Adaptation and Application of the Sheffield Care Environment Assessment Matrix (SCEAM) in Chinese Residential Care Facilities: Implications for Residents’ Quality of Life

Background: Due to the rapid growth of the population of older people in China and insufficient care provision by family members, relocating the older people to residential care facilities (RCFs) has become an increasingly popular option for older adults. The environmental qualities of care homes have been reported to have a significant effect on various aspects of residents’ quality of life (QoL), such as physical health, mental health and social relationships. However, research on how the RCF environments influence older people’s QoL in China remains limited, particularly in less developed provinces. Moreover, existing assessment methods used in China have failed to focus on environmental factors related to user needs. Aims: This PhD project aims to (1) study the feasibility of applying the Sheffield Care Environment Assessment Matrix (SCEAM) to assessing the environmental qualities of Chinese RCFs for older people, and (2) test the relationship between these environmental qualities and the QoL of older people living in RCFs. Methods: Three studies (Studies 1, 2 and 3) were conducted to address the research aims. An online questionnaire survey (Study 1), semi-structured interviews (Study 1) and three on-site surveys (Studies 1, 2 and 3) were conducted to collect both qualitative and quantitative data. The data analysis approaches include content analysis, descriptive statistics, the normality test, correlation analysis, relative difference and multiple linear regression. Key findings: As the research instrument adapted in Study 1, the Chinese version of the SCEAM (C-SCEAM) demonstrated reliable psychometric properties, including content validity, inter-rater reliability and test-retest reliability. However, the application of the C-SCEAM in Study 2 revealed that some items may require further adaptation to the Chinese context. Based on an on-site survey of environmental qualities in 39 RCFs in China, Study 2 uncovered that four architectural elements and six domains for user needs performed well, while other environmental variables must still be improved. After comparing the environmental qualities between the design and use stages in six RCFs, the most noticeable differences were observed in the domains of support for cognitive frailty and personalisation, and in the architectural elements of the WC and overall layout of building. After combining the findings of Study 2 and Study 3, seven environmental factors—including choice and control, safety and health, comfort of the environment, awareness of outside world, dining room, personal rooms, and garden—received relatively high environmental quality scores and demonstrated significant associations with residents’ QoL. When examining the influence of covariates, the present study further identified three variables related to management practices (i.e. building type, owner-operator model and occupancy rate) and one variable related to building size (site area) that could have a significant influence on both environmental factors and residents’ QoL. Additionally, the present study also noted that rehabilitation and medical space may function independently from other environmental factors. These findings suggest that the potential influence of staff should not be overlooked. The results of this research project offer an innovative assessment instrument for the environmental qualities of RCFs. Notably, comparative analyses between the design and use stages of RCFs can reveal weaknesses and inform strategies for improving existing standards. Moreover, the findings from correlation analysis and regression analysis provide valuable insights into the environmental qualities of RCFs in practice, which are essential for decision-making and management strategies.