Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia

Abstract Background Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching...

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Main Authors: Claudia M. Groot Kormelinck, Charlotte F. van Teunenbroek, Sytse U. Zuidema, Martin Smalbrugge, Debby L. Gerritsen
Format: Article
Language:English
Published: BMC 2021-07-01
Series:BMC Geriatrics
Subjects:
Online Access:https://doi.org/10.1186/s12877-021-02357-w
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author Claudia M. Groot Kormelinck
Charlotte F. van Teunenbroek
Sytse U. Zuidema
Martin Smalbrugge
Debby L. Gerritsen
author_facet Claudia M. Groot Kormelinck
Charlotte F. van Teunenbroek
Sytse U. Zuidema
Martin Smalbrugge
Debby L. Gerritsen
author_sort Claudia M. Groot Kormelinck
collection DOAJ
description Abstract Background Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. Methods We used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. Results The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. Conclusions Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.
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spelling doaj.art-d86e0b5fd74e43b7bfffb51868c68e1b2022-12-21T19:43:02ZengBMCBMC Geriatrics1471-23182021-07-0121111410.1186/s12877-021-02357-wProcess evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementiaClaudia M. Groot Kormelinck0Charlotte F. van Teunenbroek1Sytse U. Zuidema2Martin Smalbrugge3Debby L. Gerritsen4Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center GroningenDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center GroningenDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center GroningenDepartment of medicine for older people, Amsterdam Public Health research institute, Amsterdam UMC - Vrije UniversiteitDepartment of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer CenterAbstract Background Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. Methods We used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. Results The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. Conclusions Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.https://doi.org/10.1186/s12877-021-02357-wProcess evaluationComplex interventionParticipatory action researchNursing homeNeuropsychiatric symptomsPsychotropic drugs
spellingShingle Claudia M. Groot Kormelinck
Charlotte F. van Teunenbroek
Sytse U. Zuidema
Martin Smalbrugge
Debby L. Gerritsen
Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
BMC Geriatrics
Process evaluation
Complex intervention
Participatory action research
Nursing home
Neuropsychiatric symptoms
Psychotropic drugs
title Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
title_full Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
title_fullStr Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
title_full_unstemmed Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
title_short Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia
title_sort process evaluation of a tailored intervention to reduce inappropriate psychotropic drug use in nursing home residents with dementia
topic Process evaluation
Complex intervention
Participatory action research
Nursing home
Neuropsychiatric symptoms
Psychotropic drugs
url https://doi.org/10.1186/s12877-021-02357-w
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