An Ethnographic Exploration of Social‐Ecological Influences on Physical Activity in Care Homes for Older People

BACKGROUND: Robust evidence confirms that physical activity (PA) levels among older people who live in care homes are considerably lower than those who live in their own homes. Low PA in care homes may reduce independence, function, and quality of life. OBJECTIVE: To explore social ecological factors that influence PA facilitation in care homes. METHODS: Focussed ethnographic study informed by social ecological models in five care homes for older people comprising 54 h of non-participant observation and 15 in-depth interviews with care workers. Observations focused on key interactions between staff and residents, the daily routines of care homes, and the physical environment. Interviews were informed by observations and sought explanations for observed behaviour. Data were subjected to reflexive thematic analysis. RESULTS: The findings show how care workers' perceived roles, identity, and sense of purpose influenced how (or if) PA was facilitated. The study identified blurred role boundaries between formal and informal care practices in relation to PA. Blurred role boundaries led to a continuum between formal and informal PA facilitation practices that were mediated by intrapersonal, interpersonal, organisational and physical environmental factors. Formal roles in PA promotion were defined by their explicit inclusion in job descriptions, for example, staff employed as activity coordinators, and were highly demarcated leading to limited interprofessional collaboration among care workers regarding PA. Conversely, informal roles reflected how recognising and creating incidental opportunities to promote PA occurred for all staff as they enacted their roles during day-to-day work. Social spaces in the care home physical environment acted as destinations that encouraged walking and incidental PA, especially when supported by staff creativity and encouragement. CONCLUSIONS: These findings provide evidence to support the transformation of care worker roles in a way that emphasises PA facilitation as a key part of the role. PATIENT OR PUBLIC CONTRIBUTION: Care home staff, residents, and family members contributed to the design of the observation topic guide and the practical procedures to implement the observation element of the ethnography. Member checking of the themes with two care home managers and three members of care home staff that were participants in the study was conducted to obtain feedback on the findings.