Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults

Abstract

Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303). Registered 26 September 2017.

A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints

“…Tighter financial and organizational constraints could also affect the boundary between helping and enabling by derailing the shift towards enabling (and not ‘doing for’) older people. While the features of reablement reported in our findings are in line with existing reablement literature [ 9 , 11 , 41 , 62 ], there is variation in what is understood as reablement care, its components and implementation [ 5 , 11 , 45 ]. Findings from this study and others, and The recently developed and more unified definition of reablement [ 9 ], should help advance research and practice in the field [ 9 , 11 ], including in the areas of process and outcomes evaluation.…”

Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior: A cluster randomized controlled trial

“…A 1‐year time window may not suffice to bring about change at both levels. This is in line with findings of the earlier process evaluation that staff experienced positive changes in their knowledge, attitude, and skills about reablement, and perceived social and organizational support to implement reablement, but still considered it challenging to integrate reablement into their way of working 31 . More time and effort may be needed to change the behavior of both staff and clients to allow for a more adequate evaluation of how these changes impact health outcomes (both in terms of improving function and reducing the rate of decline in function).…”

“…This is in line with findings of the earlier process evaluation that staff experienced positive changes in their knowledge, attitude, and skills about reablement, and perceived social and organizational support to implement reablement, but still considered it challenging to integrate reablement into their way of working. 31 More time and effort may be needed to change the behavior of both staff and clients to allow for a more adequate evaluation of how these changes impact health outcomes (both in terms of improving function and reducing the rate of decline in function). Adjustments to SAaH, such as adding components that directly intervene on clients, revising program materials, and clarifying roles and responsibilities of staff involved in the implementation, may optimize the program and require further research.…”

“…More information on the program's implementation can be found elsewhere. 31 Control group staff ( n = 159) received no training and delivered care as usual.…”

“… 29 , 30 Furthermore, a process evaluation revealed that staff generally accepted the program, experienced positive changes in their knowledge, attitude, and skills about reablement, and perceived social and organizational support to implement reablement. 31 This cluster randomized controlled trial (c‐RCT) aimed to evaluate the effectiveness of SAaH on older homecare clients' sedentary behavior (primary outcome), and daily functioning, physical functioning, psychological functioning, and falls (secondary outcomes).…”