title: Development and usability of the MAINtAIN, an inventory assessing nursing staff behavior to optimize and maintain functional activity among nursing home residents: a mixed-methods approach.
abstract: BACKGROUND
  Functional decline is common in nursing home residents. Nursing staff can help prevent this decline, by encouraging residents to be more active in functional activities. Questionnaires measuring the extent to which nursing staff encourage functional activity among residents are lacking. In addition, there are no measurement instruments to gain insight into nursing staff perceived barriers and facilitators to this behavior. The aim of this study was to develop, and study the usability, of the MAastrIcht Nurses Activities INventory (MAINtAIN), an inventory assessing a) the extent to which nursing staff perceive to perform behaviors that optimize and maintain functional activity among nursing home residents and b) the perceived barriers and facilitators related to this behavior.
  
  
  METHODS
  Using a mixed-methods approach the MAINtAIN was developed and its usability was studied. Development was based on literature, expert opinions, focus group (N = 3) and individual interviews (N = 14) with residents and staff from nine nursing homes in the Netherlands. Usability was studied in a cross-sectional study with 37 nurses and certified nurse assistants; data were analyzed using descriptive statistics.
  
  
  RESULTS
  Development of the MAINtAIN resulted in two distinctive parts: MAINtAIN-behaviors and MAINtAIN-barriers. MAINtAIN-behaviors, targeting nursing staff behavior to optimize and maintain functional activity, includes 19 items covering activities of daily living, household activities, and miscellaneous activities. MAINtAIN-barriers addresses the perceived barriers and facilitators related to this behavior and comprises 33 items covering barriers and facilitators related to the residents, the professionals, the social context, and the organizational and economic context. The usability study showed that the inventory was not difficult to complete, that items and response options were clear, and that the number of missing values was low. Few items showed a floor or ceiling effect.
  
  
  CONCLUSIONS
  The newly developed inventory MAINtAIN provides a usable method for researchers and nursing homes to obtain insight into nursing staff perceived behavior in optimizing functional activity among residents and their perceived barriers and facilitators related to this behavior. Outcomes of the MAINtAIN may contribute to change in nursing staff behavior and may improve nursing care. Further research with regard to the psychometric properties of the MAINtAIN is recommended.
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. n.kuk@maastrichtuniversity.nl.
authors.forename: Nienke O
authors.initials: NO
authors.lastname: Kuk
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: G A Rixt
authors.initials: GAR
authors.lastname: Zijlstra
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Zuyd University of Applied Sciences, Research Centre for Autonomy and Participation for Persons with a Chronic Illness, Heerlen, The Netherlands.
authors.forename: Gerrie J J W
authors.initials: GJJW
authors.lastname: Bours
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan P H
authors.initials: JPH
authors.lastname: Hamers
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gertrudis I J M
authors.initials: GIJM
authors.lastname: Kempen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D005851:Geriatric Nursing / Q000592:standards*; D006299:Health Services for the Aged / Q000592:standards; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D007326:Institutionalization / Q000592:standards; D008297:Male; D009426:Netherlands; D009723:Nurse-Patient Relations; D009726:Nurses / Q000592:standards; D009735:Nursing Homes / Q000592:standards*; D009740:Nursing Staff / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D011795:Surveys and Questionnaires
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