The Applicability of Photovoice in Pseudo-total Institutions – Methodological Insights From an Exploratory Study on Physical Activity in Nursing Homes

Photovoice helps participants express their perspectives through photography. As a setting for Photovoice, nursing homes represent challenging, yet promising, contexts partly characterized by elements of Goffman’s concept of “total institutions” and more fully characterized as Heinzelmann’s “pseudo-total institutions.” We analyzed Photovoice’s applicability in nursing homes within the context of physical activity promotion research. Our results indicate Photovoice (1) helps overcome fear and builds trust between researchers and participants, (2) requires certain ethical considerations, (3) addresses technical alienation, (4) determines what is relevant from participants’ point of view, and (5) points out the invisibility of significant others. Further, we provide insights for (6) making Photovoice research a priority in organizational routines, (7) contextualizing photographs, and (8) adjusting for COVID19-related methodological challenges. We also discuss our insights for potential adaptations to ensure participant privacy and safety when using Photovoice in pseudo-total institutions, such as nursing homes. Photovoice reveals activity-promoting and activity-impeding factors possibly unrecognized with other research methods, as well as differences in stakeholder perspectives about physical activity

Patterns of physical activity among nursing home residents before and during the Covid 19 pandemic—a systematic observation

Abstract Background The Covid-19 outbreak in spring of 2020 posed an array of challenges for nursing homes, including promoting resident physical activity (PA). Given the diversity of factors affecting resident PA, we explored how activity patterns outside weekly-scheduled structured activities changed during the pandemic and what factors promoted or inhibited PA during the pandemic. Methods We conducted systematic direct observations over 823.5 h in eight nursing homes in Southern Germany in 2020 and 2021. Results: In 2020, 84.7% of person observation units were classified as sedentary (average activity level: 1.14 MET). In 2021, the percentage increased to 91.6% of observed person units (average activity level: 1.08 MET) (t = 6.947; p = .000). According to tree classification, influencing factors of PA included mealtime and daytime in 2020 and 2021, as well as presence of men residents only in 2020 and guided low threshold activities in 2021. Conclusions Nursing homes constitute highly sedentary places—an issue exacerbated by access restrictions for external activity experts and significant others as well as behavioural restrictions for residents during the Covid-19 pandemic. Staff could not compensate due to existing time restraints and lack of training in PA promotion. Based on our findings, we recommend future studies to develop feasible and resource-low activities to be integrated into the daily routines of nursing homes