By Andrew Sommerlad, Division of Psychiatry, University College London, UK

Social connection is fundamental to person-centred care in care homes. Yet, the development and implementation of psychometrically robust measures or questionnaires which can accurately measure social connection is limited, particularly for people living with dementia in care homes.

We therefore created the social connection in long-term care home residents (SONNET) study to improve measurement of this person-centred outcome by evaluating existing measures and develop a new validated measurement approach. We also wanted to improve understanding of the experience of social connection for people living in care homes.

 In a study funded by a grant from the Alzheimer’s Association and Brain Canada, our international team worked together on a program of work.

• First, we reviewed all the existing measures which have been studied in research on social connection among care home residents. We found that none of these had sufficient evidence to recommend their use in a care home setting. Many were not designed for people living in care homes and so they asked questions which were not relevant, or did not consider the specific needs of residents.
• Next, we conducted qualitative interviews with 67 people including care home residents, family members, care home staff, and healthcare professionals. They told us about the elements of social connection considered most important to those living in care homes. We learnt that building relationships with other residents and staff, and maintaining older relationships, were important. Care homes could support this by trying to maintain some familiar activities, getting to know residents well to deepen relationships, connecting residents with existing networks outside the home, and other policies.
• Finally, we then used the information from steps 1 and 2 to help us write a new questionnaire comprising 12 questions which can be administered to residents (or a staff member) to assess residents’ levels of social connection – the SONNET scale. We tested the measure with 163 residents. We found that the scale was acceptable and feasible to be completed – it took 5-8 minutes to complete and residents and staff could answer over 95% of questions. We found that responses to the scale questions were consistent when different researchers asked the question (inter-rater reliability) and when the questions were asked after an interval of 2 weeks (test-retest reliability). We also found that the score on the SONNET scale questions correlated with responses to other scales measuring social connection, and scales of measuring linked domains. For example social connection measured by SONNET was higher for residents with milder dementia and those who did not have distressing behavioural and psychological symptoms. This suggests that the SONNET scale can reliably and accurately assess social connection.

We have now made our questionnaire freely available to any researcher or care home who wishes to use it: https://www.sonnetstudy.com/measure. Our questionnaire can be used to evaluate the effectiveness of care, including the impact of staff training, and of treatments such as care home groups or arts-based therapy, and why these benefit some residents more than others, informing how they could be delivered most effectively. It could also track changes in social connection for residents across the time that they live in the care home. Our hope is that this scale will help researchers prioritise social connection, demonstrate the value of different approaches, and inform best practice.

During the study, we received really valuable contributions from a panel of people in the UK and Canada with lived experience of care homes and dementia, and were also helped by several students and junior staff who have gone on to roles furthering research into these areas. We are sincerely grateful for the contribution from all our study participants which helped to make the study a success.