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Adapting Strategies for Optimal Intervention Implementation in Nursing Homes: A Formative Evaluation
Camilla B Pimentel1,2,3, Whitney L Mills4,5, Andrea Lynn Snow6,7,8
1Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.
The Gerontologist
|May 26, 2020
Summary
Adapting research interventions in nursing homes requires incremental implementation and ongoing evaluation. This approach enhances staff engagement and overcomes challenges in quality improvement initiatives.
Area of Science:
- Gerontology
- Healthcare Quality Improvement
- Implementation Science
Background:
- Nursing homes present unique difficulties for research and quality improvement (QI).
- A prior study showed success in a nursing home-led intervention to improve staff-resident relationships in VA Community Living Centers (CLCs).
- This study details early adaptations to enhance frontline staff participation in such interventions.
Purpose of the Study:
- To evaluate the formative implementation of a nursing home-led intervention.
- To identify adaptations needed to enhance frontline staff participation.
- To provide a blueprint for research and QI in nursing home settings.
Main Methods:
- Formative evaluation using field notes, facilitation records, and staff interviews.
- Analysis informed by the Capability, Opportunity, Motivation, and Behavior (COMB) model.
- Adaptation of five key implementation strategies based on early findings.
Main Results:
- Adaptations were made to leader and staff training, intervention tailoring, feedback mechanisms, and facilitation.
- A 6-month implementation period at the first CLC informed adaptations for the second CLC.
- Key elements and strategies were identified to boost frontline staff engagement.
Conclusions:
- Incremental implementation and continuous formative evaluation are crucial for enhancing staff capability, opportunity, and motivation.
- This study offers a practical framework for addressing challenges in nursing home research and QI.
- Successful adaptation strategies are vital for initiating and sustaining interventions in long-term care settings.
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