Aged Care

Study identifies barriers and facilitators to skin hygiene care in residential care homes


The population of older individuals residing in care homes is increasing, and as their skin ages, it becomes more susceptible to dryness, itching, cracks and tears.

These skin conditions not only impair the quality of life for older people but can also lead to skin breakdown, increased dependency, hospital stays and significant financial and human costs.

While prevention of these conditions is possible, adherence to best practice guidelines is suboptimal.

In order to address this issue, a study on “Barriers and facilitators to skin hygiene care and emollient use in residential care homes: Instrument design and survey” by Fiona Cowdell RN, Megan Heague and Judith Dyson RN, PhD was conducted to develop and test a theory-based diagnostic instrument and survey the barriers and facilitators faced by care home staff in delivering skin hygiene care.

The study involved three stages: instrument development, instrument testing and data collection. The researchers utilised the Theoretical Domains Framework (TDF) to categorise barriers and facilitators identified from the literature and pilot study. A Delphi survey involving eight experts was conducted to assess the fit of these barriers and facilitators within the TDF domains. An instrument called the Skin Hygiene and Emollient in Later Life-Care Homes Index (SHELL-CH) was developed, consisting of 29 valid and reliable items. The instrument was tested for face validity, construct validity, and test-retest reliability. Barriers and facilitators were surveyed using the instrument in the second round of testing.

The SHELL-CH instrument demonstrated good validity and reliability (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872).

Key barriers to delivering skin hygiene care identified in the survey included providing care to agitated or confused residents, time constraints and pressure from colleagues, being busy and unrealistic expectations from relatives. On the other hand, knowledge of skin hygiene care emerged as a facilitator.

This study significantly contributes to existing knowledge in gerontology by highlighting that simply providing information through staff education sessions does not guarantee improved care practices.

It emphasises the need to address barriers to change in addition to providing information. The study also suggests that barriers to changing gerontological practice vary depending on the context. The SHELL-CH Index enables accurate and prospective assessment of barriers and facilitators to deliver optimal skin hygiene care in individual residential settings.

Understanding these barriers and facilitators allows the development of tailored interventions to improve skin hygiene care based on specific needs.

This study has identified a comprehensive list of barriers and facilitators to skin hygiene care, including previously unreported barriers. These findings highlight the need for the development and testing of context-specific interventions to improve skin hygiene care in residential settings.

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Ritchelle is a Content Producer for Healthcare Channel, Australia’s premier resource of information for healthcare.


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