Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults
Abstract Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining o...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-01-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-020-01936-7 |
| _version_ | 1818411129884377088 |
|---|---|
| author | Teuni H. Rooijackers G. A. Rixt Zijlstra Erik van Rossum Ruth G. M. Vogel Marja Y. Veenstra Gertrudis I. J. M. Kempen Silke F. Metzelthin |
| author_facet | Teuni H. Rooijackers G. A. Rixt Zijlstra Erik van Rossum Ruth G. M. Vogel Marja Y. Veenstra Gertrudis I. J. M. Kempen Silke F. Metzelthin |
| author_sort | Teuni H. Rooijackers |
| collection | DOAJ |
| description | Abstract Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303 ). Registered 26 September 2017. |
| first_indexed | 2024-12-14T10:26:31Z |
| format | Article |
| id | doaj.art-cf688c6daafa417995559c686804da3d |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-14T10:26:31Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-cf688c6daafa417995559c686804da3d2022-12-21T23:06:19ZengBMCBMC Geriatrics1471-23182021-01-0121111510.1186/s12877-020-01936-7Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adultsTeuni H. Rooijackers0G. A. Rixt Zijlstra1Erik van Rossum2Ruth G. M. Vogel3Marja Y. Veenstra4Gertrudis I. J. M. Kempen5Silke F. Metzelthin6Department of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityBurgerkracht LimburgDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht UniversityAbstract Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303 ). Registered 26 September 2017.https://doi.org/10.1186/s12877-020-01936-7Activities of daily livingBehavior and behavior mechanismsHome and community based care and servicesIndependenceProcess evaluationReablement |
| spellingShingle | Teuni H. Rooijackers G. A. Rixt Zijlstra Erik van Rossum Ruth G. M. Vogel Marja Y. Veenstra Gertrudis I. J. M. Kempen Silke F. Metzelthin Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults BMC Geriatrics Activities of daily living Behavior and behavior mechanisms Home and community based care and services Independence Process evaluation Reablement |
| title | Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults |
| title_full | Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults |
| title_fullStr | Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults |
| title_full_unstemmed | Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults |
| title_short | Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults |
| title_sort | process evaluation of a reablement training program for homecare staff to encourage independence in community dwelling older adults |
| topic | Activities of daily living Behavior and behavior mechanisms Home and community based care and services Independence Process evaluation Reablement |
| url | https://doi.org/10.1186/s12877-020-01936-7 |
| work_keys_str_mv | AT teunihrooijackers processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT garixtzijlstra processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT erikvanrossum processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT ruthgmvogel processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT marjayveenstra processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT gertrudisijmkempen processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults AT silkefmetzelthin processevaluationofareablementtrainingprogramforhomecarestafftoencourageindependenceincommunitydwellingolderadults |