From development to implementation through a RE-AIM lense: lessons learned from a qualitative process evaluation of...

Workplace Health Promotion (WHP) in long-term care facilities is essential to support staff wellbeing and sustain workforce capacity, yet implementing such interventions remains challenging. Within the pilot project "Healthy Care Cares for Health", WHP workshops were developed and implemented. To strengthen the feasibility of future WHP projects in long-term care facilities, this study pursued two objectives: first, to present the development and implementation of the workshops to ensure traceability and enable adaptation in future setting-specific WHP projects; second, to derive implications for practice, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, based on the barriers and facilitators encountered during implementation.

Three WHP workshops were developed in an iterative multi-step procedure. Implementation in one pilot facility was evaluated through a qualitative process evaluation. Data collection included (1) systematic documentation of the development workflow and (2) structured observations during the workshops. Data were analyzed through qualitative content analysis with a deductive approach, complemented by inductive coding. To structure and clarify the lessons learned derived from the findings, the RE-AIM framework was applied.

The development of the workshops comprised seven phases: expert selection, onboarding, individual and collaborative development, first implementation, adaptation, and second implementation. Findings from the process evaluation showed that levels of engagement varied. While approximately one-third of participants were actively involved, others remained passive or even showed signs of resistance. Key challenges included motivation, perceived content relevance, group dynamics, fatigue, and language barriers. The adjustments that were made, based on observations and feedback from the first workshop round, led to improved structure, delivery, and acceptance of the workshops. The evaluation revealed two key areas for improvement: (1) organizational preparation; (2) workshop design, including content, structure, and methodology. Participation proved to be a central factor for motivation, serving both as a prerequisite for successful WHP initiatives and an indicator of successful implementation. Using the domains of the RE-AIM framework, the lessons learned were summarized and synthesized into implications for future WHP interventions.

This study sheds light on the development and implementation of WHP interventions in long-term care settings. Active participation and organizational readiness were identified as crucial factors for successful implementation. The key lessons learned were structured according to the RE-AIM framework to derive practical implications, enabling a transferable synthesis of the results. These offer practical guidance on designing, adapting, and implementing WHP interventions in long-term care contexts.

The pilot project HCCH has been registered with the German Clinical Trials Register (DRKS) under the registration number DRKS00036359 (date of registration: 17 March 2025).