Bringing stakeholders on board in the development of integrated care through the Theory of Change approach

Abstract

Similar to other fields, research and implementation in the field of long-term care (LTC) provision in the community increasingly focuses on taking on participative approaches to improve the quality of LTC. However, levels of participation differ vastly in terms of needed resources, aims and opportunities - ranging from informing experts by experience to co-design and involvement in action research. Our presentation is targeted at providers, policy makers and researchers who aim for engaging diverse stakeholders in the development of LTC in the community. We will present how InCARE included a wide range of stakeholders, including experts by experience, in developing three pilot projects aiming at improving LTC for older people in Spain, North Macedonia and Austria. We will focus on how we used the Theory of Change (ToC) approach and subsequent stakeholder workshops in the Austrian pilot project context. This participation process started in 2021 and aimed at informing and engaging stakeholders in the field of LTC in the province of Styria. Two consecutive participatory Theory of Change workshops prior to the project implementation phase both contributed to the quality of the pilot project by adapting it to the local context, and also heightened interest locally and regionally. Subsequent stakeholder workshops tackled issues raised in the ToC workshops, such as financing of LTC provision and relief options for informal carers. Starting the project during a time of thorough Covid-19 restrictions, the ToC workshops had to be conducted online. For various reasons, we decided to use online formats also for subsequent stakeholder workshops in the year 2022. We will present the advantages and challenges of using Theory of Change for stakeholder engagement, including the structuring of the process, the adaptation to the local context, how to heighten a sense of ownership, and what resources are needed. We will also highlight the advantages and disadvantages of online formats, including possibilities for a less-hierarchical communication. Taking the implementation of the local pilot project as an example, we will also link our experience to questions of participation, representation by proxy, self-representation and political representation.