Natalie Davoodi, Miranda Olson, Rebecca Uth, Rosa Baier, James Rudolph, Esme Zediker, Renee Shield, McCreedy Ellen
Center for Gerontology and Healthcare Research Brown University School of Public Health Providence Rhode Island USA.
Center for Long-Term Care Quality & Innovation Brown University School of Public Health Providence Rhode Island USA.
Alzheimers Dement (N Y). 2024 Oct 21;10(4):e70006. doi: 10.1002/trc2.70006. eCollection 2024 Oct-Dec.
Non-pharmacological interventions (NPIs) are preferred alternatives to using antipsychotic medications to manage disruptive behaviors in nursing home (NH) residents living with dementia. However, the implementation of these interventions is often complex in the NH environment. In this qualitative analysis of data from an embedded pragmatic clinical trial (ePCT) of a personalized music intervention, we describe NH-level implementation barriers and facilitators.
In a 54-facility trial, we randomized 27 NHs from four US corporations to the personalized music intervention. In this qualitative analysis, we analyzed barriers and facilitators at 9 of the 27 intervention NHs, using (1) routinely collected data collector observations and (2) semi-structured interviews with NH staff. We iteratively developed codes to best describe these data and generated themes.
We found five qualitative themes related to the variation of intervention implementation across NHs: (1) turnover and institutional changes interfered with implementation; (2) consistent with pragmatic implementation, delivery strategies varied across NHs; (3) family members influenced residents' participation; (4) non-clinical program champions needed clinical buy-in, which was challenging and required demonstrating the intervention's clinical benefits; and (5) technological barriers among staff and residents impeded implementation.
Qualitative results from nine facilities participating in a NH ePCT of personalized music intervention highlight the importance of identifying an intervention's key components to ensure fidelity, while allowing the flexibility necessary for pragmatic implementation. Engaging family caregivers may improve the implementation of NPIs in the NH setting. Results may be helpful to other researchers implementing NPIs to manage neuropsychiatric symptoms for people living with dementia in NHs.
This was a real-world trial of a personalized music for nursing home (NH) residents with dementia.Pragmatic adaptations to intervention delivery may have compromised fidelity.Family caregivers are important to the success of behavioral interventions in NHs.
非药物干预（NPIs）是管理患有痴呆症的养老院（NH）居民破坏性行为的首选替代方法，可替代使用抗精神病药物。然而，在养老院环境中实施这些干预措施通常很复杂。在这项对个性化音乐干预的嵌入式实用临床试验（ePCT）数据的定性分析中，我们描述了养老院层面的实施障碍和促进因素。
在一项涉及54个机构的试验中，我们将来自美国四家公司的27家养老院随机分为个性化音乐干预组。在这项定性分析中，我们使用（1）常规收集的数据收集者观察结果和（2）对养老院工作人员的半结构化访谈，分析了27家干预养老院中的9家的障碍和促进因素。我们反复制定代码以最好地描述这些数据并生成主题。
我们发现了五个与各养老院干预实施差异相关的定性主题：（1）人员更替和机构变化干扰了实施；（2）与实用实施一致，各养老院的实施策略各不相同；（3）家庭成员影响居民参与；（4）非临床项目支持者需要临床认可，这具有挑战性且需要证明干预措施的临床益处；（5）工作人员和居民之间的技术障碍阻碍了实施。
参与养老院个性化音乐干预ePCT的九个机构的定性结果强调了确定干预关键组成部分以确保保真度的重要性，同时允许实用实施所需的灵活性。让家庭护理人员参与可能会改善养老院环境中NPIs的实施。研究结果可能有助于其他实施NPIs以管理养老院中痴呆症患者神经精神症状的研究人员。
这是一项针对患有痴呆症的养老院（NH）居民的个性化音乐的实际试验。对干预实施的实用调整可能会损害保真度。家庭护理人员对养老院行为干预的成功很重要。
