08:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":770784,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7815093/v1/ecd6c1fb-c2a6-424a-89cf-8c8db3244bed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Swedish evaluation of an educational intervention in person-centred communication for nursing assistants in home care for older adults: The ACTION programme","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe study introduces the ACTION programme, a person-centred communication educational intervention for nurse assistants (NAs) in home care for older adults. Home Care Services (HCS) differ internationally in structure, organisation, and funding. There is a global trend towards supporting ageing at home, due to rising institutional costs, the older adults\u0026rsquo; preference for familiar environments, and demographic shifts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A gap exists, however, between the theoretical understanding and practical implementation of person-centred care (PCC), largely due to organisational barriers such as low staffing levels, low caregiver motivation, limited recognition of efforts, and insufficient opportunities for continuous professional development [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Sweden, NAs play a crucial role in the provision of HCS, particularly for older adults. Home care is an essential component of the Swedish welfare system, allowing older adults to continue living in their homes while receiving the health and social support they need. NAs form one of the largest occupational groups in Sweden\u0026rsquo;s healthcare sector, responsible for providing most of the direct health care and social services in home settings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. They perform a variety of tasks that require not only practical nursing skills but also interpersonal and communication competencies. NAs assist with daily living activities such as personal hygiene, dressing, and mobility, and also administer basic medical care, such as medication management and wound dressing. They are also expected to respect each older adult\u0026rsquo;s dignity and individuality while supporting their emotional and psychological well-being. However, NAs report facing challenges due to time constraints, rigid schedules, and lack of training [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Older adults have diverse needs, including physical, emotional, and existential concerns. These needs may be subtly expressed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], requiring NAs to have communication skills to identify and address them. Their role is complex because older adults often present with frailty, cognitive decline, and chronic illnesses, all of which complicate communication and care. Additionally, nursing staff face conflicting demands from the healthcare system, organisational constraints, patients, and relatives, and struggle to balance personal values with professional obligations under time pressure [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These aspects further highlight the complexity of implementing interventions in healthcare settings, particularly in dynamic environments such as home care. Educational interventions on communication have demonstrated positive outcomes, including increased knowledge, improved communication skills, and enhanced job satisfaction among healthcare professionals [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the success of these programmes often depends on the implementation strategies employed and the contextual factors influencing them. The Medical Research Council\u0026rsquo;s guidance emphasises the importance of systematically planning, implementing, and evaluating complex interventions. This involves understanding the multifaceted nature of such programmes and their interaction with the local context [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Web-based and blended learning methods enhance flexibility and accessibility in training, and improve healthcare professionals' behaviours, patient outcomes, and adoption of new practices [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Education, whether individual or group-based, is described in a review as positively influencing nurses' attitudes, knowledge, perceived control, skills, and social norms, allowing them to adopt multifaceted strategies showing slight but non-significant advantages over single approaches in clinical practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Key enablers include management support, resource availability, and structured facilitation during the training process. Conversely, challenges such as high workloads, limited time for training, and variability in participants\u0026rsquo; educational backgrounds and attitudes can hinder participation and programme completion [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ACTION programme is a web-based educational intervention designed by parts of this research group to enhance the competence of NAs in person-centred communication while providing home care for older adults. It has been pilot-tested and evaluated in studies that provide insights into its implementation, feasibility, and outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The programme includes modules and in-person group supervision, and focuses on developing empathy, active listening, and tailored communication. It supports self-directed and reflective learning, allowing NAs to access content online through various devices. The programme encourages integrating personal experiences into learning and applying knowledge daily. Evaluations show it enhances NAs' communication skills and job satisfaction by fostering accomplishment and connection with older adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To gain a deeper insight into the significance of competence development in communication, this study aimed to evaluate an educational intervention focused on person-centred communication for NAs providing home care for older adults.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eDesign\u003c/h2\u003e\n\u003cp\u003eThis study has a two-group pre-test and post-test design, combining both quantitative and qualitative data and analyses. It is a part of a larger research initiative \u0026ndash; the ACTION programme [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. The programme was initiated in 2017 with a small-scale intervention [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. The evaluations indicated a need for certain refinements but also demonstrated promising results, forming the foundation for the development of this scaled-up intervention.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSetting and samples\u003c/h3\u003e\n\u003cp\u003eFourteen home care team managers in Mid-Sweden were contacted by one of the co-authors regarding participation in the ACTION program. Eleven teams agreed to participate. Each team was randomly assigned to either an intervention or a control group.\u003c/p\u003e\n\u003cp\u003eA total of 132 NAs agreed to participate, resulting in 79 NAs in the intervention group (70 women, nine men) and 53 in the control group (43 women, 10 men). However, not all enrolled NAs completed the education programme or the surveys, citing reasons such as challenging working conditions, stress, and heavy workloads. In the intervention group, approximately half (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;43) completed all educational modules and the evaluation form. Among these, 35 NAs completed both the pre- and post-surveys. In the control group, 44 NAs completed both the pre- and post-surveys (see Fig.\u0026nbsp;1). A description of the sample is presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOverview of participation in the intervention and control groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"41%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en = 43\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e = 44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSign\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"41%\"\u003e\n\u003cp\u003eFemale, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e33 (76.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e34 (77.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eNS\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"41%\"\u003e\n\u003cp\u003eAge, years; mean, SD (min- max)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e43.2, 10.5 (26-61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e42.4, 13.6 (19-64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eNS\u003csup\u003e a\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"41%\"\u003e\n\u003cp\u003eWorking experience in care of older adults, months; mean, SD (min-max)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e14.2, 8.9 (2-36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e16.5, 11.4 (1-40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eNS\u003csup\u003e a\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"41%\"\u003e\n\u003cp\u003eSecond language \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e10 (23.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e10 (22.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eNS \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003et\u003c/em\u003e-tests, \u003csup\u003eb\u003c/sup\u003e chi-square tests, NS = Not Significant\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eTo evaluate the effect of the intervention on NAs\u0026rsquo; communication, data were collected through surveys using validated instruments, as well as responses from an evaluation of the education programme. The validated instruments included questions related to PCC [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e], empathy [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e], job satisfaction [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], and self-efficacy communication skills [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, the surveys included demographic questions about sex, age, native language, and work experience in the care of older adults. The intervention group completed a baseline survey before the intervention and another survey six to eight weeks later. The control group completed the same pre- and post-surveys as the intervention group [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. At the end of the education programme, the intervention group completed an evaluation. This evaluation consisted of open-ended questions and was administered as a final assignment in the last education module. The questions included were: 1\u003cem\u003e) What do you think has been important and interesting about the communication education programme? 2) What new knowledge and ideas have you gained? 3) How do you think your way of communicating might have been affected after the education programme?\u003c/em\u003e and \u003cem\u003e4) Is there anything you felt was missing or that could be improved in the education programme?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data collection and participation in the ACTION programme took place during the NAs\u0026rsquo; regular work hours, with time specifically allocated within their schedules to participate.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003ePerson-Centred Care Assessment Tool\u003c/h2\u003e\n\u003cp\u003eThe Person-Centred Care Assessment Tool (P-CAT) measures to what extent staff members rate the care provided as being person-centred. It uses 13 items, rated on a five-point Likert-type scale ranging from 1 (disagree completely) to 5 (agree completely), with scores from 13 to 65, where higher values indicate a higher degree of self-scored person-centredness [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Cronbach\u0026rsquo;s alpha was .642 and .639 across the two measurements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eJefferson Scale of Empathy\u003c/h2\u003e\n\u003cp\u003eThe Jefferson Scale of Empathy (JSE) measures empathy in the context of health professions education and patient care and is designed for use with health professions students and practitioners [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. The 20 items are on a five-point Likert-type scale ranging from 1 (disagree) to 7 (Strongly Agree), with scores from 20 to 140, where higher values indicate a higher degree of self-scored empathy (Cronbach\u0026rsquo;s alpha was .689 for survey 1, and .808 for survey 2). The scale consists of three factors: I \u003cem\u003ePerspective-taking\u003c/em\u003e (ten items) (Cronbach\u0026rsquo;s alpha was .718 for survey 1, and .804 for survey 2): II \u003cem\u003eCompassionate care\u003c/em\u003e (eight items) (Cronbach\u0026rsquo;s alpha was .537 for survey 1, and .704 for survey 2), and III: \u003cem\u003eWalking in the patient\u0026rsquo;s shoes\u003c/em\u003e (two items) (Cronbach\u0026rsquo;s alpha was .641 for survey 1, and .659 for survey 2). The JSE was used in this study with permission from Thomas Jefferson University.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMeasure of Job Satisfaction\u003c/h3\u003e\n\u003cp\u003eJob satisfaction measures to what extent staff rate job satisfaction, with 37 items on a five-point Likert-type scale ranging from 1 (Very displeased) to 5 (Very pleased), with scores from 1 to 185, where higher values indicate a higher degree of job satisfaction. Cronbach\u0026rsquo;s alpha was .833 for survey 1, and .835 for survey 2. The question \u003cem\u003eMy clinical grading\u003c/em\u003e was excluded from the survey because it was not relevant to this group. The scale consists of five factors: I \u003cem\u003ePersonal satisfaction\u003c/em\u003e (ten items) (Cronbach\u0026rsquo;s alpha was .405 for survey 1, and .346 for survey 2), II: \u003cem\u003eSatisfaction with workload\u003c/em\u003e (seven items) (Cronbach\u0026rsquo;s alpha was .358 for survey 1, and .137 for survey 2), III: \u003cem\u003eSatisfaction with professional Support\u003c/em\u003e (nine items) (Cronbach\u0026rsquo;s alpha was .690 for survey 1, and .675 for survey 2), IV: \u003cem\u003eSatisfaction with pay and prospects\u003c/em\u003e (eight items) (Cronbach\u0026rsquo;s alpha was .582 for survey 1, and .792 for survey 2), and V; \u003cem\u003eSatisfaction with training\u003c/em\u003e (three items) (Cronbach\u0026rsquo;s alpha was .332 for survey 1, and .681 for survey 2).\u003c/p\u003e\n\u003ch3\u003eSelf-Efficacy Questionnaire\u003c/h3\u003e\n\u003cp\u003eThe Self-Efficacy Questionnaire (SE-12) measures the clinical communication skills of healthcare professionals [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. The 12 items are on a 10-point Likert-type scale ranging from 1 (very uncertain) to 10 (very certain), with scores from 12 to 120, where higher values indicate a higher degree of self-scored clinical communication skills. Cronbach\u0026rsquo;s alpha was .862 and .878 across the two measurements.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalyses\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were analysed, using frequencies and percentages for categorical variables, and means and standard deviations (SD) for continuous variables. Group differences were examined using independent sample t-tests for continuous variables and chi-square tests for categorical variables. Age and working experience in care of older adults were analysed using t-tests, while gender and second language status were compared using chi-square tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were employed, with frequencies and percentages calculated for categorical variables and means and standard deviations (SD) reported for continuous variables. Independent sample t-tests were employed to assess group differences in continuous variables, while chi-square tests were utilised for categorical variables. Age and experience in the care of older adults were analysed using t-tests, whereas gender and second language status were compared through chi-square tests. Analyses for nonparametric statistics were used as the data did not have normal distribution or homoscedasticity (equal variances). Therefore, the Mann-Whitney \u003cem\u003eU\u003c/em\u003e test was used to investigate the changes between the intervention group and the control group concerning \u003cem\u003eP-CAT, Empathy, Job satisfaction\u003c/em\u003e, and \u003cem\u003eClinical communication skills\u003c/em\u003e. A Wilcoxon Signed Rank Test was used to analyse the changes in the groups between the measures at baseline and the second survey. For the missing values, we imputed the average of the values of the other attributes of the test case [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. All tests were two-tailed, and statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;.05. All analyses were conducted using IBM SPSS Statistics (Version 28.0; IBM SPSS, Armonk, NY, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnswers from the evaluation form were analysed following an inductive content analysis [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. The texts were read several times to give the authors a thorough understanding of their content. Secondly, meaning units, such as words, sentences or sections related to the study aim, were identified in the text. With the analysis, meaning-bearing units were re-read to obtain a sense of the whole and become immersed in the data. Thereafter, the data was coded, grouped into categories and abstracted. The codes were then compared to identify similarities and differences, leading to the emergence of seven subcategories and three generic categories, which were ultimately synthesised into a main category (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eExamples of the abstraction process\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSubcategories\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGeneric categories\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMain category\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGood communication\u003c/p\u003e\n\u003cp\u003eNon-verbal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInclusive communication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eThe impact of communication\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRelationships\u003c/p\u003e\n\u003cp\u003eTrust\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBuilding relationships\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQuestions\u003c/p\u003e\n\u003cp\u003eListening\u003c/p\u003e\n\u003cp\u003eUnderstanding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive listening\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewas obtained from the Swedish Ethical Review Authority (Dnr 2021\u0026ndash;05233), in accordance with the principles of the Declaration of Helsinki [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Both managers and NAs at the home care units received oral and written information about the ACTION programme and the research, how data would be collected, handled, stored, and presented /published, and their rights as participants. All participants were guaranteed confidentiality and their right to withdraw their participation at any time, without consequences and with no need to state reasons. Written informed consent to participate was obtained from the NAs before any participation in the research programme. All data was coded and managed according to the General Data Protection Regulation (GDPR, 2016/679). In accordance with the ethical approval, only researchers have access to data and information about the participants.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe results were divided into two main sections: statistical answers from the surveys and answers from the evaluation forms.\u003c/p\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eResults from the surveys\u003c/h2\u003e\n\u003cp\u003eIn the NAs\u0026rsquo; responses to questions regarding PCC (P-CAT), group comparisons showed no significant differences between the intervention and control groups at either baseline or follow-up (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Similarly, no significant differences were found in the questions regarding empathy (JSE) or communication skills (SE-12) (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). However, empathy increased for both groups between baseline and the second surveys, although the changes were not significant.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eData from the intervention group (IG) and control groups (CG) concerning \u003cem\u003ePerson-Centred Care Assessment Tool, Empathy, Working satisfaction\u003c/em\u003e, and \u003cem\u003eClinical communication skills\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBaseline Mean (SD)\u003c/p\u003e\n\u003cp\u003eMedian\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAfter Mean (SD)\u003c/p\u003e\n\u003cp\u003eMedian\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-CAT IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e52.9 (6.5)\u003c/p\u003e\n\u003cp\u003e53.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.3 (6.4)\u003c/p\u003e\n\u003cp\u003e51.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.456\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-CAT CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e51.5 (5.4)\u003c/p\u003e\n\u003cp\u003e51.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.0 (5.1)\u003c/p\u003e\n\u003cp\u003e50.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.686\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.165\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.281\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmpathy index (Factor I-III) IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e113.5 (12.3)\u003c/p\u003e\n\u003cp\u003e113.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114.8 (14.4)\u003c/p\u003e\n\u003cp\u003e118.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.497\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmpathy index (Factor I-III) CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e112.2 (11.6)\u003c/p\u003e\n\u003cp\u003e113.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e113.8 (13.1)\u003c/p\u003e\n\u003cp\u003e116.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.364\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.657\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.719\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI: Perspective-taking IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e60.1 (6.0)\u003c/p\u003e\n\u003cp\u003e60.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.3 (7.8)\u003c/p\u003e\n\u003cp\u003e62.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.781\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI: Perspective-taking CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e58.8 (7.9)\u003c/p\u003e\n\u003cp\u003e60.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.1 (7.9)\u003c/p\u003e\n\u003cp\u003e58.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.168\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.638\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.084\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eII: Compassionate care IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e41.9 (7.5)\u003c/p\u003e\n\u003cp\u003e41.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.9 (7.2)\u003c/p\u003e\n\u003cp\u003e43.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.530\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eII: Compassionate care CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e42.3 (6.3)\u003c/p\u003e\n\u003cp\u003e42.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.3 (7.7)\u003c/p\u003e\n\u003cp\u003e44.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.039\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.782\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.290\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII: Walking in the patient\u0026acute;s shoes IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11.5 (2.7)\u003c/p\u003e\n\u003cp\u003e12.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.6 (2.2)\u003c/p\u003e\n\u003cp\u003e12.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.838\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII: Walking in the patient\u0026acute;s shoes CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11.1 (3.0)\u003c/p\u003e\n\u003cp\u003e12.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.4 (3.0)\u003c/p\u003e\n\u003cp\u003e13.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.703\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.828\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.687\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eJob satisfaction index (V factors) IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e158.7 (16.6)\u003c/p\u003e\n\u003cp\u003e156.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e151.7 (14.1)\u003c/p\u003e\n\u003cp\u003e152.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e.012\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eJob satisfaction index (V factors) CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e142.7 (19.1)\u003c/p\u003e\n\u003cp\u003e140.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e141.2 (18.2)\u003c/p\u003e\n\u003cp\u003e136.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.266\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e.002\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI: Personal IG\u003c/strong\u003e,\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e45.3 (5.7)\u003c/p\u003e\n\u003cp\u003e44.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.5 (4.2)\u003c/p\u003e\n\u003cp\u003e44.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.788\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI: Personal CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e41.8 (5.4)\u003c/p\u003e\n\u003cp\u003e41.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.7 (5.6)\u003c/p\u003e\n\u003cp\u003e41.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.129\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e016\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e.002\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e: \u003cstrong\u003eWith workload IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e27.3 (4.6)\u003c/p\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.2 (3.8)\u003c/p\u003e\n\u003cp\u003e29.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.102\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eII: With workload CC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26.5 (4.8)\u003c/p\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.6 (4.3)\u003c/p\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.987\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.583\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e.026\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e: \u003cstrong\u003eProfessional support IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e37.8 (3.9)\u003c/p\u003e\n\u003cp\u003e37.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.4 (4.2)\u003c/p\u003e\n\u003cp\u003e38.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.881\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e: \u003cstrong\u003eProfessional support CC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e36.6 (5.7)\u003c/p\u003e\n\u003cp\u003e36.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.9 (5.5)\u003c/p\u003e\n\u003cp\u003e36.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.695\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e406\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.570\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIV\u003c/strong\u003e: \u003cstrong\u003ePay and prospects IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e30.9 (4.4)\u003c/p\u003e\n\u003cp\u003e31.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.1 (3.6)\u003c/p\u003e\n\u003cp\u003e27.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIV: Pay and prospects CC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e23.4 (4.7)\u003c/p\u003e\n\u003cp\u003e22.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.2 (4.8)\u003c/p\u003e\n\u003cp\u003e23.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.522\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV: With training IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e17.5 (3.5)\u003c/p\u003e\n\u003cp\u003e17.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.4 (2.9)\u003c/p\u003e\n\u003cp\u003e14.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV: With training CC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e14.3 (3.1)\u003c/p\u003e\n\u003cp\u003e14.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.8 (2.9)\u003c/p\u003e\n\u003cp\u003e14.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.133\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e361\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eClinical communication skills IG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e104.2 (7.8)\u003c/p\u003e\n\u003cp\u003e104.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e103.3 (9.0)\u003c/p\u003e\n\u003cp\u003e105.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.694\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eClinical communication skills CG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e101.0 (10.1)\u003c/p\u003e\n\u003cp\u003e100.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e101.6 (9.6)\u003c/p\u003e\n\u003cp\u003e102.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.670 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.219\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e.540\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e Mann-Whitney \u003cem\u003eU\u003c/em\u003e test, \u003csup\u003eb\u003c/sup\u003e Wilcoxon signed-rank test, \u003cstrong\u003ebold\u003c/strong\u003e\u0026thinsp;=\u0026thinsp;statistically significant\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eP-CAT\u0026thinsp;=\u0026thinsp;Person-Centred Care Assessment Tool\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe job satisfaction decreased significantly in the intervention group from 158.7 (16.6) at baseline to 151.7 (14.1) in the second survey (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.012). Concerning factor I and factor II, there were significant differences; the intervention group had higher values at both measuring points (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 versus \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.002). The same logic applied for factor IV, Pay and prospect (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 versus \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e001) (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eImpact of communication\u003c/h2\u003e\n\u003cp\u003eIn the evaluation from the intervention group after the education programme, it became evident that the education had been useful and had raised awareness of the impact of communication. The NAs stated that the education had enhanced their awareness of the importance of communication. They also highlighted how the repetition of previous knowledge served as a valuable reminder of the significance of communication, but there were also some suggestions for the development of the educational design.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eAwareness of the Importance of Communication\u003c/h2\u003e\n\u003cp\u003eIn the evaluation, communication was described as a fundamental and important part of care, and the ACTION programme was said to have helped increase the NAs' awareness of the importance of good communication.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eCommunication is important, that has always been known, but through the course [ACTION program], I have realised how much more and in everything we do, say, and don't say, we are communicating (NA2).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eNAs described an increased awareness of communication as essential for creating trust, confidence, and establishing good relationships with the older adult. They also emphasised communication as crucial for enhancing their understanding of the older adult. One example of how to increase their understanding was through active listening.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eCommunication training shows how important it is to listen actively and affirm the older adult (NA8).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eMany of the NAs said that the education programme had reminded them of the importance of taking the time to listen and not be hurried. They had also become more aware of the significance of actively showing, non-verbally, the other person that they were listening.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eIt's about being more mindful of how I express myself and my posture. I'm more aware of listening properly, reading body language, and paying attention to the tone of voice and facial expressions (NA7).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSome NAs also mentioned being reminded of the importance of asking the older adult questions during their visit. One participant also mentioned that the training had encouraged them to ask questions, even those that might feel uncomfortable.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e I have learned not to be afraid to ask difficult questions, to listen to the person, and to reflect on what someone is trying to convey with their verbal and non-verbal communication (NA22).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eValue of Repeating Knowledge\u003c/h2\u003e\n\u003cp\u003eThe NAs described the education programme as an appreciated repetition of previous knowledge, and they valued being reminded of important communication principles.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eSome things I already knew, but I learned a lot as well. I will carry this with me both in my personal and professional life (NA34).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eRepetition was described as reinforcing and consolidating knowledge and served as a useful reminder of important information, even for those with prior experience who might discover gaps in their understanding.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eI thought I knew a lot about communication before, but I was wrong. I feel that I have grown from this education (NA13).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eFurthermore, the NAs stated that the education programme strengthened and validated previous knowledge and how they already communicated in their interactions with the older adults.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eWhat has been interesting about the training is that it has covered many things we do daily without really thinking about it when working with people. Through the videos and during the training, I have seen that what I do myself is included as examples or information, and that it works in everyday life with the clients (NA37).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAt the same time, I am proud of myself for the validations [through the education] that I have been very good at (NA38).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eStrengths and Areas for Development in the Education Design\u003c/h2\u003e\n\u003cp\u003eBased on the evaluation, the education programme was generally received positively by the NAs. Many stated that they did not find any specific content missing, and the group reflections and recorded lectures were considered useful. A podcast in the education field, about challenging communication and interacting with people with dementia, was noted as interesting and beneficial.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eI have found it interesting to listen to the podcasts. The latest one was particularly valuable, discussing how to listen and talk to those with dementia or who have other illnesses that can make it difficult to connect or find topics of conversation, and how to remain calm when talking to them (NA25).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe discussions you had [in the podcast] and the suggestions on how to approach such situations were very helpful (NA3).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe education programme was also described as providing useful new tools and ideas for communication.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eAfter the training, my way of communicating with the older adults has improved significantly. I try to use everything I learned as much as possible (NA8).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIt has been an educative training that has provided me with many new tools and ways of thinking to use when communicating, especially with older adults at my job (NA21).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSpecific examples of communication tools and strategies were also mentioned, such as: \u003cem\u003eMirroring, maintaining presence, using appropriate body language, and sustaining eye contact (NA13).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOther examples included:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSpeaking clearly while maintaining calmness, eye contact, and good posture (NA19).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, participants emphasized the importance of:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSitting down, not being afraid of silence, and recognizing that it is not always necessary to keep talking to maintain the conversation (NA33).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe NAs also provided suggestions and identified areas for improvement. Although the training module specifically addressed communication strategies for managing aggressive or challenging situations, it was suggested that additional content on this topic would be beneficial. Furthermore, there was an expressed need for newly hired employees and substitutes to have ongoing access to the education programme, as it is considered essential for enhancing their communicative skills and interactions with the older adults in their care.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eI found it interesting to listen to this [education programme], and you can always learn something new\u0026hellip; It would be great for newly hired nursing staff and substitutes to listen to this because I believe it could help many who do not have much experience in this field (NA3).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eFinally, it was noted that learning how the digital platform functions can be challenging, especially for individuals who have limited technological skills.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study investigated the effects of a person-centred communication intervention on NAs working with older adults in home care settings. While the quantitative findings did not show significant differences between the intervention and control groups, the qualitative insights provided meaningful reflections on participants\u0026rsquo; experiences and perceptions. The lack of changes in survey outcomes brings the study\u0026rsquo;s design into question. Overestimation by the intervention group could be a factor, as participants might have initially rated their communication skills highly, leading to a ceiling effect. Many NAs believed they had strong communication skills before the education programme, and this could explain the high baseline scores and the lack of significant post-intervention changes. Research participation has consequences for behaviours being investigated, although little can be known about the conditions under which NAs operate, their mechanisms of effects, or their magnitudes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Similarly, the timing of the post-measurements might not have been optimal. It is plausible that the true benefits of such interventions require a longer time frame to manifest.\u003c/p\u003e \u003cp\u003eContextual factors such as staff shortages and time constraints may complicate the implementation of educational interventions. These challenges can create a work environment that might hinder NAs from effectively using communication techniques such as person-centred communication. The gap between PCC practices and theoretical knowledge often arises due to organisational issues, including insufficient staff ratios, lack of caregiver motivation and team cohesion, limited managerial recognition, and inadequate ongoing training and support [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Such barriers can reduce the quality of care for older individuals and limit NAs attention to the older adults. It is important to implement a tailored personal health plan and facilitate inter-professional teamwork and collaboration with older adults and their relatives, establishing a person-centred approach [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThough the quantitative results were inconclusive, the qualitative findings revealed improved self-awareness among NAs regarding communication techniques. The participants valued tools like mirroring, managing silence, and calmness, praising their practicality. The intervention fostered reflection on non-verbal cues and strengthened trusting relationships, enhancing interactions with older adults through mindful and effective communication practices. The participants noted that the education programme made them more aware of their expressions, body language, and tone when interacting with the older adults. They valued the reminder to ask questions, even if uncomfortable, to better understand the older adults\u0026rsquo; needs. This aligns with previous research emphasising reflective practices in improving healthcare communication [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, the intervention seemed to enhance NAs' ability to clearly articulate their understanding of effective communication. After the training, their responses to qualitative questions became more detailed and descriptive, indicating improved reflection and expression regarding communication practices. Qualitative methods can capture subtle changes of interventions that might not be immediately apparent in quantitative data, highlighting the value of subjective evaluations in understanding intervention impacts [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The fidelity of the intervention remains vital, as inconsistent attendance or lack of follow-up may affect practical implementation.\u003c/p\u003e \u003cp\u003eAdditionally, the participants noted challenges with navigating the digital platform used for the training, particularly for those with limited technological skills. This highlights the need for technological support and simplified instructions in future implementations to ensure accessibility for all staff members. This is in line with a review describing that technology is reshaping education by expanding the traditional learning environment and encouraging the development of digital programmes for cognitive growth [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Operational challenges, such as staff shortages and time constraints, were also mentioned as obstacles to fully integrating the new strategies into daily workflows. These factors not only influence the effectiveness of interventions but also underscore the complexities of working in care environments. The participants also emphasised the importance of extending access to the education programme to newly hired staff and substitutes. Providing training early in their careers could significantly enhance their communicative abilities and interactions with older individuals.\u003c/p\u003e \u003cp\u003eThe link between job competency and the intention to stay in the workplace was found to be significantly influenced by intrinsic and extrinsic job satisfaction. Considering the challenges of staff shortages and retention in long-term care settings, organisations should focus on strategies to boost employees\u0026rsquo; intention to remain. One way to achieve this is by enhancing employees\u0026rsquo; competency, as higher competency leads to improved care quality and increased extrinsic job satisfaction. Strengthening competency fosters both intrinsic and extrinsic job satisfaction, improving care standards, affirmation, personal achievement, and willingness to stay in long-term care roles [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results could help build a more robust foundation for PCC. The positive reflections from the participants demonstrate that even if measurable improvements were absent, the intervention contributed to meaningful shifts in self-awareness and communication practices.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eThis study contributes to the understanding of NAs\u0026rsquo; experiences and evaluates an educational intervention aimed at improving person-centred communication in home care for older adults. Nevertheless, it has several limitations. First, some of the Cronbach\u0026rsquo;s Alpha ratings were low, for instance \u003cem\u003eSatisfaction with workload\u003c/em\u003e, at .358 and .137, suggesting a low level of internal consistency among the items being measured, indicating that they may not be measuring the same underlying construct. Another limitation is the small number of participants. According to Graneheim et al., the value of research data is not determined by the number of participants, but by the richness and depth of the information collected [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We considered the data rich enough to be analysed. The trustworthiness of the results was ensured by thoroughly describing the participants, data collection procedures and the analysis steps. However, the Swedish context should be considered regarding transferability. The authors have different backgrounds in healthcare and social work which can strengthen understanding. However, the main problem of studying the effects of a person-centred communication intervention from the perspective of professionals is that it misses the main effects, hence the experiences of older adults. Therefore, we suggest intervention studies in which the opinions of older adults and their relatives about communication and PCC are included.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003e In conclusion, while the intervention did not produce significant quantitative changes, it facilitated meaningful qualitative reflections and shifts in the participants' communication practices. The study highlights the importance of addressing contextual factors, providing ongoing support, and tailoring interventions to the unique challenges of care settings. By doing so, future initiatives can better equip NAs with the skills and confidence needed to provide high-quality, PCC. The findings also suggest a need for better adjustments in scheduling to reduce stress and improve workflow. Ensuring that NAs have the time and resources to practice new communication techniques is essential for their successful implementation. Moreover, future studies should explore the integration of tailored personal health plans, inter-professional teamwork, and collaboration with older adults and their relatives. Additionally, ongoing education and support for newly hired staff and substitutes could help bridge gaps in experience and enhance the overall quality of care. Future studies should also investigate the experiences of older adults and their relatives regarding communication and person-centredness in interactions with nursing staff.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACTION\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eA person-centred communication programme\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHome care services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNurse assistant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerson-centred care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This research was approved by the Swedish Ethical Review Authority (Dnr 2021\u0026ndash;05233) and was conducted in accordance with the Declaration of Helsinki. All participants received verbal and written information about the study. A written informed consent was obtained before participation in the research, and all participants were informed about the research, how their personal data would be processed, their right to request information, and their right to withdraw at any time without consequences. All data were coded and handled in accordance with the General Data Protection Regulation [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Participant recruitment and the handling of data, i.e. storage, transmission, and accessibility, were outlined in alignment with legal frameworks and safety routines to uphold participant safety, privacy, and confidentiality. Access to data was limited only to researchers affiliated with the ACTION programme. Based on their prior research, conducted in similar settings, the researchers had experience of the complexities and ethical considerations necessary to ensure that data handling was carried out in a responsible and ethically sound way.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eAll participants received information about the study, including how the findings would be reported and published. Written informed consent was obtained before their participation in the research.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eOpen access funding was provided by M\u0026auml;lardalen University. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJH initiated this study and proposed the study design, which was developed in collaboration with BK, DL, and TG. The data were collected by JH and analysed by JH, BK, and DL. The study was drafted by all authors. All authors reviewed and edited the manuscript and approved the final draft.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We specially thank the participants who took part in the present study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of the data and ethical considerations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. The growing need for home health care for the elderly Home health care for the elderly as an integral part of primary health care services. 2015; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://applications.emro.who.int/dsaf/EMROPUB_2015_EN_1901.pdf\u003c/span\u003e\u003cspan address=\"https://applications.emro.who.int/dsaf/EMROPUB_2015_EN_1901.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Cited 2025 Oct 08.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026uuml;ney S, Karadağ A, El-Masri M. Perceptions and experiences of person-centered care among nurses and nurse aides in long term residential care facilities: A systematic review of qualitative studies. Geriatr Nurs. 2021;42(4):816\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gerinurse.2021.05.007\u003c/span\u003e\u003cspan address=\"10.1016/j.gerinurse.2021.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Swedish National Board of Health and Welfare. V\u0026aring;rd och omsorg f\u0026ouml;r \u0026auml;ldre. L\u0026auml;gesrapport 2024. [Health and social care of elderly. Situation report 2024]. 2024; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2024-3-8991.pdf\u003c/span\u003e\u003cspan address=\"https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2024-3-8991.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGustafsson T, Maurin S\u0026ouml;derholm H, Sundler AJ, Karlsson P, Lindberg E. Sometimes you need an eye-opener\u0026rsquo;: A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person‐centred communication. Nurs Open. 2023;10(7):4560\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.1702\u003c/span\u003e\u003cspan address=\"10.1002/nop2.1702\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSundler AJ, Ekwall A, Lundin S, Holmstr\u0026ouml;m IK. Communicative challenges in the home care of older persons\u0026ndash;a qualitative exploration. J Adv Nurs. 2016;72(10):2435\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jan.12996\u003c/span\u003e\u003cspan address=\"10.1111/jan.12996\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRasoal D, Kihlgren A, Skovdahl K. Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach. BMC Geriatr. 2018;18:70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12877-018-0756-9\u003c/span\u003e\u003cspan address=\"10.1186/s12877-018-0756-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmmentorp J, Sabroe S, Kofoed PE, Mainz J. The effect of training in communication skills on medical doctors\u0026rsquo; and nurses\u0026rsquo; self-efficacy: A randomized controlled trial. Patient Educ Couns. 2007;66(3):270\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pec.2006.12.012\u003c/span\u003e\u003cspan address=\"10.1016/j.pec.2006.12.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolderslund M, Kofoed PE, Ammentorp J. The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. Patient Educ Couns. 2021;104(6):1423\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pec.2020.11.018\u003c/span\u003e\u003cspan address=\"10.1016/j.pec.2020.11.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.n2061\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n2061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFontaine G, Cossette S, Maheu-Cadotte M, Mailhot T, Desch\u0026ecirc;nes M-F, Mathieu-Dupuis G, et al. Evaluation of a web-based e-learning platform for brief motivational interviewing by nurses in cardiovascular care: a pilot study. J Med Internet Res. 2016;18(8):e224. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/jmir.5532\u003c/span\u003e\u003cspan address=\"10.2196/jmir.5532\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300(10):1181\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.300.10.1181\u003c/span\u003e\u003cspan address=\"10.1001/jama.300.10.1181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy J, Wootton S, Saxton J, Power E, Bridle C, Williams K, et al. Translating research into practice: evaluation of an e-learning resource for health care professionals to provide nutrition advice and support for cancer survivors. Nurse Educ Today. 2015;35(1):271\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2014.11.003\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2014.11.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinclair PM, Kable A, Levett-Jones T. The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: a systematic review. Int J Nurs Stud. 2016;57:70\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnurstu.2016.01.011\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnurstu.2016.01.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFontaine G, Cossette S, Gagnon MP, Mailhot T, Boyer L, Desch\u0026ecirc;nes M-F, et al. Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis. Implement Sci. 2024;19(1):68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGustafsson T, Sundler AJ, Maurin S\u0026ouml;derholm H, Karlsson P, Lindberg E. Process evaluation of the ACTION programme: a strategy for implementing person-centred communication in home care. BMC Nurs. 2021;20:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore L, Britten N, Lydahl D, Naldemirci \u0026Ouml;, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/scs.12376\u003c/span\u003e\u003cspan address=\"10.1111/scs.12376\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGustafsson T, Maurin S\u0026ouml;derholm H, Sundler AJ, Karlsson P, Lindberg E. Communication in home care\u0026mdash;A feasibility study of an educational intervention in self-efficacy and job satisfaction. Nurs Open. 2023;10(3):1375\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.1\u003c/span\u003e\u003cspan address=\"10.1002/nop2.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026ouml;glander J, Gustafsson T, Maurin S\u0026ouml;derholm H, Sundler AJ, Karlsson P, Lindberg E. Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol. BMC Geriatr. 2023;23(1):112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12877-023-03842-4\u003c/span\u003e\u003cspan address=\"10.1186/s12877-023-03842-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026ouml;gren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). Int Psychogeriatr. 2012;24(3):406\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1041610211001839\u003c/span\u003e\u003cspan address=\"10.1017/S1041610211001839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, Veloski J, Magee M. The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educ Psychol Meas. 2001;61(2):349\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/00131640121971158\u003c/span\u003e\u003cspan address=\"10.1177/00131640121971158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraynor M, Wade B. The development of a measure of job satisfaction for use in monitoring the morale of community nurses in four trusts. J Adv Nurs. 1993;18(1):127\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1365-2648.1993.18010127.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-2648.1993.18010127.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAxboe MK, Christensen KS, Kofoed PE, Ammentorp J. Development and validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication skills of health care professionals. BMC Med Educ. 2016;16:272. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12909-016-0798-7\u003c/span\u003e\u003cspan address=\"10.1186/s12909-016-0798-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaar-Tsechansky M, Provost F. Handling missing values when applying classification models. J Mach Learn Res. 2007;8:1625\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElo S, Kyng\u0026auml;s H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2648.2007.04569.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2648.2007.04569.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013. 310(20): pp. 2191\u0026ndash;2194. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jamanetwork.com/journals/jama/fullarticle/1760318/\u003c/span\u003e\u003cspan address=\"https://jamanetwork.com/journals/jama/fullarticle/1760318/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Cited 2025 Oct 08.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinepi.2013.08.015\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2013.08.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs. 2021;42(1):213\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gerinurse.2020.10.011\u003c/span\u003e\u003cspan address=\"10.1016/j.gerinurse.2020.10.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYadav D. Criteria for good qualitative research: A comprehensive review. Asia Pac Educ Res. 2022;31(6):679\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40299-022-00660-7\u003c/span\u003e\u003cspan address=\"10.1007/s40299-022-00660-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMhlongo S, Mbatha K, Ramatsetse C, Dlamini R. Challenges, opportunities, and prospects of adopting and using smart digital technologies in learning environments: An iterative review. Heliyon. 2023;9(6):e17134. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.heliyon.2023.e17134\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2023.e17134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang YC, Yeh TF, Lai IJ, Yang CC. Job competency and intention to stay among nursing assistants: The mediating effects of intrinsic and extrinsic job satisfaction. Int J Environ Res Public Health. 2021;18(12):6436. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18126436\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18126436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2003.10.001\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2003.10.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeneral Data Protection. General Data Protection Regulation\u0026mdash;GDPR. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gdpr-info.eu/\u003c/span\u003e\u003cspan address=\"https://gdpr-info.eu/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Cited 2025 Oct 08.\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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Competence development, Education intervention, Home care, Nursing assistant, Older adults, Person-centred communication","lastPublishedDoi":"10.21203/rs.3.rs-7815093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7815093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Home Care Services for older adults vary widely across countries regarding how they are structured, organised, and funded. The study presents an educational intervention called ACTION (a person-centred CommunicaTION programme for nurse assistants (NAs) in home care for older adults). The aim was to evaluate the impact of the person-centred communication educational intervention for nursing assistants in home care for older adults. \u003cbr\u003e\n \u003cstrong\u003eMethods \u003c/strong\u003eData were collected from both intervention and control groups using pre- and post-intervention surveys assessing person-centred care, empathy, job satisfaction, and communication self-efficacy. The intervention group also completed a programme evaluation with open-ended questions upon completing the educational modules.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eNAs participating in the intervention reported increased awareness of the importance of communication and valued acquiring practical tools to enhance their interactions with older adults. While quantitative measures showed no significant differences between groups, qualitative feedback highlighted improvements in reflective practices and self-confidence in communication skills.\u003c/p\u003e\n\u003cp\u003eThe intervention did not yield significant quantitative outcomes, yet it prompted valuable qualitative changes in NAs’ communication awareness and practices. These findings highlight the importance of considering contextual factors and providing ongoing support when implementing person-centred communication interventions in elder care. The evaluation shows both strengths and methodological limitations. While some positive qualitative changes were observed, the findings emphasise the need to include the perspectives of older adults and their relatives in future research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eIn summary, this study demonstrates that while quantitative improvements may be limited, qualitative insights reveal the meaningful impact of educational interventions on person-centred communication for nursing assistants. Continued attention to contextual challenges and ongoing support can further enhance the quality of care for older adults in home settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003eISRCTN64890826. Registered 10 January 2022, https:// www. isrctn. com/ ISRCT N6489 0826\u003c/p\u003e","manuscriptTitle":"A Swedish evaluation of an educational intervention in person-centred communication for nursing assistants in home care for older adults: The ACTION programme","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 15:27:42","doi":"10.21203/rs.3.rs-7815093/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T05:08:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T21:38:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170523618360900800436374410853058377478","date":"2026-02-09T06:53:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292863851104628604825510649811978690115","date":"2026-02-04T07:07:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-03T13:37:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-02T15:43:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282013397040656055756172167115089052088","date":"2025-12-29T18:12:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2878092580149223080762136217568487273","date":"2025-12-24T09:13:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84385809970731536936239049803655799042","date":"2025-12-23T05:15:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-17T05:57:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T15:09:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-11T13:12:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T09:23:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-11-11T09:15:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a233e9aa-ea37-4e49-b367-0c97fb37b0a9","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:05:29+00:00","versionOfRecord":{"articleIdentity":"rs-7815093","link":"https://doi.org/10.1186/s12877-026-07507-6","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-04-18 15:58:48","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2025-12-23 15:27:42","video":"","vorDoi":"10.1186/s12877-026-07507-6","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07507-6","workflowStages":[]},"version":"v1","identity":"rs-7815093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7815093","identity":"rs-7815093","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}