Evaluating existing evidence about home adaptations & supportive home design
While the DesHCA project represents a rare opportunity to draw together stakeholders from across the UK to explore the different ways that homes can be designed and adapted to support people as they age, we are not the first research project to explore adaptations or design.
One of the first tasks of the project was to identify where existing research could help us lay a strong foundation for our own activities. We did this in four ways: conducting a literature review, exploring existing data using secondary analysis, capturing different perspectives using an eDelphi consultation, and drawing this information together into a cost/benefit framework.
A Rapid Systematic Literature Review (led by Dr Alison Dawson)
What is a rapid systematic literature review?
Academic research usually begins with some kind of literature review.
A literature review allows academics to identify where research already exists on the topic and highlight any flaws or gaps that they notice. Conducting a systematic literature review means ensuring that the research team plans ahead and clearly documents each step of the process. This usually includes their search strategy (what they looked for, where, and how), how many items they found, how they sorted through those papers and decided which were relevant to their question, and what literature was included at the end of the process.
It is not uncommon for a systematic review to take over a year to complete. A rapid literature review can shorten this process by skipping certain steps or narrowing the scope of the search.
The team at DesHCA conducted a rapid systematic literature review, between August and December 2021. This meant that the project looked for information on a narrow topic (to create a rapid review), while planning and documenting each step of the process carefully (making it a systematic review).
What did DesHCA find?
Our search strategy initially identified over six thousand papers that might be relevant to how housing adaptations could help to support for older people with and without cognitive impairment to live in the home of their choice.
Reviewing these papers allowed the team to identify some key issues with the existing research knowledge: it often focused on very specific adaptations, such as specific pieces of technology; it rarely discussed issues of inequality or lack of access to adaptations; and there was limited information on how cost-effective adaptations could be.
This represents a significant gap in the research literature, as it is impossible to make good, evidence-based recommendations about adaptations and cognitively supportive housing for older people without knowing
- What older people want and need
- How homes can be designed to plan for this (and the issues that prevent this)
- How existing homes can be adapted to support the people that live there (and the problems people experience with this)
- How supportive homes can help different local authorities and businesses meet their goals
It’s impossible to create good guidance without understanding what different individuals and groups need. DesHCA certainly has its work cut out!
Secondary Data Analysis (led by Professor Alasdair Rutherford)
What is Secondary Data Analysis?
Most research in the social sciences deals with either primary data, which researchers collect themselves during a project, or secondary data which involves using data that already exists. Therefore, secondary data analysis simply means analysing pre-existing data to answer new questions as part of a different study.
Research using secondary data often uses quantitative methods to look for patterns in datasets with responses from hundreds or thousands of people. This type of research is ideal for collecting a (relatively) small amount of data from many people, to answer particular questions about what is happening at a group or population level. In fact, if you’ve ever answered a survey, or taken part in the census, it is likely your answers were analysed in this way!
What is DesHCA doing?
The quantitative researchers at DesHCA, led by Professor Rutherford, are using data from the English Longitudinal Study of Ageing (ELSA) and the Scottish Household Survey (SHS) to explore how adaptations to someone’s home relates to their health and wellbeing.
Analysis using ELSA and SHS data is exploring whether certain characteristics (such as cognitive impairment, age, wealth, or tenure) might affect how likely a person is to have adaptations installed in their home. Adaptations can include structural changes like widening doorways, or the installation of stairlifts, as well as smaller changes like using a shower chair to make personal care easier. ELSA data also captures whether people are having problems with their home, such as the property being too small, having issues with damp, or if there are problems with anti-social behaviours, like vandalism, happening nearby.
Exploring ELSA data will help identify if people in particular groups might find it more difficult to make adaptations to their home when they need it. This insight will then be used to tailor our later research to answer questions about why this might be the case, and what could be done to change things in the future.
eDelphi Consultations with Stakeholders (led by Dr Alison Dawson)
What is an eDelphi Consultation?
One of the challenges facing the DesHCA Project is that tackling the issues around developing housing that can support people as they age involves working with a wide variety of groups, or stakeholders.
Its vital that we hear the voices of older people, for example, so that we know what kind of changes they might welcome, and what kind of adaptations they might need. But if we think about the process that a person might have to go through to get something adapted, then we realise we also need to be talking to builders, who might carry out the changes, or local authorities who might provide them. Following that logic, we should also talk to architects, because they design our homes in the first place, and third sector organisations who provide information and signposting so people know what they can ask for… The list goes on and on.
A Delphi (or eDelphi, when it is conducted online) consultation process allows us to capture the insights from each of these groups at a time that suits them, without the challenges associated with traditional methods like focus groups.
What is DesHCA doing?
The process works like this:
A panel of participants representing different groups and perspectives are invited to take part in the process.
The DesHCA team designs the first round of questions with the aim of figuring out what outcomes (or results) are meaningful to people when we talk about designing homes to support healthy cognitive ageing. These questions will ask the members of the panel to tell us what they think, and why.
The team will then analyse these responses and prepare a new set of questions based on what we’ve learned from round 1.
Panel members will then be presented with the new set of questions, alongside the anonymised answers everyone gave in round 1. This allows panellists to take in the perspectives of everyone else involved in the eDelphi process and answer the questions in round 2 with that information in mind.
Using the eDelphi process allows people to give their opinions openly, in their own time, without being worried about what other people may think. It also allows people to take in the answers of everyone else involved and change their mind about certain topics in round 2 without feeling embarrassed.
This process can be repeated as many times as needed until the participant group comes to an answer (or set of answers) that works well for most of the group. In this case, a set of outcomes that DesHCA should look for to make sure that our recommendations are meaningful to a range of different groups as we move through the research project.
Developing a Cost/Benefit Framework (led by Professor Alasdair Rutherford)
What is a Cost/Benefit Framework?
While most people will not have used a formal cost benefit framework as part of their day-to-day lives, the idea itself isn’t overly complicated.
The first step in creating a Cost/Benefit framework is examining the costs and benefits (or pros and cons) of a particular action. This could be something as simple as buying a new vacuum cleaner, or as complicated as adapting someone’s home to meet their needs.
The second step is to turn this process into a framework. This would involve laying out your thinking in a way that would allow someone else to follow in your footsteps the next time that they wanted to think about whether buying a new vacuum would be worth the expense (for example).
The main difference between thinking about costs and benefits as a person buying or doing something for themselves and examining the costs and benefits of something as a research project is scale. If I replace my vacuum, it mostly effects my family and people who visit my home. It becomes much more complicated when we look at changes at a larger scale, such as encouraging architects and builders to design housing that supports people as they age or supporting people to adapt homes they already live in to better meet their needs.
What is DesHCA doing?
DesHCA’s goal is to pull together everything that we learn about the costs and benefits of home adaptation and create a cost/benefit framework that people in a variety of positions and industries can use to assess how promoting and implementing supportive designs and adaptations might impact their organisation.
This means collecting the perspectives of older people, housing professionals, allied health professionals, local authority representatives as well as the academic literature to create a robust model that guides them through this process.
Our hope is that this framework will allow people in a variety of positions to see the many benefits of supportive design, while still giving a realistic idea of the costs involved.
