COVID-19 Knowledge and Attitudes among Nursing Home Patients, Family and Staff.

COVID19 has especially impacted residents in skilled nursing facilities and long term care(SNF/LTC). Who are at extraordinary risk for infection and mortality. Residents with dementiaare at even higher risk because of their need for individual personal care, lack of cognition, andthe impact of social distancing and reduced social interaction on their underlying dementia. Thestaff and family members at SNF/LTCs are facing major challenges in confronting a newinfectious disease, imposing visitation and socialization limits, and needing to identify newworkflows to provide care to this group of residents who often have significant physical andmental health impairmentThis Supplement builds on our previous R21 work in SNF/LTCs and partners with 2 BaltimoreSNF/LTCF network. We will use two complementary models to inform formative research and todevelop a survey instrument which will ultimately guide an intervention: (1) Knowledge,Attitudes and Behavior (KAB) which is individual-focused; and, (2) Systems EngineeringInitiative for Patient Safety (SEIPS), a Human Factors and Systems Engineering model, whichdefines the interactions among humans and other elements in complex sociotechnical worksystems. Integrating both models will identify both knowledge gaps for the educationalintervention and facilitators and barriers within the work system that may require structuralmodification. This is an NIA-defined Stage 0 Behavioral Intervention. The formative researchphase of Aim 1 will include in-depth qualitative research with resident, family, and staffstakeholders in SNF/LTCFs. This will include 25 in-depth interviews with residents and/or theirfamily members, 15 interviews with facility staff. The interview domains will address both KABand human factors issues including intervention facilitators and barriers. This will informdevelopment of a survey instrument in Aim 2, which combines the KAB and SEIPs approachesand which will be piloted in 50 residents/family and 20 staff members, to include post-hocfeasibility assessments. Data obtained from the formative research and pilot surveys willsupport the ultimate objective of developing an interactive intervention in Aim 3 based onbehavioral science and human factors engineering principles, which will inform facility workflowredesign and a potential clinical trial intervention.