Social Care Professionals Research Articles

Structural reforms in action - Singapore's population health journey and the structural changes at the national and local level

Summary: This workshop explores the challenges and opportunities for health systems in transition using Singapore as a case study to explore:
 
 a) How the health system is shifting towards a population approach
 b) Change management and implementation approaches required at the macro, meso and micro level
 
 Background: Confronted with the challenges of an ageing population, rising prevalence of chronic diseases, and increasing healthcare costs – Singapore’s Ministry of Health has embarked on “Healthier SG”, an ambitious health transformation strategy which aims to shift the system to a population health approach and place a stronger focus on preventive health. Healthier SG is a multi-year healthcare transformation journey which will be launched in the second half of 2023, with the commencement of a national enrolment programme for residents, to a primary care physician of their choice. Key enablers such as financing shift towards capitation will also be implemented gradually, along the with building of a strong digital data background and relevant supporting IT architecture. 
 Objectives:
 1.Introduce Singapore’s “Healthier SG” strategy, a primary care and community-centric movement to bring key stakeholders across public and private healthcare providers, and community care partners, to better enable Singaporeans to take charge of their health. 
 2.Share on a range of Singapore’s population health strategies, including child and maternal health, promoting a healthy lifestyle, enhancing personal mental health, and supporting well-being and care planning for our elderly population. 
 3.Through the sharing, understand the process and journey for countries and health systems undergoing similar transformation journeys, and be able to describe and discuss the structural changes that are happening at the national and local levels.
 4.Discuss and explore the enablers, challenges and opportunities for structural reforms in this case study, using the selected Pillars of Integrated Care as a reference
 
 Target Audience: Policy makers, health sector decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and the staff working on implementation, digitalization and/or evaluation of integrated care.
 Session Format:
 Time
 10 minsIntroduce Singapore’s “Healthier SG” population health strategy and plans
 15 minsHighlight the opportunities, challenges and structural changes happening at (a) national, (b) local, and (c) primary care levels
 40 minsModerated group discussion, using the selected Pillars of Integrated Care as reference, for 4 groups
 10 minsRead back on group discussion and insightsPlenary style read-back by groups, facilitated by group leads
 15 minsDiscussion and Round Up, facilitated by workshop lead
 Group discussions will be guided and facilitated by the workshop speakers, and attendees will be encouraged to contribute and participate actively in the group discussions. Flipcharts and post-its will be used to facilitate the group discussions.
 Key Learnings / Takeaways
 1.Gain knowledge about how other countries are progressing with their integrated care, people-centred care and population health journeys
 2.Understand and appreciate the importance of the local context and cultural considerations for countries and health systems undergoing transformation and structural changes
 

Restructuring Healthcare Financing to Enable Effective Integrated Care and Population Health

Singapore faces an aging population and spiraling healthcare costs. To address these challenges, Healthier SG will launch in 2023 to shift towards a population health approach to care for Singaporeans, to keep them healthy, and prevent or slow down disease progression. Residents will be encouraged to enrol with a primary care physician and take on an upstream preventive approach to healthcare. Delivery systems must focus on integrated care. In addition, there is a need to bend the rate of growth of cost curve. NHG, as one of the three public healthcare clusters, will take on the role of a “Population Health Manager” responsible for the health outcomes of 1.5M population assigned.
 Who is it for? Policy makers, health sector decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and the staff working on implementation of integrated care, healthcare finance professionals
 Who did you involve and engage with? Singapore Ministry of Health officials, Chief financial officers of hospitals, healthcare professionals, and clinicians (both specialist and primary care physicians) and community care partners.
 What did you do? NHG restructured itself organisationally to form an Accountable Care Organisation (ACO). The Health Ministry would be providing funding for subsidised care in the form of capitation funding per assigned resident per year (as opposed to the predominant fee for service funding currently) and additional funding for preventive care and health screening. NHG will aggregate the funds to design payment models that cut across different care setting to integrate care delivery. Incentive payments tied to performance outcomes and indicators will be established. Providers will also part-take in shared savings. NHG will also serve as a network of providers to join up care delivery, with focus on primary and preventive care.
 What results did you get? What impact did you have?We are in the stages of planning and design. The results we hope to achieve are for residents to enrol with a single primary care provider who will be partnering NHG to oversee the end to end care of the enrolled residents. Some of the indicators to be monitored measure resource allocation, resident enrolment rate, primary care physician enrolment rate with NHG, avoidable ED and hospitalisation rates and total subsidised healthcare cost per resident.
 What is the learning for the international audience? The learnings to share are the importance of engagement of leadership across the ecosystems, appropriate funding and resource allocation based on care needs of the population, setting up of enablers, including IT and data exchange, use of incentives to prompt behaviour changes, and the need for change management to get buy-in.
 What are the next steps? NHG will be rolling out key activities in the areas of primary care enrolment, designing the financing framework for payment and sharing of incentives with the providers, and is also in the midst of implementing key IT system enablers.

The Integrated Care Workforce - why is nobody interested?

Introduction: The health and care workforce was under pressure long before the pandemic, not least because of the constant development of new technologies, policy reforms and dwindling ressources. In recent years, concepts like the Quadruple Aim or the WHO European Framework for Action for integrated health services delivery have helped to highlight the importance of workforce planning, education and training or role definitions for integrated care. If we want the principles of integrated care working to become engrained in the work ethic and culture of health and care, a lot more needs to happen on many levels in order to ensure that the full potential of the individual and the concept as a whole can be fulfilled. However, as the lack of response to a recent call for papers on the subject has shown, there still doesn’t seem to be much interest in the research, practice and planning to support an integrated care workforce.
 Aims and Scope of the workshop: We want to use this workshop therefore to discuss with the integrated care community, why so little is done to support the integrated care workforce. We understand the integrated care workforce to comprise of health and social care professionals, carers, volunteers, etc. but we are open to being challenged on this point. Interesting questions to explore include:
 •Why are there hardly any integrated care cases, which include continuous professional education and training programmes?
 •Why are professionals so seldomly included in research and practice design?
 •What role do patients, service users, volunteers, families, etc. play in the future workforce? Are they a part of it? How formal or informal should their role be? How can we use them more strategically in education and training at the least?
 •What support does the workforce need during the transition process from fragmented to integrated working?
 •How can professional associations become promoters of integrated care?
 •What are some of the good examples which illustrate the development of a resilient, compassionate and integrated workforce? How can digital solutions support them?
 Audience: The workshop is for professionals, policy makers, educators and teachers, managers and academics, as well as people with lived experience of health and social care (including family carers) who are committed to a healthy, integrated workforce as the basis of integrated care implementation.
 Programme:
 5 minutes introduction to the topic
 15 minutes brainstorming world café round 1
 5 minutes change over
 15 minutes world café round 2
 15 minutes plenary discussion on key messages and next steps
 5 minutes wrap-up and personal actions
 Objectives and outcomes: Th objective of this workshop is to identify the reasons, why the workforce is still not recognised as a crucial topic in theory and practice, except for headlines in the media. It will also define the most urgent research questions, and priorities for policy and practice, which should be discussed within the international network of integrated care to support a better prepared workforce for the future.

Older People and Carers’ experiences of ‘Hospital-at-Home’

Introduction: Hospital at home (HAH) is an acute model of care that provides episodes of care to acutely unwell persons in their usual residence, i.e., their own home or in a care home. Providing intense and integrated care and treatment packages enables people to remain in their familiar environment and avoid the potential harm from in-patient stays. 
 Background Research: Currently, hospital-at-home research in the United Kingdom and internationally is limited regarding the lived experiences of older people and their unpaid carers. When older people and carers are excluded from research or not considered, we cannot understand how their experiences of services impact their everyday lives. The research also provides insight into how professionals can support people outside of hospitals more effectively by integrating this care model with other statutory services, such as social care, occupational and physiotherapy. Hospital-at-home initiatives can potentially reduce the risks associated with hospitalisation, such as infection, mental health and physical decline. Older people, carers and health and social care professionals may find this exciting and helpful research.
 Involvement: The research is nested into a wider research programme which people with lived experience have framed. There is also a panel of people with lived experience of receiving adult social care and those who support them, all of which form the approach to public and patient involvement.
 Data Collection & Methodology: There will be approximately 65 participants in this qualitative study, including health and social care staff, older people, and unpaid carers. All participants will be offered a one-off 60-minute semi-structured interview allowing them to respond in their own words. This contrasts with previous HaH studies in the United Kingdom that rely on fixed yes or no responses in surveys or questionnaires. Inductive Thematic Analysis is being used to analyse the data. As the data collection and analysis is still in progress, results are not fully concluded; however, the aim is to have themes fully developed from the data before the conference in May 2023. Some initial themes have emerged from the interviews with professionals, including risk, person-centred care, communication, and service delivery.
 Findings: The findings will create learning opportunities for an international audience, for example, concerning effective interprofessional working and person-centred care in HAH. Indeed, there is evidence of international HAH models in the literature review so that any new learning can be cascaded internationally via this conference. For example, when referring to communication, there could be an effective communication system developed at the point of discharge from HAH back to the care of their general practitioner, as this is an area of concern emerging from the professional interviews. The next steps will be to complete the research and give feedback to the local site in England where the research is taking place and to the Applied Research Collaboration (ARC) that has funded the research. This will highlight ideas and improvements for the future of community-based health and social care for older people and their carers.
 

Development of multiprofessional teamwork in Finnish health and social service centers, achievements, and challenges

In Finland all health and social services are moved from the responsibility of municipalities to Well-being service counties in 2023. The reform emphasizes service integration. At practical level Health and social service centers (HSS) are developed for the first contact points in Finland. Long waiting times, shortage of staff and lack of coordination have been major problems in primary care. As a solution, multiprofessional teams of both health and social care professionals in HSS centers and better collaboration between professionals have been built. This study explores, how the teams work and what challenges they have. 
 Methods: The study is based on 16 interviews of 25 managers and so far on 8 interviews of 10 employees (interviews are ongoing) in 5 HSS centers. The study is carried out in the territory of one future well-being services county, which launched the new organization beforehand. The county provided specialized care in the whole area. The primary care and social services were provided by the county in in two HSS centers. One HSS center was provided by a municipality, and two by a private firm. In the interviews the participants were asked about work organization and the functioning of the team model. The participants were GPs, registered nurses, psychiatric and substance abuse nurses, social workers and managers from different levels. The interviews were analyzed using content analysis. 
 Results: The core team in HSS centers consisted of GPs and nurses, but also of psychiatric and substance abuse nurses, social worker and physiotherapist. The managers saw the team work as functioning rather well. The waiting times had shortened clearly. But the team model was only a part of the changes done. Ehealth services were started at the same time by an outsourced organization, which lowered the demands in the HSS centers. An important part of the changes was the new care process which highlighted the effective telephone services. Nurses answered the phone and started the care process. It was possible to guide the client to laboratory or directly (without referral) to some other professional (such as physiotherapist) or to prescribe medicine at phone. This was possible, because one GP was working as consulting the nurses without own appointments. The new service model included the task shifting and strengthening the role of nurses. 
 Common facilities and close connection of all team members was seen as crucial as it enabled getting to know each other and the services they provided. In the teams the responsibility of care was on teams, not on single professionals. This raised a discussion of care continuity and due this of efficacy. The professionals saw it important to have one contact person for the client with chronic conditions. 
 Conclusions: Multiprofessional work can streamline and improve the treatment process, but eHealth and task shifting are needed too. Teamwork requires participatory development and getting to know each other. Easy consultation of GP’s is required for task shifting. Despite the benefits of teamwork care continuity must be taken into account. 

Proactive Telecare - Promoting personal autonomy, improving quality of life and facilitating healthy ageing.

Background: Telecare is defined as support to maintain or improve person's health and wellbeing, independent living and/or to tackle loneliness and social isolation, or to anticipate and prevent crises, provided using an outgoing call made to people's home. Outgoing calls are made regularly based on a person's choice, or in response to a need or another trigger event. Proactive services are tailored to service users' needs, delivering a coordinated mix of several elements of care and support e.g. wellness, check, meal/hydration reminders appointment reminders, birthday calls, etc. Over the last years, the main reason for calling telecare service has been the need for social contact and support. The wellbeing and social support of telecare users has a positive impact on their health status and therefore on the public expenditure. Given the size and heterogeneity of users, there has been a need to maximise the efficiency and efficacy of the service by adapting it to specific profiles and situations. This has been achieved by developing specific solutions such as: APPs and mobile devices to improve the accessibility to the service, collection of information and measurement of key indicators on the users general habits and lifestyle; setting gas and smoke detectors to increase the safety of our users; provision of specific campaigns to alert and prevent risk situations such as the flu campaign, heat wave campaign and preventing isolation through the Christmas campaign; or support of the health service in the provision of medical appointments and medical advice, specially over the last year with the COVID-19 pandemic.
 Objectives: This workshop is an opportunity to explore the potential of digital solutions and proactive telecare to promote personal autonomy, improve quality of life and facilitate healthy ageing of elderly people, people with disabilities and people in a dependent situation. It will feature in details the experience from two regions, Scotland and Andalusia, in implementing proactive telecare in real-life settings with citizens at the centre of designing, implementing and evaluating telecare solutions. Each region is at different pace of proactive telecare implementation increasing thus potential for mutual learning and exchange of good practices, including the learning about the practicalities, pitfalls, outcomes and costs of this new way of working.
 Format
 1.Welcome and Introduction
 Donna Henderson, Scottish Government, Scotland [5’]
 2.Proactive telecare services in Scotland - What, why and how to deliver proactive services?
 Doreen Watson, Scottish Government, Scotland [15’]
 3.Proactive telecare services in Andalusia - What, why and how to deliver proactive services?
 Pablo Quinones Delgado, Junta de Andalucia, Andalusia [15’]
 4.Facilitated discussion & conclusive remarks
 Donna Henderson, Scottish Government, Scotland [25’]
 Target Audience: A wide spectrum of stakeholders is being targeted: national and regional decision-makers, health and social care authorities, professionals, managers and academia.
 Learning/Take away: The proactive telecare enables learning who might benefit most from wellbeing calls, how to have good conversations with people, identify the ‘triggers’ for a decline in health, wellbeing and resilience, and how to support a person to take action if they want to.

What professionals say and do: the tension between egalitarianism and hierarchy in interprofessional teamwork

ABSTRACT This study aimed to explore the power dynamics in interprofessional teamwork by conducting an ethnographic study of three interprofessional teams working in mental health and substance use services in Norway. Data were collected through 14 observation sessions and 18 in-depth interviews with health and social work professionals. Given the potential difference between “what people say and what people do,” we explored how ideas of power were articulated by health and social care professionals and how such structures were observed to be played out in practice. The findings suggest a presence of contrasting egalitarian and hierarchical structures, and that professionals were aware of the resulting tension and operated within it. This study contributes to the literature on interprofessional health and social care through providing an analysis of the power dynamics of teamwork interaction and how professionals relate to such structures. The results are relevant to a broad context of interprofessionalism as they provide valuable insight into how power should be understood as a continuum of changeable positions and motivations.

CO-PRODUCING A BOARDGAME TO LEARN AND ENGAGE ABOUT DEMENTIA INEQUALITIES: THE DEMENTIA INEQUALITIES GAME

Abstract Receiving a diagnosis and accessing care after a diagnosis of dementia, both for the person and their carer, are fraught with inequalities. Finding different ways to address these inequalities is important. The aim of this public engagement activity was to co-produce a boardgame about dementia inequalities to facilitate learning, dialogue and educate about different barriers, and facilitators, to diagnosis and care. Two virtual and two face-to-face workshops with people with dementia, unpaid carers, health and social care professionals, and Third Sector representatives were held between October 2022 and June 2023. The virtual workshops were split into discussions of inequalities and how a boardgame may feature inequalities. The first face-to-face workshop was split into the same activities, aided by outcomes from workshops 1 and 2. Workshop 4 attendees tested the prototype. Attendees were reimbursed for their time. Nine brief remote interviews with attendees were conducted to evaluate their experiences in the co-production of the boardgame. Forty stakeholders attended four workshops. Workshops provided step-by-step thoughts on how the game could be designed or modified. The final game, prototype tested in Workshop 4, consists of a one-sided, two-half board depicting the pre-diagnosis process (left half) and post-diagnosis process (right half). Interviews with nine attendees reported on their reasons for attending the workshops, experiences of being involved, and the game design and purpose. The game can be used to improve knowledge about dementia inequalities for health and social care professionals, carers, people living with dementia, decision makers, and the general public.

WHEN POLICY INTENTIONS GO ASTRAY: THE DEPLOYMENT OF HOME CARE AND HOME SUPPORT MARKET TOOLS IN FRANCE AND QUEBEC

Abstract Using Gingrich’s (2011) typology of welfare markets, this contribution studies the selection and enactment of market tools in two different jurisdictions (France and Quebec). Quebec represents a classic example of a managed market with regional health authorities (CISSS/CIUSSS) seeking the lower the cost of long-term care by contracting services to community groups and the private sector. These contractual agents have gradually replaced health and social care professionals within the public system. France has opted to enact a consumer driven market with the introduction of the allocation personnalisée d’autonomie (APA) which provides cash benefits to eligible older adults who can then select the provider of their choice. Both of these market reforms are compared and analyzed across three types of territories : rural (Finistère and Bas-St-Laurent), urban (Paris and Montreal), and in industrial decline (Somme and Mauricie). Despite operating within highly differentiated long-term care policy frameworks and market tools, both jurisdictions face similar difficulties in the enactment of market mechanisms. For instance, rural territories fail to generate sufficient providers to develop a market where a regional health authority (Quebec) or older adults (France) can actually select a provider and negotiate terms of service. Public authorities must then intervene to generate market-like conditions. Regardless of the jurisdiction, the conceptualization of market mechanism has clearly an urban setting in mind making them ill-suited for other environment and there is gradual movement towards the development of austerity market where individuals are forced to seek alternatives beyond the market tools deployed by governments.

"I Genuinely Believe This Is the Most Stigmatised Group within the Social Care Sector"-Health and Social Care Professionals' Experiences of Working with People with Alcohol-Related Brain Damage: A Qualitative Interview Study.

Appropriate diagnosis, treatment and care contribute to better service engagement, improvements to wellbeing, cost savings and reductions in morbidity and mortality for people with alcohol-related brain damage. In Northeast England, large amounts of alcohol are consumed; this is reflected in the number of alcohol-related deaths in the region. However, the pathway for people with alcohol-related brain damage to receive diagnosis, treatment and care is unknown and could be unwittingly influenced by stigma. Qualitative, in-depth, semi-structured interviews were completed with 25 health and social care professionals from organizations involved with people with alcohol-related brain damage recruited via snowball sampling. Interviews were recorded, transcribed verbatim, coded, and analysed. People with alcohol-related brain damage were found to be stigmatised by both society and professionals, inhibiting their entry into services. Therefore, alcohol-related brain damage remains underdiagnosed and misdiagnosed. There was found to be no dedicated service; silos with revolving doors and underfunded generic care with long waiting lists typically exclude those with alcohol-related or neurological problems. Reducing stigmatising processes associated with alcohol-related brain damage could counteract professionals' reluctance to provide care.

Development of an eLearning intervention for enhancing health professionals' skills for addressing COVID-19 vaccine hesitancy.

Like many countries, Greece has faced resistance to coronavirus disease 2019 (COVID-19) vaccination among residents for both the initial and booster doses. Supporting healthcare professionals with delivering brief advice on COVID-19 vaccination may assist with reaching national vaccination targets. We sought to rapidly develop, pilot test, and deploy an eLearning intervention on skills training on effective techniques for addressing COVID-19 vaccine hesitancy for primary health and social care professionals in Greece. A five-part, 1.5-h eLearning was produced in Greek which featured two behavior change techniques, Very Brief Advice (VBA) and Motivational Interviewing (MI) adapted for use in addressing COVID-19 vaccine hesitancy. Six-film-based case studies modeling the use of VBA and MI in the context of challenging scenarios typically seen in Greek health and social settings were produced for the eLearning. The CME was pilot tested using a pre-post design in a small convenience sample (n = 17) of health care professionals. Pilot study results found the training provided new knowledge (80%), improved provider skills (80%), and was useful to provider's clinical practice (90%). There was a mixed effect in provider capability, motivation, and opportunity. Ninety percent of providers strongly agreed or agreed that they planned to use the information and skills provided by the training in their clinical practice. This project has resulted in new training assets for use by health and social professional tailored to the nationally context in Greece including supporting uptake of booster doses of the COVID-19 vaccine.

'There's a timebomb': Planning for parental death and transitions in care for older people with intellectual disabilities and their families.

Increasing numbers of older adults with intellectual disabilities are living with ageing parents. These families need support to plan for the future to avoid crisis interventions following parental death. Interviews and focus groups were conducted with people with intellectual disabilities (aged 40+) (N = 9), parents (N = 11) and siblings (N = 16) to understand their perspectives about living with parents and future planning. Data were analysed using framework analysis. Four themes were identified: 'What matters to me', 'When should we plan', 'What are the options' and 'Who will help'. Participants knew they needed to make plans but did not feel supported to do so. While they viewed moving as an opportunity for independence, they feared there were no viable alternatives. Person-centred resources and support are needed for families to plan for transitions in care, including proactive approaches from social services and help to prepare for conversations with social care professionals.

Health and social care professionals' views and experiences of supporting parents with serious mental illness.

A significant number of individuals with a serious mental illness (SMI) such as schizophrenia or bipolar disorder are also parents of dependent children. Despite the risk of adverse psychological, behavioral, and social outcomes their needs often go unmet. To better understand the needs of parents with SMI and their children it is necessary to gain insight into the perspectives and experiences of the professionals in adult mental health and children's services who work with them, and who, ultimately, are best placed to meet those needs. To explore the views and experiences of health and social care professionals working with parents with SMI to understand the needs of, and their role supporting, parents with SMI and their children. Semi-structured interviews were conducted with seventeen professionals from six NHS and Local Authority settings in England, UK. Participants were included if they were employed in adult mental health or local authority children's services and had experience of working with parents with SMI. Sampling was purposive, including a wide range of professions in these settings. Interview data were analyzed using template analysis taking a critical realist perspective. Three top-level themes were generated: (1) Impact of parental SMI on the child, (2) Accessing support from services, (3) Role of professionals working with parents with SMI. Themes highlight diverse, wide-ranging effects of SMI on the child and a reluctance from parents to seek help due to stigma and fear. Available services are reported to be inaccessible and unacceptable to parents with SMI and practitioners experience conflict when balancing the needs of the parent and child. A whole-family approach facilitated by improved communication between services is advocated. Participants believed that parents with SMI experience complex parenting challenges over and above other parents, describing a largely detrimental impact on the child. Support services were deemed inadequate, and participants stressed the need to develop specialist services tailored toward the needs of parents with SMI and their children. Although participants endorsed joined up working across health and social care settings to facilitate a whole family approach, they required greater service knowledge and training in parental SMI.

Forward with Dementia: process evaluation of an Australian campaign to improve post-diagnostic support

BackgroundForward with Dementia is a co-designed campaign to improve communication of dementia diagnosis and post-diagnostic support.MethodsWebinars, a website, social and traditional media, and promotions through project partners were used to disseminate campaign messages to health and social care professionals (primary audience) and people with dementia and carers (secondary audience). The campaign ran between October 2021 and June 2022, with 3-months follow-up. The RE-AIM framework was used for process evaluation. Measurements included surveys and interviews, a log of activities (e.g. webinars, social media posts) and engagements (e.g. attendees, reactions to posts), and Google Analytics.ResultsThere were 29,053 interactions with campaign activities. More than three-quarters of professionals (n = 63/81) thought webinars were very or extremely helpful. Professionals and people with dementia and carers reported that the website provided appropriate content, an approachable tone, and was easy to use. Following campaign engagement, professionals planned to (n = 77/80) or had modified (n = 29/44) how they communicated the diagnosis and/or provided post-diagnostic information and referrals. Qualitative data suggested that the campaign may have led to benefits for some people with dementia and carers.ConclusionsForward with Dementia was successful in terms of reach, appropriateness, adoption and maintenance for professionals, however flow-through impacts on people with dementia are not clear. Targeted campaigns can potentially change health professionals’ communication and support around chronic diseases such as dementia.

P207: Pilot testing of the Health and Social Care Professionals’ Knowledge & Attitudes towards Later Life Sexuality (HSCP-KALLS) instrument

Objective:Due to a lack of validated assessment instruments, this study aimed to pilot test the newly developed Health and Social Care Professionals’ Knowledge & Attitudes Towards Later Life Sexuality (HSCP-KALLS) instrument. The HSCP-KALLS instrument is designed to assess health and social care professionals’ knowledge (46 items) and attitudes (40 items) towards later life sexuality including components related to dementia, sex worker services and Lesbian, Gay, Bisexual, Transgender, Intersex or Queer/Questioning (LGBTIQ+).Methods:A group of health and social care professionals (n = 22) and Healthcare-related educator (n = 2) were invited to complete the HSCP-KALLS instrument. Feedback on items phrasing and the experience of completing the instrument was sought.Results:Written feedback regarding either phrase of items or use of the instrument was not specifically addressed by participants. A high level of internal consistency was revealed for both the knowledge and attitude items (α = 0.84 & 0.88, respectively). A decent level of knowledge (M=39.75, SD=4.90) and positive attitudes (M=161.04, SD=13.50) towards later life sexuality were demonstrated by participants. Participants had greater knowledge on items related to ageing, intimacy, and sexuality (95%), with a lower level of knowledge on items related to sexuality diversity (e.g., LGBTIQ+). Providing more trainings about later life sexuality was frequently addressed in the knowledge written feedback. Participants generally demonstrated positive attitudes towards later life sexuality. However, a high proportion of ambivalent responses were noted on some attitude items (e.g., A9 & A18) that participants indicated in written feedback that their responses would depend on circumstances.Conclusion:Preliminary reliability and feasibility of using the HSCP-KALLS instrument has been encouraging, with further testing in large samples now, required to robustly establish psychometric properties. Supporting later life sexuality is essential and the use of HSCP-KALLS instrument can inform and identify professional development needs of health and social care professionals to improve care provision for older people by supporting their expression of sexuality in healthcare settings.

Forward with dementia: process evaluation of an Australian campaign to improve post‐diagnostic support

AbstractBackgroundPost‐diagnostic support for dementia is lacking in Australia and internationally. Across five countries, we co‐designed and delivered Forward with Dementia, a campaign to improve the communication of diagnosis and provision of post‐diagnostic support. This is a process evaluation of the Australia campaign which included social media, online advertising, webinars, a website hosting downloadable materials, newsletters and promotion through partner organisations. The campaign ran between September 2021 and June 2023 with a budget of AUD$50,000 and staff time.MethodThe Reach, Effectiveness, Adoption, Implementation, Maintenance (RE‐AIM) Framework with the addition of Appropriateness structured the evaluation. Data collected included a campaign activity log, surveys of health and social care professionals immediately after webinars (n = 81) and 3‐6 months afterwards (n = 45), interviews with eight health and social care professionals and six key stakeholders, and surveys and interviews with people with dementia (n = 24) and carers (n = 47).Result Reach: 28,460 interactions with campaign activities including engagement through the website, webinars, and social media. Appropriateness: Campaign activities and resources were described to have appropriate content, a hopeful friendly tone, user‐friendly, and trustworthy and be authoritative. >75% of professionals reported webinars were helpful to their work. Adoption: 95% of professionals planned on using the information from webinars, and 93% intended to share the website with patients. Professionals provided examples of how they had changed practice – for instance being more positive, writing a care plan, making referrals, and sharing Forward with Dementia resources. Effectiveness: Professionals described being more confident in managing dementia. Some people with dementia and carers gave examples of how the campaign decreased self‐stigma, increased carer confidence, and led to actions which increased wellbeing. Maintenance: The majority of professionals had made ongoing changes to their post‐diagnostic support practices, some organisations were routinely using Forward with Dementia resources, which are also included in Department of Health and Dementia Australia websites.ConclusionThis relative short and economical campaign had broad reach and appropriate materials that produced sustained changes to post‐diagnostic support provided by health and social care professionals and organisations. Qualitative data suggests improved outcomes for people with dementia and carers.

Developing a psychoeducational programme for family caregivers of people living with late stage dementia

AbstractBackgroundFamily caregivers often find it difficult to access information and support in the later stages of dementia. They may have difficulties attending in‐person support groups due to caring responsibilities. If caregivers are able to attend these groups, the information and support is often targeted towards the earlier stages of dementia.MethodAn eight session psychoeducational programme was developed in order to enable caregivers to access peer support and information from professionals with expertise relevant to the later stages of dementia. The programme sessions are held over Zoom and include the following topics: sensory stimulation, nutrition diet and swallowing, legal matters, care in the home and care homes, palliative care and pain management, funeral planning and brain donation. Sessions are co‐facilitated by health and social care professionals with relevant expertise, including a speech and language therapist, dietitian, solicitor and palliative care practitioner. Themes and session content have been co‐created through partnership working between facilitators and programme participants.ResultThe programme has been completed by four groups of caregivers (n = 26). All participants care for someone living with a rare or young onset form of dementia, and include those caring at home as well as caregivers of people living in a care or nursing home. Participants have reported a number of positive outcomes from attending the programme, with one participant stating: ‘Joining this late stage carers group – I was a bit worried about it… it’s absolutely one of the best things I could have done. In some respects, I wish I could have joined this earlier’. The programme is currently being evaluated using a time and cost survey to determine ongoing feasibility.ConclusionThere is a need for accurate and timely access to information and support for family caregivers of people living with dementia in the later stages. Online psychoeducational programmes provide the opportunity for caregivers to access both peer and professional support in their own homes. The development of this programme has benefited from ongoing and iterative input from both caregivers and professionals in the dementia support field.

P102: Supporting Informal Carers to Undertake Regular Physical Activity from Home: a Co-design and Prototype Development Study of a novel app, “CareFit”

Background:Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.Objective:The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.Methods:We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.Results:Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.Conclusions:Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.

'I don't think they really link together, do they?' An ethnography of multi-professional involvement in advance care planning in nursing homes.

Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n = 6), relatives (n = 4), nursing home staff (n = 19), and visiting health and social care professionals (n = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care.

Clinical effectiveness of the NIDUS randomised control trial of a tailored, goal‐focused intervention for increasing goal attainment in people living with dementia and their family carers

AbstractBackgroundMost people living with dementia want to remain living in their own homes and are supported to do so by family carers. We have co‐produced, with family carers of people with dementia and health and social care professionals, a psychosocial intervention (NIDUS‐family). NIDUS‐family is the first fully manualised intervention that is tailored to personal goals of people living with dementia and their families and is delivered by facilitators without clinical training. The intervention utilizes components of behavioural management, carer support, psychoeducation, communication and coping skills training, enablement, and environmental adaptations, with modules selected to address dyads’ selected goals.MethodA randomised, two‐arm, single‐blind, multi‐site clinical trial involving 302 people living with dementia‐family carer dyads. Dyads were randomised 2:1 to receive the NIDUS‐family intervention with usual care (n = 204) or usual care alone (n = 98). The intervention group received over 1 year, 6‐8 video call or telephone sessions (or face to face if COVID‐19 restrictions allowed) in the initial 6 months, followed by telephone follow‐ups every 1‐2 months to support implementation, with a trained facilitator. We will evaluate the effect of NIDUS‐family and usual care on attainment on goals set by family carers towards the care recipient living as well as possible at home, as measured by Goal Attainment Scaling (GAS), compared to usual care alone at 12‐month follow‐up. Secondary outcomes measures include functioning, neuropsychiatric symptoms of care recipients, time remaining living at home and care costs, and family carer mood, quality of life and reported abusive behaviours.ResultThe trial recruited to target, with good adherence to the intervention (85% fully adherent) and trial retention to date (87% at 6‐month follow‐up). The trial’s 12 month follow up data will be completed in early May 2023 and results will be analysed and ready to share by July 2023.ConclusionOur intervention, which we adapted to include remote delivery prior to commencement due to the COVID‐19 pandemic, aims to address barriers to living as well and as independently as possible. If effective, NIDUS‐family is potentially scalable to benefit many people living with dementia and their family carers.