Evidence map›Paper›PMID 37263265›Full record

Trial reportThe Gerontologist2024

Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in Nursing Homes.

Liane R Ginsburg, Adam Easterbrook, Ariane Massie, Whitney Berta, Malcolm Doupe, Matthias Hoben, Peter Norton, Colin Reid, Yuting Song, Adrian Wagg and 1 more

Abstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Gerontologist, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Liane R GinsburgSchool of Health Policy & Management, York University, Toronto, Ontario, Canada.ORCID 0000-0002-4436-9198
Adam EasterbrookCentre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Ariane MassieSchool of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.ORCID 0000-0002-0577-4684
Whitney BertaInstitute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
Malcolm DoupeRady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Matthias HobenSchool of Health Policy & Management, York University, Toronto, Ontario, Canada.
Peter NortonCumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Colin ReidSchool of Health and Exercise Science, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
Yuting SongFaculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.ORCID 0000-0001-6597-0567
Adrian WaggDivision of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada.ORCID 0000-0002-5372-530X
Carole EstabrooksFaculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Funding

CIHR CIHR PS 148582
6 · The paper itself

Abstract

BACKGROUND AND

objectivesSignificant quality problems exist in long-term care (LTC). Interventions to improve care are complex and often have limited success. Implementation remains a black box. We developed a program theory explaining how implementation of a complex intervention occurs in LTC settings-examining mechanisms of impact, effects of context on implementation, and implementation outcomes such as fidelity. RESEARCH DESIGN AND

methodsConcurrent process evaluation of Safer Care for Older Persons in residential Environments (SCOPE)-a frontline worker (care aide) led improvement trial in 31 Canadian LTC homes. Using a mixed-methods exploratory sequential design, qualitative data were analyzed using grounded theory to develop a conceptual model illustrating how teams implemented the intervention and how it produced change. Quantitative analyses (mixed-effects regression) tested aspects of the program theory.

resultsImplementation fidelity was moderate. Implementation is facilitated by (a) care aide engagement with core intervention components; (b) supportive leadership (internal facilitation) to create positive team dynamics and help negotiate competing workplace priorities; (c) shifts in care aide role perceptions and power differentials. Mixed-effects model results suggest intervention acceptability, perceived intervention benefits, and leadership support predict implementation fidelity. When leadership support is high, fidelity is high regardless of intervention acceptability or perceived benefits. DISCUSSION AND IMPLICATIONS: Our program theory addresses important knowledge gaps regarding implementation of complex interventions in nursing homes. Results can guide scaling of complex interventions and future research.

Indexed as

Nursing HomesQuality ImprovementAgedAged, 80 and overCanadaHumansLong-Term CareResearch DesignEvaluationIntervention/trial methodsLong-term care

Identifiers

PMID37263265
PMCPMC10825831

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.