JMIR Publications

ABSTRACT

Background:

Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving quality of care and life for older adults and the work life for their care providers calls for effective knowledge translation of evidence-based best practices. We report the protocol for the study Influence of Context on Implementation and Improvement.

Objective:

The study purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. We have two goals: (1) advance knowledge translation science by further developing and testing the PARIHS framework (which outlines how implementation relies on the interplay of context, facilitation and context) and (2) advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation.

Methods:

This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care homes in western Canada. TREC data include: five waves of survey collection, two clinical trials, and regular ongoing outcome data for long-term care residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive re-analysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes four stakeholder panels: (1) system decision/policy makers, (2) care home managers, (3) direct care staff and (4) a citizen engagement group of people living with dementia and family members of long-term care residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings.

Results:

This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023.

Conclusions:

The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes.