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Compliance in a randomized controlled trial: the implementation of emotion-orientated care in psycho-geriatric
Veron J J Schrijnemaekers1, Erik van Rossum, Michèle J T van Heusden
1Department of Epidemiology, Maastricht University, The Netherlands. vjj.schrijnemaekers@epid.unimaas.nl
Aim:
The aim of this study was to gain insight into compliance with the introduction of a new care model [emotion-orientated care (EOC)] as part of an intervention study (RCT) in psycho-geriatric care. The success of the implementation (compliance), as well as the expectations and experiences concerning the training were studied.
Methods:
Observations were conducted in four intervention homes and four control homes, and care-plans of residents were also analysed to see whether the implementation had succeeded. Semi-structured interviews were conducted with four persons in each of the four intervention sites (a total of 16 interviews) to study the experiences with the training and implementation.
Findings:
The observations showed no clear differences between intervention and control homes with regard to the interactions between residents and professional caregivers. Analysis of the reporting systems revealed differences within, as well as between, the intervention and control homes. The content of the reports showed no differences between the intervention and control homes. The interviewees had different expectations of the EOC training, depending on their disciplinary background. The caregivers regarded the training as a confirmation of their current practice. They experienced some changes at the individual level and some of them reported that the co-operation between units had become better. At the home-level no changes were reported. Every interviewee indicated that the implementation of EOC was difficult and laborious and that there were (mainly organizational) obstacles that could hinder the implementation of the EOC training.
Conclusions:
Observations and the analysis of the reporting systems indicated that there was no clear difference between intervention homes and control homes as to the actual implementation of the intervention, indicating that the compliance with the new care model was not optimal. The interviews gave some insight into factors that caused lack of compliance.