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A 5-year examination of CAPABLE implementation using RE-AIM and CFIR frameworks.

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Summary

Implementing evidence-based programs like CAPABLE requires leadership support and technical assistance, but faces challenges in recruitment and funding. Addressing these factors is key for successful program sustainment and scaling.

Keywords:
CAPABLECFIRRE-AIMevidence-basedimplementationimplementation effectivenessprogram fundingsustainability

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Area of Science:

  • Gerontology
  • Health Services Research
  • Implementation Science

Background:

  • The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program is an evidence-based intervention designed to enhance the daily functioning of older adults and support their goal attainment through home modifications.
  • CAPABLE utilizes a multidisciplinary team, including occupational therapists, nurses, and handy workers, to guide older adults through goal setting and action planning over a 4-to-6-month period.
  • Understanding the implementation and sustainability experiences of organizations delivering CAPABLE is crucial for refining future program rollouts and addressing identified barriers.

Purpose of the Study:

  • To examine the factors that facilitate or hinder the implementation and sustainability of the CAPABLE program across various organizations.
  • To identify key components critical for successful CAPABLE implementation and to understand the challenges and facilitators from the perspective of program administrators.
  • To provide insights for the CAPABLE National Center to enhance technical support, funding, and policy to improve program dissemination and scaling.

Main Methods:

  • The study employed the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) frameworks to evaluate the implementation and sustainment of CAPABLE.
  • Data were collected over five years (2019-2024) from 65 organizations implementing CAPABLE, utilizing licensure records, annual surveys from program administrators, and notes from monthly technical assistance calls.
  • Qualitative thematic and descriptive analyses were performed on the collected data, with the organization serving as the unit of analysis. Published studies on CAPABLE outcomes were also reviewed.

Main Results:

  • Key facilitators for CAPABLE implementation included strong leadership support, access to technical assistance, and adherence to program fidelity.
  • Common challenges encountered by organizations were difficulties in recruiting participants, hiring qualified personnel, and securing sustainable funding.
  • Internal factors such as the perceived value of CAPABLE and program manager commitment, alongside external factors like initial pilot funding and alignment with "aging in community" goals, supported program adoption.

Conclusions:

  • The study identified critical facilitators and barriers to CAPABLE implementation and sustainability, highlighting areas where enhanced support is needed.
  • Findings are actively informing the development of additional technical assistance by the CAPABLE National Center and guiding efforts to improve funding and policy.
  • The combined use of RE-AIM and CFIR frameworks proved effective for monitoring and reporting on the ongoing implementation of evidence-based programs, addressing a gap in the literature.