[Barriers and facilitators in the implementation of a complex intervention in a nursing home: An in-depth case study]

The complex intervention PECAN (Participation Enabling CAre in Nursing) was developed to promote activities and participation among nursing home residents with joint contractures at organisational and resident levels. It was implemented by trained facilitators and nursing staff. In a cluster RCT, PECAN showed no effect on the primary endpoint. The cluster-wide process evaluation identified leadership behaviour and differences in the degree of implementation as possible influencing factors. This case study examines a nursing home with protocol-compliant implementation but no observed effectiveness to analyse possible causes.

A qualitative secondary data analysis was conducted as an in-depth case study based on a focus group with nursing home staff (n = 5) and an individual interview with a facilitator. Data were analysed using structured qualitative content analysis according to Kuckartz along the dimensions of context, setting, and implementation. In addition, documentation forms from ten consultation sessions related to the implementation component 'consultation of facilitators by the research team' were analysed using a deductive-descriptive approach.

This analysis identified additional influencing factors that were not apparent in the cluster-wide process evaluation, including socio-cultural expectations, spatial conditions, nursing staff workload, and organisational upheavals, particularly changes in leadership. These factors seem to play a relevant role in the limited changes observed in nursing care practice.

Organisational upheavals led to discontinuities and hindered implementation. It remains unclear what intervention dose is required to achieve measurable effects.

Early and systematic consideration of organisational conditions appears to be crucial for implementing complex interventions at the resident level. Furthermore, the effective intervention dose has yet to be determined.