Barriers and facilitators to implementing dementia care mapping in care homes: results from the DCM™ EPIC trial process evaluation

Abstract

BackgroundPsychosocial person-centred interventions are considered best practice for addressing complex behaviours and care needs such as agitation and anxiety, and for improving the quality of life of people with dementia in care homes. Dementia Care Mapping (DCM™) is an established practice development tool and process aimed to help care home staff deliver more person-centred care. To date, few studies have evaluated the efficacy of DCM™ and have found mixed results. These results are suggested to be the outcome of intervention implementation, which may be impacted by a range of factors. This study reports the barriers and facilitators to DCM™ implementation in care homes found during the process evaluation conducted as part of a randomized controlled trial.MethodsEighteen of the 31 DCM™ intervention care homes were recruited to participate in the embedded process evaluation. Semi-structured interviews were conducted with 83 participants, comprising care home managers, trained DCM™ users (mappers), expert external mappers, staff members, relatives, and residents.ResultsBarriers and facilitators to DCM™ implementation were found at the mapper level (e.g. motivation and confidence), the DCM™ intervention level (e.g. understanding of DCM™) and the care home level (e.g. staffing issues, manager support). Further barriers caused by the burden of trial participation were also identified (e.g. additional paperwork).ConclusionsImplementing DCM™ is complex and a greater consideration of potential barriers and facilitators in planning future studies and in practice could help improve implementation.Trial registrationCurrent Controlled Trials ISRCTN82288852, registered 16/01/2014.

What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

“…Table 1 displays characteristics of included studies. Most of the studies were from the Netherlands [19,21,29,30,37,42] and the UK [23,25,28,32,33,40] (each n = 6), followed by Australia [24,34,41], Canada [20,22,27], Norway [26,31,36] (each n = 3), Germany [38,39], and Belgium [18,43] (each n = 2). One multinational study took place in Italy and the Netherlands [35].…”

“…Data concerning barriers and facilitators were collected through interviews [10,43] (n = 24), by means of questionnaires [19,23,24,31,38] (n = 6), field notes or process data notes [26,32,37,38] (n = 4), observation [25,39,40] (n = 3), workshops [36] (n = 1), written evaluations by trainers/instructors [37] (n = 1), residents' records [38] (n = 1) and/or by asking openended questions [18] (n = 1). Qualitative data were analysed using thematic or content analysis [18-27, 29, 31-42] (n = 23) or framework analysis [28,32] (n = 2). Quantitative data analysis was based on multilevel regression analysis [31] (n = 1) or descriptive statistics [38] (n = 1).…”

“…All were part of the intervention or the implementation (n = 23 studies). Family caregivers were asked in three studies [22,28,42] and people with dementia in two studies [28,29]. Three studies included persons facilitating the intervention [24,30,36,40] and one study included volunteers [29].…”

“…Barriers: The category organisational culture and vision summarizes influencing factors. Distinctive hierarchical structures [18,27,28,36,38,39], inadequate regulations within the organisation [21,35] and a taskfocused, functional culture of care [34,38,39] are examples for hindering factors within this category. Furthermore, authors of several studies report a lack of management and leader support and engagement as a hindering factor [21, 28, 31-33, 36-38, 40].…”

“…High rates of staff turnover and fluctuation [19,22,32,34,37,38,40,42] as well as demands competing with the intervention [19,21,22,25,26,28,33,34,37,39,40] are mentioned as further barriers. Competing demands comprise other innovations or organisational changes taking place at the same time as well as multiple and contradictory requirements.…”