The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

Abstract

Background The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change. Methods A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis. Results Barriers and facilitators were analysed according the COM-B domains. “Capability” factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff “motivation” included skilled facilitation of training, trainees’ desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). “Opportunity” factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential. Conclusions A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

Collaborative knowledge sharing in developing and evaluating a training programme for health professionals to implement a social intervention in dementia research

“…Our findings indicate that knowledge sharing collaboratively was a core component to enable intervention facilitators to practise good communication skills and provide a range of choices and encouragements to people with dementia and their supporter to engage in the social intervention (Pals et al , 2020). Given an interactive face-to-face and group-based learning environment that enabled intervention facilitator to engage in active learning could optimise the potential of behaviour change (Surr et al , 2020) and increased positive perceptions and attitudes towards collaborative knowledge sharing (Marouf, 2015).…”

Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action Research: Examining Implementation Through the Consolidated Framework for Implementation Research (CFIR)

“…From the champions and staff perspectives, inconsistent attendance led to challenges with continuity of learning across sessions and attendance sometimes led to stress for staff when trying to catch up on work afterward. Surr et al (20) previously highlighted that opportunity factors such as lack of time and staff are prevalent barriers to implementing dementia care interventions in nursing homes. A study using the VOCALISE instrument in the inpatient mental health context found that staff attitudes to change worsened over the course of an intervention due to lack of resources to implement the change (34).…”

“…This pattern has been noted in other implementation studies in the healthcare context (38). Individual capability factors are not often identi ed as barriers compared to opportunity or motivation factors in dementia education literature (19,20). Maybe individual characteristics have a more indirect effect on implementation compared to other factors.…”

Effects of a Person Centered Dementia Training Program in Greek Hospital Staff—Implementation and Evaluation

“…Specifically, the supporting managers or conditions in the frame of strong leadership, initiative approaches, teamwork and continuous action and redesigning the ward environment are the most valuable factors [ 30 , 49 , 61 , 65 , 78 ]. However, there are some objective barriers that make the organization changes difficult, like bureaucracy [ 74 , 79 ], hierarchical culture focused on internal stability, models of working resistant to flexibility/openness [ 80 ] and lack of resources (time, financial, staffing and environmental) [ 49 , 81 ], as already mentioned. Another objective barrier regarding to the Greek community, is poor distribution of existing healthcare resources due to the unique characteristics of the healthcare system.…”