"Anybody who has a heart is going to think that it's a good idea": Pre-Implementation of the Individualized Positive...

The purpose of this paper is to describe the pre-implementation process utilized to identify potential substantive barriers and facilitators to implementing the Individualized Positive Psychosocial Interaction (IPPI) across 9 nursing home communities prior to recruitment for an embedded pragmatic clinical trial.

We conducted 9 focus groups with n = 65 staff during regularly scheduled interdisciplinary care team meetings. Sessions included a description of the IPPI program and utilized a premortem exercise to solicit feedback on all the reasons why implementation of the IPPI would fail or succeed. To include additional stakeholders, we conducted individual interviews with n = 56 staff, n = 37 residents, n = 17 family members, and n = 1 volunteer. Data were thematically coded for barriers and facilitators informed by the Inner Setting Domain of the Consolidated Framework for Implementation Research version 2.0.

Overall, participants reported the human equality-centered culture, relative priority, and mission alignment of the IPPI with the organizational priorities as major facilitators. Potential barriers to IPPI implementation were related to structural characteristics, specifically staffing concerns around not having enough staff along with communication challenges with residents and finding appropriate space to conduct IPPIs as an available resource.

Utilizing the premortem exercise to engage staff, residents, and family was successful for relationship building between researchers and end users. Several substantive barriers and facilitators to IPPI implementation were identified, helping to inform implementation strategies for a future embedded pragmatic clinical trial.