Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
Age Ageing. 2024 May 1;53(5). doi: 10.1093/ageing/afae109.
This process evaluation was conducted in parallel to the randomised controlled feasibility trial of NIDUS-Professional, a manualised remote dementia training intervention for homecare workers (HCWs), delivered alongside an individualised intervention for clients living with dementia and their family carers (NIDUS-Family). The process evaluation reports on: (i) intervention reach, dose and fidelity; (ii) contexts influencing agency engagement and (iii) alignment of findings with theoretical assumptions about how the intervention might produce change.
We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6-8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data.
32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners.
NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial.
本过程评估与 NIDUS-Professional 的随机对照可行性试验同时进行，NIDUS-Professional 是一种针对家庭护理员（HCWs）的手动远程痴呆症培训干预措施，同时为患有痴呆症的客户及其家庭照顾者（NIDUS-Family）提供个性化干预措施。该过程评估报告了以下内容：（i）干预措施的覆盖范围、剂量和保真度；（ii）影响机构参与的背景因素；（iii）研究结果与关于干预措施如何产生变化的理论假设的一致性。
我们报告了接受任何干预措施的合格 HCWs 的比例（覆盖范围）、参加的课程次数（剂量；参加≥4/6 次主要课程被定义为坚持）、HCWs 对 NIDUS-Family 的干预保真度和坚持性（参加所有 6-8 次计划课程），以及客户和照顾者对 NIDUS-Family 的坚持性。我们采访了 HCWs、经理、家庭照顾者和协调员。我们整合了定性访谈和干预记录数据，并在家庭护理机构层面上进行了主题分析。
32/141（23%）名符合条件的 HCWs 和 7/42（17%）名家庭照顾者接受了任何干预措施；大多数接受干预的人都坚持下来了（89%和 71%）。干预保真度很高。我们分析了对 20/44 名 HCWs、3/4 名经理和 3/7 名家庭照顾者的访谈，以及涉及 32/44 名 HCWs 的干预记录。所有机构都报告了在支持干预措施实施方面存在结构性挑战。管理支持度较高的机构，剂量和覆盖范围更高。HCWs 认为 NIDUS-Professional 能够促进小组反思和同行支持，提供实用的、可操作的护理策略，并提高他们作为从业者的信心。
NIDUS-Professional 受到 HCWs 的重视。机构管理、文化和优先事项是实施的关键障碍；我们讨论了如何在未来的试验中解决这些问题。
