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Abstract
Recent research suggests that establishing water clubs in care homes can counteract the dangers of dehydration and enhance residents’ health and well-being. This study provided an experimental test of this idea, and also explored the possibility that it is the social interaction that clubs provide which delivers health-related benefits. Consistent with this hypothesis, the study found no evidence that, on its own, increased focus on water consumption enhanced residents’ health or well-being. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial outcomes in terms of the number of General Practitioner calls they required. Consistent with a social identity approach to health and well-being, a mediation analysis also indicated that clubs achieve these positive outcomes by providing social support that helps to build a shared sense of social identity among residents.
Acknowledgements
Work on this article was supported by a grant from the Economic and Social Research Council (RES-062-23-0135). The authors would like to thank Kerry Ashworth and Leanne Wheatley from Somerset Care, and Cheryl Heart and Anna Hill from Wiltshire College (BSc Social Work) for carrying out the intervention. We are grateful to Pamela Bretschneider, Kathryn Bristow, Sonya Saroyan and Dimitrios Tsivrikos for help with the data collection. We further thank Jane Lynch, Sue Steeds, Linda Tungate, Julie Watts and their teams at Somerset Care and all the residents of Somerset Care who participated.
Notes
1. This is a game commonly played in Britain, very similar to bowling, in which the aim is to knock down as many skittles (or pins) with a ball.
2. The four interventions were all complex in nature, tapping into several techniques known to promote behaviour change (Abraham & Michie, Citation2008). The two interventions that focussed on water were designed to provide information about the water-well-being link (technique 1), provide encouragement (technique 6), provide instructions, and to prompt self-monitoring of behaviour (technique 12). The social interventions were intended to strengthen social support (technique 20), although in the case of the water club this also included a water component. There was no element of behaviour change in the individual control intervention.
3. These data were obtained for participants who participated in six or more intervention sessions and completed the post-test interview.
4. Within the scope of this study, it was not possible to measure fluid intake. This would have entailed research and/or care staff measuring (between-) meal fluid intake over the course of the interventions (Simmons et al., Citation2001). We tried to encourage participants to fill in a self-administered water diary, which was first of all a means of reminding participants to monitor their fluid intake and second to have a measure fluid consumption. However, these data proved to be incoherent, with more than 50% of missing values. This might be due to the fact that the cognitive ability of participants was limited and they had difficulties remembering to complete the diary. This possibility is suggested by the fact that mean value on the Mini Mental State Examination for participants was 17.5 (SD = 7.46), which is well below the cut-off point for detecting dementia with a good sensitivity and specificity of ≤24 (Kahle-Wrobleski, Corrada, Bixia, & Kanas, Citation2007).
5. The water coolers that were available in the communal area were also available for those participants, who were not in water conditions.
6. All four interventions were run in all three care homes. Of course it is possible that residents communicated with each other about the content of each intervention, but it is unlikely that this alone influenced findings in a consistent way.
7. Bootstrapping is an approach of statistical inference that is based on a resampling method and is among the most popular method of testing mediation because it (a) does not require the normality assumption to be met, and (b) can be effectively utilised with smaller sample sizes (N < 20) (Preacher & Hayes, Citation2004). A test of mediation can be demonstrated by showing that the indirect effect (product of the regression coefficients a and b) is significantly different from zero. To test for mediation, a confidence interval is computed around the product term (a × b). If zero is not included in the interval, the indirect effect is significant and thus, a mediation effect can be assumed. For calculation, Preacher and Hayes (http://people.ku.edu/~preacher/) provide an SPSS syntax file to conduct the analysis of indirect effects with this bootstrapping method.