Evaluating the social fitness Programme for older people with cognitive problems and their caregivers: lessons learned from a failed trial

H W Donkers,D J Van Der Veen,M W G Nijhuis-Vander Sanden,M J Vernooij-Dassen,S Teerenstra,M J L Graff

doi:10.1186/s12877-018-0927-8

H W Donkers, D J Van Der Veen + Show 4 more

Open Access

https://doi.org/10.1186/s12877-018-0927-8

Copy DOI

Abstract

BackgroundThis process evaluation article describes the lessons learned from a failed trial which aimed to assess effectiveness of the tailor-made, multidisciplinary Social Fitness Programme to improve social participation of community-dwelling older people with cognitive problems (clients) and their caregivers (couples).MethodsA process evaluation was performed to get insight in 1) the implementation of the intervention, 2) the context of intervention delivery from professionals’ point of view, and 3) the potential impact of intervention delivery from participants’ perspectives. Data was gathered using mixed-methods: questionnaires, focus group discussions, interviews, medical records.Results1) Implementation. High study decline (65,3%) was mainly caused by a lack of internal motivation to increase social participation expressed by clients. 17 couples participated, however, intervention delivery was insufficient. 2) Context. Barriers during intervention delivery were most often related to client (changing needs), caregiver (increased burden) and health professional factors (delivery of integrated care lacked routine). 3) Impact Qualitative analyses revealed participants to be satisfied with intervention delivery, we were unable to capture these results through our primary outcome measure.ConclusionsThis process evaluation revealed the Social Fitness study did not fit in three ways. First, framing the intervention on social participation promotion was as threatening to clients. The feeling of being unable to adequately contribute to social interactions seemed to be causing embarrassment. Second, the intervention seemed to be too complex to implement in the way it was designed. Third, there is a tension between the offering of a personalised tailor-made intervention and evaluation through a fixed study design.Trial registrationThe trial which is evaluated in this article (the Social Fitness study) is registered with the Dutch Trial Register (NTR), clinical trial number NTR4347.

Highlights

This process evaluation article describes the lessons learned from a failed trial which aimed to assess effectiveness of the tailor-made, multidisciplinary Social Fitness Programme to improve social participation of community-dwelling older people with cognitive problems and their caregivers
3) Impact Qualitative analyses revealed participants to be satisfied with intervention delivery, we were unable to capture these results through our primary outcome measure
This process evaluation revealed the Social Fitness study did not fit in three ways

Summary

Introduction

This process evaluation article describes the lessons learned from a failed trial which aimed to assess effectiveness of the tailor-made, multidisciplinary Social Fitness Programme to improve social participation of community-dwelling older people with cognitive problems (clients) and their caregivers (couples). The multi-component [15, 16] intervention is aimed at empowering and enabling clients and caregivers to participate socially through a patient-centred [17, 18] approach. This community-based [19] intervention consists of a tailor-made intervention plan which includes feasible goals [20, 21] that represent the social activities which are relevant and important to the individual person. The professionals involved in intervention delivery used coaching methods focused on improving their self-confidence and self-management

Objectives

Methods

Results

Discussion

Conclusion