Adherence
death, dementia
SAID
Participation and class size were sub-themes from the central theme of adherence. Care home staff described residents' participation in sessions as 'not as expected' due to several delivery challenges. For example, one care home staff member that struggled to get residents to adhere to the recommended dose of the intervention mentioned:"We (care home) did really struggle, especially at the start, and once the COVID cleared, it got a little bit better for a couple of weeks, and then it slipped back into them not really engaging in it."However, overall, the intervention was accepted by residents and this was seen in their participation and records of adherence. The digital intervention was an activity that the residents looked forward to. They referred to it as meaningful and purposeful. Some care home staff made comments like:"Most of our residents participated in all of the sessions. There were a couple of residents that missed a few; they just did not feel like it that day, or they were out with their families and things like that, but all in all, it was a good turnout."and:"They (residents) started to look forward to it. You know, they remembered it. It was really great. It was excellent."Also, in terms of participation, the number of sessions offered to residents varied across care homes. Some care homes offered more sessions than the recommended dose, whereas others offered fewer. In the focus group discussions, care home staff stated in response to them being able to engage residents in three movement and one music session a week:"I (AC) think we (care home) have done really well. The attendance was quite good. Actually, more residents participated, and we weren't doing this like three times a week, but probably four or five. I think it went great."but also:"…I (AC) did probably, I have run it once per week, or maybe twice per week, sometimes in different parts of the care home."Class size differed in the various care homes, with some care homes recording an increase in the number of residents participating in the intervention and others seeing a decrease, again due to the challenges of delivering an intervention specifically in a care home setting. Care home staff explained that residents were lost to death, dementia and COVID-19 in comments such as:"Two residents passed away, but we got a new resident, and then it was right up her street like music, dancing and exercise."and:"Decrease for me (AC), but again it was like I said, the three residents in particular that their level of dementia got worse, they became unwell and just could not continue with the programme"and:"I (AC) think I had the decrease just because we had COVID in the last month, just at the end of the 12 weeks. So that is why I could not really do any dancing and singing with people."