Adapting a Dementia Care Management Intervention for Regional Implementation: A Theory-Based Participatory Barrier Analysis

Abstract

Dementia is a leading cause of disability and dependency in older people worldwide. As the number of people affected increases, so does the need for innovative care models. Dementia care management (DCM) is an empirically validated approach for improving the care and quality of life for people with dementia (PwD) and caregivers. The aim of this study is to investigate the influencing factors and critical pathways for the implementation of a regionally adapted DCM standard in the existing primary care structures in the German region of Siegen-Wittgenstein (SW). Utilizing participatory research methods, five local health care experts as co-researchers conducted N = 13 semi-structured interviews with 22 local professionals and one caregiver as peer reviewers. Data collection and analysis were based on the Consolidated Framework for Implementation Research (CFIR). Our results show that among the most mentioned influencing factors, three CFIR constructs can be identified as both barriers and facilitators: Patients’ needs and resources, Relative advantage, and Cosmopolitanism. The insufficient involvement of relevant stakeholders is the major barrier and the comprehensive consideration of patient needs through dementia care managers is the strongest facilitating factor. The study underlines the vital role of barrier analysis in site-specific DCM implementation.

Project DECIDE, part II: decision-making places for people with dementia in Alzheimer’s disease: supporting advance decision-making by improving person-environment fit

“…Future research could investigate the integration of our SDM strategy into overall dementia care management (DCM). DCM is a collaborative model of care in which qualified professionals support PwAD and their caregivers in a home setting according to their individual needs [ 37 ]. These professionals could be trained in the assessment of capacity to consent and in the use of SDM to support PwAD in complex decision-making situations.…”

Participatory development and implementation of a dementia care pathway with intervention bundles in acute care during the coronavirus pandemic: A process evaluation study

“…Two recent studies using the CFIR as a theoretical framework, conducted in a long‐term care and a primary care setting, also reported similar findings. Shortage of staff and insufficient time for involvement in implementation activities, together with insufficient engagement and participation (Coffey et al, 2021), non‐readiness within the organisation, as well as a misfit between the organisation and the intervention (Seidel et al, 2022) were identified as main barriers to adoption or reasons for implementation failure.…”

“…High staff fluctuations, both within the clinical teams, the champions, as well as the research team, resulted in fractured engagement and diminishing support from the stakeholders. Prior research found that the availability of internal and external support, along with trained facilitators and flexible delivery of training units, were key enablers in dementia training and education programmes (Heward, Board, Spriggs, Blagden, & Murphy, 2021; Surr, Parveen, et al, 2020) when implementing evidence‐based guidance (Coffey et al, 2021; Karrer et al, 2020; Seidel et al, 2022). The fractured engagement processes and lack of skilled facilitation, insufficient training opportunities, particularly in relation to the champions' role, undermined some of the expected benefit of the employed co‐design strategies.…”

“…The pandemic circumstances posed particular challenges because it caused interruptions and final termination of the implementation process. For example the participating units be- (Heward, Board, Spriggs, Blagden, & Murphy, 2021; when implementing evidence-based guidance (Coffey et al, 2021;Karrer et al, 2020;Seidel et al, 2022). The fractured engagement processes and lack of skilled facilitation, insufficient training opportunities, particularly in relation to the champions' role, undermined some of the expected benefit of the employed co-design strategies.…”

The memory clinic and psychosocial intervention: Translating past promise into current practices

“…The PriDem study across England and Wales notes that despite some financial incentives, GPs may not have the capacity to deliver good quality dementia care ( 23 ). European primary care studies also report problems in GP engagement in delivery of dementia initiatives ( 24 , 25 ). Reasons for fragile post-diagnostic dementia care include fragmentation, poor communication around care pathways and inadequate health and social care policies ( 26 , 27 ).…”