title: An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.
abstract: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.
  
  
  
  The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.
  
  
  
  Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).
  
  
  
  When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants.
  
  
  
  The study was registered in ISRCTN92658034 in January 2013.
authors.affiliation: Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, 801 76, Gävle, Sweden. charlotte.roos@hig.se.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. charlotte.roos@hig.se.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Roos
authors.affiliation: Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, 801 76, Gävle, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Marit
authors.initials: M
authors.lastname: Silén
authors.affiliation: Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, 801 76, Gävle, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bernice
authors.initials: B
authors.lastname: Skytt
authors.affiliation: Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, 801 76, Gävle, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Engström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D010549:Personal Satisfaction; D058996:Quality Improvement; D011788:Quality of Life; D012112:Residential Facilities / Q000592:standards; D057566:Self Report; D063586:Social Validity, Research; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: A sense of well-being; Empowerment; Experimental design; Life satisfaction; Living in dignity; Person-centered climate; Residential facilities for older people