支持痴呆症患者照料者的电子健康干预措施可能已被证明有效,但它们是否已做好实施准备?
eHealth interventions to support caregivers of people with dementia may be proven effective, but are they implementation-ready?
作者信息
Christie Hannah L, Martin Jennifer L, Connor Jade, Tange Huibert J, Verhey Frans R J, de Vugt Marjolein E, Orrell Martin
机构信息
Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands.
NIHR MindTech MedTech Co-operative, The Institute of Mental Health, Nottingham University Innovation Park, Nottingham, United Kingdom.
出版信息
Internet Interv. 2019 Jul 24;18:100260. doi: 10.1016/j.invent.2019.100260. eCollection 2019 Dec.
OBJECTIVES
A variety of health services delivered via the Internet, or "eHealth interventions," to support caregivers of people with dementia have shown evidence of effectiveness, but only a small number are put into practice. This study aimed to investigate whether, how and why their implementation took place.
METHODS
This qualitative study followed up on the 12 publications included in Boots et al.'s (2014) widely cited systematic review on eHealth interventions for informal caregivers of people with dementia, in order to explore further implementation into practice. Publicly available online information, implementation readiness (ImpRess checklist scores), and survey responses were assessed.
FINDINGS
Two interventions were freely available online, two were available in a trial context, and one was exclusively available to clinical staff previously involved in the research project. The remaining seven were unavailable. All scores on the ImpRess checklist were at 50% or lower of the total, indicating that the interventions were not ready to implement at the time of the Boots et al. (2014) review, though some interventions were scored as more implementation-ready in subsequent follow-up publications. Responses to the survey were received from six out of twelve authors. Key learnings from the survey included the importance of the involvement of stakeholders at all stages of the process, as well as the flexible adaptation and commercialization of the intervention.
CONCLUSIONS
In general, low levels of implementation readiness were reported and often the information necessary to assess implementation readiness was unavailable. The only two freely available interventions had long-term funding from aging foundations. Authors pointed to the involvement of financial gatekeepers in the development process and the creation of a business model early on as important facilitators to implementation. Future research should focus on the factors enabling sustainable implementation.
目的
通过互联网提供的各种健康服务,即“电子健康干预措施”,已被证明对支持痴呆症患者的照料者有效,但只有少数措施得以付诸实践。本研究旨在调查这些措施的实施情况、方式及原因。
方法
这项定性研究对Boots等人(2014年)关于痴呆症患者非正式照料者电子健康干预措施的广泛引用的系统评价中包含的12篇出版物进行了跟进,以进一步探讨其在实践中的实施情况。评估了公开可得的在线信息、实施准备情况(ImpRess清单得分)和调查回复。
结果
两项干预措施可在网上免费获取,两项在试验环境中可用,一项仅提供给先前参与该研究项目的临床工作人员。其余七项无法获取。ImpRess清单上的所有得分均为总分的50%或更低,表明在Boots等人(2014年)进行综述时,这些干预措施尚未准备好实施,不过在后续的跟进出版物中,一些干预措施的实施准备得分更高。十二位作者中有六位回复了调查。调查的主要经验教训包括利益相关者在过程各阶段参与的重要性,以及干预措施的灵活调整和商业化。
结论
总体而言,报告的实施准备水平较低,而且通常无法获得评估实施准备情况所需的信息。仅有的两项免费干预措施获得了老年基金会的长期资助。作者指出,资金把关人参与开发过程以及尽早创建商业模式是实施的重要促进因素。未来的研究应关注实现可持续实施的因素。