Mapping mood-improving behaviors in nursing homes: development and evaluation of the Actions to Improve Mood inventories.

BACKGROUND: Nursing home residents and professional caregivers may engage in behaviors that, although not considered formal treatments for depression, can improve residents’ mood. To support future studies aiming to explore ways to complement formal depression care in nursing homes, reliable and valid instruments for measuring these informal mood-improving behaviors are needed. METHODS: This project developed and evaluated inventories to measure mood-improving behaviors in Dutch and Belgian nursing homes. Study 1 followed an iterative mixed-methods approach to develop two inventories: the Actions to Improve Mood by Residents (AIM-R) and the Actions to Improve Mood by Caregivers (AIM-C), and to assess their content validity (N = 31 residents; N = 35 caregivers, respectively). Study 2 evaluated test-retest agreement (N = 206; N = 125) and inter-rater agreement (AIM-C: N = 81) using a test-retest design. Study 3 explored the inventories’ practical application through semi-structured interviews (N = 12; N = 6). Data were analyzed through thematic analysis, content validity indices, and Gwet’s AC2 agreement coefficients. RESULTS: Both inventories demonstrated acceptable content validity, with moderate to very good test-retest agreement. Inter-rater agreement for most AIM-C items was classified as “fair,” and appeared lower when caregivers completed the inventories for residents with moderate to severe cognitive decline compared to residents with no to mild cognitive decline. Thematic analysis suggested that using the inventories increased awareness of mood-improving behaviors and contributed to better knowledge about residents. Challenges regarding usability and interpretability were identified, along with suggestions for refinement. CONCLUSIONS: The inventories appear to adequately capture mood-improving behaviors and show consistency over time. Nevertheless, their usability and interpretability could benefit from further refinement. Pending additional research, these inventories hold promise for assessing mood-improving behaviors in nursing homes, aiding future efforts to explore new ways to enhance depression care alongside traditional treatments.