Proposing a multi-method phenomenological approach in exploring the perceived daily life experiences of people with dementia in their dementia care environments and immediate outdoor settings

Abstract

The environment in this study is presented primarily drawing on the theoretical definition of home, and its experience and meaning to the individual with dementia, with an interest in access to outdoors. Notions of perception, cognitive image and affordance are central to the sense of home, and in turn the sense of self that this may inform and support. This theoretical framework informs the multi-method phenomenological approach proposed, through themes of spatial legibility, cultural appropriateness, fascination, user-centredness and personalisation. The novelty of the methodological toolkit lies in the incorporation of methods that have been traditionally used in research with people with dementia as the basis of the framework, but which are supplemented by additional layers developed from conventional architectural tools to create a more visual representation of the environmental experience. Despite its apparent complexity, the methodology yields a very clear and precise image of the person's presence in her surroundings, at once providing a location in space and time, her mood and engagement, as well as a layering of the affordances that may have informed her behavior. This method was developed as part of this research, and remains unique to it. Its innovation lies in the progression of the DCM tool, the integration of the notion of affordances and architectural mapping techniques to propose a holistic depiction of the care experience of people with dementia.

Keywords: architecture; dementia design; dementia outdoors; enabling environments; multi-methods.

Figure 1

Continuum of research paradigms. Source: Groat and Wang (, p. 67) (Adapted from Mugerauer, 1995; Guba and Lincoln, 1998; Teddlie and Tashakorri, 2009; Mertens, 2010).

Figure 2

Four internationally recognized assessment methods for residential care environments. Source: Topo et al. (, p. 122).

Figure 3

A model for describing four hypothetical types of environments that emerge from the co-variation of children's independent mobility and the number of actualised affordances. Source: Kontos (, p. 183), adjusted by author to focus on Bullerby example.

Figure 4

Sample hand-written mapping sheet. Source: Author.

Figure 5

Sample DCM data sheet. Source: Author using standard DCM data sheets.

Figure 6

Drilling and abstracting out qualitative data. Source: O'Leary (2010), cited in Groat and Wang (, p. 246).

Figure 7

Framework depicting the performance of a person with dementia in residential care. Source: Author, adapted from Topo et al. (2012).

Figure 8

Sample route working diagram. Source: Author.

Figure 9

Location X_Day X_Group well- and ill-being profile.

Figure 10

Location X_Day X_Group behavior profile.

Figure 11

Location X_Day X_Individual well- and ill-being scores.

Figure 12

Location X_Day X_Travel route for resident 1.

Figure 13

Location X_Day X_Response chart for resident 1.

Figure 14

Location X_Day X_Cultural setting diagram_Residents 1, 3, 5.

Figure 15

Location X_Day X_Response charts summary.