Implementing a training intervention to support caregivers after stroke: a process evaluation examining the...

Area of Science:

• Healthcare Intervention Implementation
• Complex Healthcare Interventions
• Process Evaluation

Background:

• Medical Research Council guidance emphasizes implementation in healthcare intervention development.
• Implementation involves mobilizing resources within existing organizational structures.
• Process evaluations are key to understanding implementation dynamics and influencing factors.

Purpose of the Study:

• To qualitatively evaluate the implementation of a caregiver training program within a pragmatic cluster randomized controlled trial.
• To examine professional engagement, caregiver reach and involvement, and caregiver experiences with the training.
• To explore the impact of contextual factors on the implementation and embedding of the intervention.

Main Methods:

• Qualitative process evaluation of the 'Training Caregivers after Stroke' trial.
• Utilized Normalization Process Theory as a framework for analysis.
• Examined how professionals delivered training, involved caregivers, and how caregivers responded.

Main Results:

• Organizational history, team dynamics, and external policies significantly influenced implementation.
• Factors facilitating or impeding the cascade training model were identified.
• Understanding of the intervention and engagement levels impacted its embedding into routine practice.

Conclusions:

• Agreement on responsibilities and monitoring mechanisms are vital when multiple providers are involved in complex interventions.
• Explicit consideration of organizational, practice, and service delivery levels is necessary for effective implementation.
• Normalization Process Theory aids in identifying critical aspects of embedding complex interventions into practice.