Discussion
death, cognitive impairment, anxiety, CMO, depression
SECONDARY
The findings of this mixed-methods feasibility study on multidimensional health outcomes of a digital PA intervention using music and movement resources were evaluated through a context-mechanism-outcome (CMO) configuration using a realist approach. This method considered the challenging situation that care homes in Scotland, UK were in during the COVID-19 pandemic, as well as the resources available to the care homes and staff. Consequently, the feasibility of this intervention was established as a component of how the programme would translate into the domain of policy and practice. Discovered delivery challenges were (1) motivation and engagement, (2) cognitive impairment and disabilities of the participants and changes in these, (3) death and hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Regarding the secondary aim of performing limited efficacy testing on multidimensional health markers, ACs and residents commented on improved mood, physical health, job satisfaction and social support, with large effect size values and improvements in the questionnaire scores for anxiety, depression, feelings of loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health and appetite. Due to the feasibility nature of this study and the small sample size, pre- to post-intervention data should be considered preliminary. Overall, these findings tentatively support the recommendation to implement a future RCT, with limitations discussed below. The initial programme theory was therefore refined as discussed below.