Table A1.
Detailed codebook for qualitative content analysis with anchor examples (according to Kowalski et al. 2015 and based on HLHO-10 questionnaire).
| Category | Subcategories | Definition | Anchor Examples |
|---|---|---|---|
| 1. Mission statement | The facility’s leadership is explicitly committed to HL (e.g., mission statement, HR planning). | ||
| 1.1. High level of HL in mission statement | Strongly anchored in mission statement or concept, part of processes, defined objectives, or liabilities | ‘It’s an integral part of our concept.’ (FPD 4, person B) | |
| 1.2. Medium level of HL in mission statement | HL is anchored to an extent in the mission statement; not as a binding objective or element in the concept; plays a relatively insignificant role or has a different designation | ‘But in writing I have to say that it’s only a small part.’ (FPD 1) | |
| 1.3. HL is not part of the mission statement | HL is not structurally embedded; the concept does not include any special requirements or rules regarding health | ‘(…) There are no completely integrated (…) no real processes anywhere that are a real part of the concept. That just isn’t happening.’ (FPD 3, person A) | |
| 1.4. Implicit anchoring and implementation of HL in mission statement | HL without conceptual requirements or binding objectives; health-relevant offerings or measures are voluntary and out of the interest of the skilled staff; part of a philosophical mission statement based on anthroposophical principles and holistic spiritual background | ‘There are many everyday processes that I would say might unconsciously lead to this way of health behavior.’ (FPD 3, person B) | |
| 2. Quality management | Is HL part of quality management in your facility? | ||
| 2.1. Quality management in general | QM in crisis situations: ensures understanding of the situation, routine or standard processes; QM in working conditions, work safety; measures to improve and monitor working conditions | ‘We have (…) trained first-aiders (…) and we have an internal direct number. So by a key combination on the phone (…) you start an internal emergency call when fast action is needed and first of all the first-aiders are on site and then it actually sets off a relatively fast chain reaction.’ (FPD 3 person B) | |
| 2.2. HL in Quality management | HL in quality management for working and living together; relevance of HL in the facility regarding possible conflict in operations or care; measures to prevent or availability of contact points; quality management measures that are aimed at ensuring medical care or supporting HL during medical interventions | ‘We have two colleagues who are trained in de-escalation techniques and how already told, they share their knowledge with the skilled staff. All employees are required to take part in this training.’ (FPD 3, person B) | |
| 3. Clients involvement | Are clients involved in developing health information in your facility? | ||
| 3.1. Participatory | Clients are involved in developing health information. | - | |
| 3.2. Non-participatory | Clients are not involved in developing health information. | ‘Up to now, this has mainly been due to the intuition of the employees. So, in principle, the employees always have a feeling for how my clients tick, what their interests are.’ (FPD 8) | |
| 4. Communication standards | Are there communication standards that ensure that clients understood critical information (e.g., translators, pause to allow time to think before responding, encourage questions)? | ||
| 4.1. Implementation | Design of the communication between skilled staff and clients | ‘So, that always has to be individual and it depends on the person.’ (FPD 3, person B) | |
| 4.2. Influences | Factors influencing the communicative situation, such as critical situations or individual clients’ limitations | ‘So, we always have appointments with the clients. Time appointments. (…) And during this time (…) There are always situations that make you see that you should really stop for a moment and really take more time for a topic. But I really don’t have the time because I already have to go somewhere else. It’s also a question of relationships whether you can put something off to another day. (…) The better your relationship is to a client, the better the possibility to communicate in this area. It’s very much about trust. (FPD 5) | |
| 4.3. Basics | Use of communication technologies and media | ‘Violence free communication and easy language.’ (FPD 5); ‘Use picture.’ (FPD 2) | |
| 5. Navigation | Is an effort made in your facility to help clients easily find their way (e.g., signs, information staff)? | ||
| 5.1. High level of navigation aids | A number of different aids to facilitate navigation are used, e.g., signs in plain language, pictograms, color codes, clearly designed homepage, flyers, information staff | ‘We have a homepage with an app for your phone. So that you can use it on your phone. We have an area with easy language. We have signs in the building. We have prepared all light switches that they can be used by people in a wheelchair. Barrier-free access to all rooms. In each work area, we have a flyer which we provide for initial interviews (…) Then there is a general flyer. Then we have regular open house days and celebrations for our skilled staff and clients.’ (FPD 5) | |
| 5.2 Medium level of navigation aids | There is at least one feature/tool that serves as a guide; for example, signs in plain language, pictograms, color codes, clearly designed homepage, flyer or information staff | ‘And I think we have a very strong presence of staff offering guidance. (…) Guidance is, I think, relatively easy. (…) We don’t even have decent signs. Every external remembers this. But every person in care will be able to tell you where the wool workshop is. There is much (…) always this presence from people, someone is always there.’ (FPD 2) | |
| 5.3 No navigation aids | There are no aids in the facility that explicitly serve as guidance | ‘I would say, at the moment there isn’t a guidance system and it’s not clear at all, so in terms of the homepage and all.’ (FPD 1) | |
| 5.4 Examples of navigation aids | Structures or systems that serve as guidance in the facility | ‘Homepage’; ‘plain language app’; ‘flyers for each area.’; ‘Signs.’ (FPD 5) | |
| 5.5 Wishes and prospects for an improved guidance system | Improvements to the system are planned or expressed as desirable | ‘We are working on what offerings we have in this area, what offers our homepage for navigation already, what’s missing, what we need, what relatives need, what our clients need, what outsiders need.’ (FPD 8) | |
| 6. Client support in health-related issues | In your facility, do you offer support in determining costs such as additional payments for medications or other treatments relative to health? | ||
| 6.1 Offerings/services | Offerings that are supported, e.g., doctor appointments, health offerings | ‘As a rule, we arrange an appointment with the doctor together with the clients. We call there together or the person calls and I help out depending on what the client can do. But the initiative has to be there. I can’t force anyone to go anywhere.’ (FPD 5) | |
| 6.2 Type/kind of support | Design of the support mechanisms | ‘That’s very diverse. It’s as individual as the people with us, as individual as the solutions. There are people who can hardly tell us about their illness, their pain, or other things. You have to observe very carefully to even see if they aren’t feeling well. And there are others that complain the whole day long about pain they don’t even have. You have to handle things on an individual basis and respond its.’ (FPD 7) | |
| 6.3 Media use for health-related topics | Auditory (audio media), visual (print media), audio-visual (media with images or videos and sound), multimodal (media combining language and images) | Language, audio material (FPD 8); ‘There’s a pictogram for every condition: stomach aches, fever, everything. We have a little box in the rehabilitation workshop for those clients who are able to show us what’s wrong with them.’ (FPD 3, person B) | |
| 7. Initiatives to promote HL | Are skilled staff in your facility trained in HL? | ||
| 7.1 Client-related training | Offerings training and further education related to special diseases or activities affecting clients; opportunities and resources for training in HL communication | ‘We have different departments such as care sector, assistant area. Assistants are trained, they work individualized how the clients prefer. And we, in assisted living, where I work, some clients I care for have a special condition like diabetes or trouble with their heart. I have a client who has multiple such as problems with her kidneys, and I went to special training courses.’ (FPD 5) | |
| 7.2 Staff-related training | Opportunities for skilled staff to inform themselves about HL, support for personally managing occupational health risks or developing a healthier lifestyle; measures, rules, or regulations with the aim of supporting skilled staff health | ‘Yes, well, I think, of course, self-management is a good thing, to have a good perception of oneself, that is, good provision for oneself, and team discussions and development discussions with skilled staff is a bit of a thing we do.’ (FPD 2) | |
| 7.3 Wishes and ideas about training | Concepts or ideas about an ideal HLO regarding skilled staff training; wishes for the establishment or expansion of training, or potential for development | ‘If it would be a concert of desire, I think it would be important for every skilled staff to have more training in communication to learn how I can best reach my clients.’ (FPD 8) | |
| 7.4 Planning and implementation | Modalities of training: type of training opportunities for skilled staff, optional or mandatory, frequency, regularity, external or internal training, dissemination in team, type of availability, implementation in HR development plans, origins and development of offerings | ‘We have an internal training network and if something is in the program [brochure] then you can apply to take part in it if you want to.’ (FPD 3, person B) | |
| 8. Health promoting for staff | All offerings to improve health in skilled staff | ||
| 8.1 Prevention and health promotion | Offerings to prevent, delay, or reduce the risk of health impairment as well as means for the prevention or early detection of disease; offerings to strengthen health and knowledge about improving health, and also to increase health-preserving factors; salutogenetic approach | ‘The sheltered workshop offers a sport activity free of charge at the gym of your choice in your preferred region. You can just join it, which is already a very big offer, of course. Employers expect there will be less downtime because of back problems or whatever happens when you don’t get enough exercise. That’s really something.’ (FPD 4, person A) | |
| 8.2 Disease management and health care | Offerings to support coping with the stress brought about by disease; psychological or physical support in coping with a disease and its consequences; support for offerings in health organizations, products, and services available within the health system and whose use involves cooperation with health insurance companies or other types of support | ‘B2: And I think that’s a really great thing, and then there’s also such an offer for the non-disabled employees that you can turn to your colleagues even after traumatizing experiences at work. (…) B1: [We have| Colleagues as first-aiders (…)’ (FPD 3, person B1 and B2) | |
| 8.3 Wishes and ideas | Specific wishes about new, more, or other health offerings; ideas about what offerings should be provided; need for changes or development; actual plans to restructure offerings; expanding or providing initial offerings for skilled staff | ‘We should see if we could do and embed things like this without consulting with the board. To simply bring things into life more freely and faster and to implement them as well. Yes.’ (FPD 1) | |
| 9. Health services for clients | All offerings to improve health for clients | ||
| 9.1 Prevention and health promotion | Offerings to prevent, delay, or reduce the risk of health impairment as well as means for the prevention or early detection of disease; offerings to strengthen health and knowledge about improving health, and also to increase health-promoting (environmental) factors; salutogenetic approach | ‘Nevertheless, in sheltered workshops there are health promoting offerings like exercise, eating the right food we’re looking at here.’ (FPD 7) | |
| 9.2 Health promotion and health care | Offerings to support coping with the stress brought about by disease; psychological or physical support in coping with disease and its consequences; support for offerings in health organizations, products, and services available within the health system and whose use involves cooperation with health insurance companies or other types of support | ‘If an individual (client) needs, for example, cancer treatment, then of course we look into how they can be dealt with individually, what has to happen, what else can be done, whether it’s possible to use external offerings. To go with them. Are there doctors they will come to us if the client can’t leave our premises?’ (FPD 8) | |
| 9.3 Wishes and ideas | Specific wishes about new, more, or other health offerings; ideas about what offerings should be provided; need for changes or development; actual plans to restructure offerings; expanding or providing initial offerings for clients | ‘(…) We have a recreation room. That’s where we’ll have this relaxation group. (…) We also want to offer a day group, expand it significantly and offer a larger spectrum. Where things like (…) health literacy, sport offers, nutrition offers play a more significant role. So, those are all ideas that are being developed. (…) There are already scheduled days, there are already staff being hired, but it’s all starting first in the summer.’ (FPD 1) |
FPD = Facilities for people with disabilities.