Implementation of the Medication Literacy Assessment Instrument MELIA in the Home Care Setting: A Multi-Method Study

This study aimed to identify determinants for successfully implementing the MEdication LIiteracy Assessment tool (MELIA) by nurses, from developing an implementation plan to evaluating its feasibility in two Swiss home care organizations.

A multi-center pilot study using a multi-method design.

Phase 1 (pre-implementation) involved forming nurse stakeholder groups at each site to identify determinants of MELIA implementation, including potential barriers and facilitators. Subsequently, nurse stakeholders developed implementation plans with strategies to address identified determinants and to test MELIA within their organizations. In Phase 2 (pilot implementation), one care team per organization tested MELIA. Registered nurses (RNs) completed an anonymous questionnaire collecting focus on perceived acceptability and feasibility, with optional free-text responses. Phase 3 consisted of focus group discussions with RNs from each organization to explore their experiences using MELIA, particularly regarding feasibility, acceptability, and adoption.

Two home care organizations participated. The stakeholder groups consisted of 1 team leader, 1 clinical nurse specialist, and 2 RNs at one site and 3 advanced practice nurses at the other site. Pilot testing was performed by seven and six nurses, respectively. Several barriers to the use of MELIA were identified by participating RNs: limited nurse-patient communication skills, insufficient knowledge about assessment tools, and unclear understanding of RNs' roles in structured assessments within interprofessional teams. Not all RNs were willing to conduct structured assessments, mostly influenced by awareness of patient benefits. Interprofessional collaboration was hindered by unclear communication and differing perceptions of role responsibilities. Organization and planning were time-consuming, and some RNs were reluctant to read the lengthy instruction manual required for correct use.

The study identified contextual factors influencing implementation of clinical interventions in home care. Key facilitators included RNs' awareness of MELIA's patient benefits, clear and accessible instructions, and defined professional roles in structured assessments and communication. Policymakers should strengthen treatment networks to enhance collaboration in medication management. Nursing education should emphasize communication skills and structured assessment instruments, while home care managers should provide clear structures and role guidance. Future research should examine transferability, scalability, and broader adoption of MELIA in home care organizations.

Combining clinical supervision with more education about using structured assessment instruments in general should increase RNs' knowledge and skills. This should support the desired behavioural change of having RNs use structured instruments more frequently to screen and assess the medication literacy of older adult home care patients.

This study investigated the determinants of successfully implementing and using the MELIA tool. The identified barriers to and facilitators of this-primarily RNs' awareness of its benefits to patients, an easy-to-understand instruction manual, and RNs' communication skills regarding medication-can be used by policymakers, in nursing curricula, and in clinical practice. The study's insights will aid the implementation and use of the MELIA intervention in other home care settings, enabling the structured screening and assessment of older adult patients' medication literacy. This should subsequently lead to improved medication safety for older adult home care patients.

This multi-method study applied the Standards for Reporting Qualitative Research guidelines.

Stakeholder participation was an integral part of this pilot implementation study. A stakeholder group was formed at each organization's headquarters, comprising professionals in leadership positions and nurses providing everyday care. These stakeholders provided contextual information and planned pilot testing by their home care organization. They also recruited the focus group interviewees at each headquarters.

The protocol for this manuscript was not registered.