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Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in
Liane R Ginsburg1, Adam Easterbrook2, Ariane Massie3
1School of Health Policy & Management, York University, Toronto, Ontario, Canada.
The Gerontologist
|June 1, 2023
Summary
Implementing complex interventions in long-term care (LTC) requires understanding contextual factors. Supportive leadership significantly enhances implementation fidelity, even when intervention acceptability is low.
Area of Science:
- Gerontology
- Healthcare Management
- Implementation Science
Background:
- Long-term care (LTC) faces significant quality challenges.
- Complex interventions often yield limited success due to implementation barriers.
- The process of implementing interventions in LTC settings is not well understood.
Purpose of the Study:
- To develop a program theory explaining the implementation of complex interventions in LTC.
- To identify mechanisms of impact, contextual influences, and implementation outcomes.
- To explore how frontline workers implement interventions and drive change.
Main Methods:
- Concurrent process evaluation of the Safer Care for Older Persons in residential Environments (SCOPE) trial.
- Mixed-methods exploratory sequential design utilizing grounded theory and mixed-effects regression.
- Qualitative data analyzed to develop a conceptual model of implementation.
Main Results:
- Moderate implementation fidelity was observed.
- Key facilitators included care aide engagement, supportive leadership, and role perception shifts.
- Leadership support was the strongest predictor of implementation fidelity, irrespective of intervention acceptability or perceived benefits.
Conclusions:
- The developed program theory fills critical knowledge gaps in nursing home intervention implementation.
- Findings can inform strategies for scaling complex interventions and guide future research.
- Understanding implementation dynamics is crucial for improving care quality in LTC.
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