Abstract
BackgroundPsychosocial interventions offer opportunities to improve care for people with dementia in care homes. However, implementation is often led by staff who are not well prepared for the role. Some interventions use external experts to support staff. However little is known about external expert, care home staff and manager perceptions of such support. This paper addresses this gap.MethodsMulti-methods study within a process evaluation of a cluster randomised controlled trial of Dementia Care Mapping™ (DCM). Interviews were conducted with six external experts who also completed questionnaires, 17 care home managers and 25 care home staff responsible for DCM implementation. Data were analysed using descriptive statistics and template analysis.ResultsThree themes were identified: the need for expert support, practicalities of support and broader impacts of providing support. Expert support was vital for successful DCM implementation, although the five-days provided was felt to be insufficient. Some homes felt the support was inflexible and did not consider their individual needs. Practical challenges of experts being located at a geographical distance from the care homes, limited when and how support was available. Experts gained knowledge they were able to then apply in delivering DCM training. Experts were not able to accurately predict which homes would be able to implement DCM independently in future cycles.ConclusionsAn external expert may form a key component of successful implementation of psychosocial interventions in care home settings. Future research should explore optimal use of the expert role.
Highlights
Psychosocial interventions offer opportunities to improve care for people with dementia in care homes
This study has identified that support from an external expert was essential to successful implementation of Dementia Care MappingTM (DCM) by care home mappers
Just under two thirds of homes were judged to need further support for future cycles. These findings indicate that attending DCM training plus completing one expert supported cycle is unlikely to provide enough training and support for sustainable care home staff led DCM implementation in most care homes
Summary
Psychosocial interventions offer opportunities to improve care for people with dementia in care homes. Little is known about external expert, care home staff and manager perceptions of such support. A range of common barriers and facilitators have been identified [11, 12] They include: staff motivation, attitudes and confidence to implement the intervention; use of topdown implementation approaches reducing staff/team ownership of the intervention; time, competing priorities and staff turnover; the degree of management support; whether specific support for intervention implementation is provided (e.g. supervision, mentorship); staff perceptions of whether the intervention is practicable and will improve care/resident well-being; and whether there is a ‘learning organisation’ culture. The expert may be a member of the research team, or an independent expert in use/application of the intervention provided/funded by the study, but who is not a member of the immediate research team
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