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Choi H, Jung YI, Kim H. Implementation fidelity of the Systems for Person-Centered Elder Care (SPEC): a process evaluation study. Implement Sci 2021; 16:52. [PMID: 33980251 PMCID: PMC8117605 DOI: 10.1186/s13012-021-01113-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Systems for Person-Centered Elder Care (SPEC), a complex intervention, was conducted to examine its effectiveness as a technology-enhanced, multidisciplinary, and integrated care model for frail older persons among ten nursing homes (NHs) in South Korea where formal long-term care has recently been introduced. The purpose of this study was to evaluate the implementation fidelity of the SPEC intervention and to identify moderating factors that influence the implementation fidelity. METHODS This study was a process evaluation based on an evidence-based framework for implementation fidelity using a mixed-methods design. Quantitative data from consultant logbooks, NH documentations, an information and communications technology (ICT) system, and a standardized questionnaire were collected from April 2015 to December 2016 and analyzed by calculating the descriptive statistics. Semi-structured focus group interviews were held with multidisciplinary teams from the participating NHs. Qualitative data from a semi-structured questionnaire and the focus group interviews were analyzed using content analysis. RESULTS The SPEC program demonstrated good implementation fidelity, and adherence to the SPEC program was strong in all aspects, such as content, coverage, frequency, and duration. Of the participating on-site coordinators, 60% reported that the SPEC model positively impacted needs assessment and the reporting system for resident care. The important facilitating factors were tailored facilitating strategies, assurance of the quality of delivery, and recruitment strategies. CONCLUSION The effectiveness of the SPEC program was driven by good implementation fidelity. The key factors of good implementation fidelity were tailored delivery of evidence-based interventions over process evaluation work, facilitating strategies, and ICT support. Larger implementation studies with a more user-friendly ICT system are recommended. TRIAL REGISTRATION ISRCTN registry, ISRCTN11972147 . Registered on 16 March 2015.
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Affiliation(s)
- Hyoungshim Choi
- Department of Nursing, Hansei University, 30 Hansei-ro, Gyeong-gi, South Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, 86 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Hongsoo Kim
- Graduate School of Public Health, Department of Public Health Sciences, Institute of Aging, Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
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2
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Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, van Balen R, Kempen GIJM, Achterberg WP, van Haastregt JCM. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr 2021; 21:224. [PMID: 33794804 PMCID: PMC8017759 DOI: 10.1186/s12877-021-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION Netherlands Trial Register: NTR5695 (7 March 2016).
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Rooijackers TH, Zijlstra GAR, van Rossum E, Vogel RGM, Veenstra MY, Kempen GIJM, Metzelthin SF. Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults. BMC Geriatr 2021; 21:5. [PMID: 33407189 PMCID: PMC7789187 DOI: 10.1186/s12877-020-01936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Teuni H Rooijackers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Research Center for Community Care, Academy of Nursing, P.O. Box 550, 6400 AN, Heerlen, The Netherlands
| | - Ruth G M Vogel
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Marja Y Veenstra
- Burgerkracht Limburg, P.O. Box 5185, 6130 PD, Sittard, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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4
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Evers SMAA, Dorresteijn TAC, Wijnen BFM, van Haastregt JCM, Kempen GIJM, Zijlstra GAR. Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people. Expert Rev Pharmacoecon Outcomes Res 2019; 20:641-651. [PMID: 31502897 DOI: 10.1080/14737167.2019.1666714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Concerns about falls, or fear of falling, are frequently reported by older people and can have serious consequences. Aim of this study was to evaluate the cost-effectiveness of a home-based, cognitive behavioral programme for independently-living, frail older people in comparison with usual care from a societal perspective. Methods: This economic evaluation was embedded in a randomized-controlled trial with a follow-up of 12-months. In the trial 389 people aged 70 years or older were allocated to usual care (n = 195) or the intervention group (n = 194). The intervention group received a home-based, cognitive behavioral programme. Main outcome measures were concerns about falls and Quality Adjusted Life Years (QALYs). Results: Average total costs per participant in the usual care group were 8,094 Euros and 7,890 Euros for participants in the intervention group. The intervention group showed a significant decrease in concerns about falls and a non-significant increase in QALYS in comparison with the usual care group. The probability that the intervention was cost-effective was 75% at a willingness to pay of 20,000 Euros per QALY. Discussion: The programme is likely to be cost-effective, and therefore a useful addition to current geriatric care, particularly for those persons who are not able or willing to attend group programmes. Trial registration: NCT01358032.
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Affiliation(s)
- Silvia M A A Evers
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands
| | - Tanja A C Dorresteijn
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Ben F M Wijnen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
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Fall Risk Reduction Program Paired with a Transportation Program in an Underserved, Urban Minority Community: A Qualitative Evaluation. J Aging Res 2019; 2019:2719290. [PMID: 31354996 PMCID: PMC6636562 DOI: 10.1155/2019/2719290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/04/2019] [Indexed: 11/20/2022] Open
Abstract
This study sought to evaluate A Matter of Balance/Volunteer Lay Leaders (AMOB/VLL) fall prevention curriculum in combination with a “door-through-door” program: Coordinated Older-Adult Senior Transportation Services (COASTS) for older adults living in an urban, underserved community. AMOB/VLL participants were offered eight 2-hour classes as part of the training program. Focus groups were conducted with older adult participants, COASTS mobility facilitators, and AMOB/VLL master trainers. A thematic analysis was conducted, and primary themes relating to curriculum content, cultural relevancy, and outcomes were examined. Older adults and facilitators felt the course was rewarding and led to improvements in mobility and confidence. Master trainers were more critical and recommended simplifying content, with tailored guidance for specific populations. They also recommended increased emphasis on balance and physical activity. Although participants and MoFas felt combining AMOB/VLL and COASTS was rewarding and improved participant mobility, master trainers and participants suggested minor modifications to increase program benefits for urban, underserved communities.
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Lorthios-Guilledroit A, Filiatrault J, Richard L. Assessment of Implementation Outcomes of a Peer-Led Program Targeting Fear of Falling Among Older Adults. J Appl Gerontol 2019; 39:1035-1045. [PMID: 31130035 DOI: 10.1177/0733464819850083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This study examined the implementation outcomes (program reach, fidelity, adaptations, responsiveness) of a peer-led program for older adults with fear of falling -Vivre en Équilibre (VEE). Method: VEE was implemented in six independent-living residences for older adults in Quebec (Canada) as part of an effectiveness study. Implementation outcomes were documented using attendance sheets, peer leaders' logbooks, observation sheets, and phone-administered questionnaires. Qualitative interviews were also conducted with peer leaders, activity coordinators of residences, and a subsample of program participants. Results: The program reached 71 participants who generally corresponded to the program's target population. Peer leaders delivered the program with moderate to high fidelity but adapted some elements. Responsiveness was good, as reflected by a high attendance rate (91%) and respondents' satisfaction levels. Conclusion: Findings revealed that VEE was well implemented, suggesting that it can be successfully delivered by peer leaders.
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Affiliation(s)
| | - Johanne Filiatrault
- Université de Montréal, Québec, Canada.,Institut universitaire de gériatrie de Montréal, Québec, Canada
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7
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van Knippenberg RJM, de Vugt ME, Smeets CMJ, Myin-Germeys I, Verhey FRJ, Ponds RW. Dealing with daily challenges in dementia (deal-id study): process evaluation of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia. Aging Ment Health 2018; 22:1199-1206. [PMID: 28714738 DOI: 10.1080/13607863.2017.1348466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study describes the process evaluation of the experience sampling method (ESM) intervention 'Partner in Sight' for spousal caregivers of people with dementia. The aim was to determine internal and external validity of the intervention and provide information for future implementation in clinical practice. METHOD Qualitative and quantitative data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, adherence to protocol) were evaluated using descriptive statistics and conventional content analysis. RESULTS The participation rate included 31.4%. Due to recruitment difficulties and time constraints the original goal to include 90 caregivers was not met. The intervention was largely performed according to protocol and well received by the participants. Overall, the ESM-derived feedback was considered supportive and increased participants' awareness of their feelings and behavior. A large variance was found in the extent to which caregivers applied the feedback into their daily lives. The importance of the personal coach to provide face-to-face feedback and stimulate caregivers to implement new insights into their daily lives was emphasized. Suggestions for improvement were to reduce the time intensity of the program, to better tailor the program content to one's personal situation, and to improve the ESM device. CONCLUSION Although recruitment barriers were encountered, results indicate that future implementation of the ESM intervention 'Partner in Sight' is likely to be feasible in regular health care. If the intervention turns out to be (cost-) effective, a fine-tuned version of the program could be a valuable addition to the current health care system.
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Affiliation(s)
- Rosalia J M van Knippenberg
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Marjolein E de Vugt
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Claudia M J Smeets
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Inez Myin-Germeys
- b Department of Neurosciences, Center for Contextual Psychiatry , KU Leuven , Leuven , Belgium
| | - Frans R J Verhey
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
| | - Rudolf W Ponds
- a Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands
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Boots LM, de Vugt ME, Smeets CM, Kempen GI, Verhey FR. Implementation of the Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Process Evaluation of a Randomized Controlled Trial. J Med Internet Res 2017; 19:e423. [PMID: 29258980 PMCID: PMC5750419 DOI: 10.2196/jmir.7666] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 09/14/2017] [Accepted: 09/30/2017] [Indexed: 12/28/2022] Open
Abstract
Background Caring for a family member with dementia puts caregivers at risk of overburdening. Electronic health (eHealth) support for caregivers offers an opportunity for accessible tailored interventions. The blended care self-management program “Partner in Balance” (PiB) for early-stage dementia caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored Web-based modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability and interpretation of results. Objective The aim of this study was to describe the process evaluation from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to determine internal and external validity before the effect analysis and aid future implementation. Methods Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from logistical research data, coach questionnaires (n=13), and interviews with coaches (n=10) and participants (n=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis. Results The participation rate of eligible caregivers was 51.9% (80/154). Recruitment barriers were lack of computer and lack of need for support. Young age and employment were considered recruitment facilitators. All coaches attended training and supervision in blended care self-management. Deviations from the structured protocol were reported on intervention time, structure, and feedback. Coaches described an intensified relationship with the caregiver post intervention. Caregivers appreciated the tailored content and positive feedback. The blended structure increased their openness. The discussion forum was appreciated less. Overall, personal goals were attained after the program (T>50). Implementation barriers included lack of financing, time, and deviating target population. Conclusions Participants and coaches were satisfied with the intervention, but adapting the content to specific subgroups, for example, younger caregivers, was recommended. Implementation of the program requires more awareness of the benefits of blended care self-management programs and training in tailored self-management skills. Trial Registration Dutch Trial Register (NTR): NTR4748; http://www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg)
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Affiliation(s)
- Lizzy Mm Boots
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Claudia Mj Smeets
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gertrudis Ijm Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Frans Rj Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Maastricht, Netherlands
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Kuk NO, Zijlstra GAR, Bours GJJW, Hamers JPH, Tan FES, Kempen GIJM. Promoting Functional Activity Among Nursing Home Residents: A Cross-Sectional Study on Barriers Experienced by Nursing Staff. J Aging Health 2017; 30:605-623. [PMID: 28553799 DOI: 10.1177/0898264316687407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To obtain insight into (a) the prevalence of nursing staff-experienced barriers regarding the promotion of functional activity among nursing home residents, and (b) the association between these barriers and nursing staff-perceived promotion of functional activity. METHOD Barriers experienced by 368 nurses from 41 nursing homes in the Netherlands were measured with the MAastrIcht Nurses Activity INventory (MAINtAIN)-barriers; perceived promotion of functional activities was measured with the MAINtAIN-behaviors. Descriptive statistics and hierarchical linear regression analyses were performed. RESULTS Most often experienced barriers were staffing levels, capabilities of residents, and availability of resources. Barriers that were most strongly associated with the promotion of functional activity were communication within the team, (a lack of) referral to responsibilities, and care routines. DISCUSSION Barriers that are most often experienced among nursing staff are not necessarily the barriers that are most strongly associated with nursing staff-perceived promotion of functional activity.
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Affiliation(s)
- Nienke O Kuk
- 1 Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands
| | - G A Rixt Zijlstra
- 1 Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands
| | - Gerrie J J W Bours
- 1 Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands.,2 Research Centre for Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jan P H Hamers
- 1 Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands
| | - Frans E S Tan
- 3 Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands
| | - Gertrudis I J M Kempen
- 1 Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands
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10
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Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr 2016; 16:2. [PMID: 26739339 PMCID: PMC4704266 DOI: 10.1186/s12877-015-0177-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/17/2015] [Indexed: 11/05/2022] Open
Abstract
Background Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs. Trial registration ClinicalTrials.gov, NCT01358032. Registered 17 May 2011
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Affiliation(s)
- Tanja A C Dorresteijn
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Antonius W Ambergen
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, P.O. Box 1165, Randwick, NSW, 2031, Australia.
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium. .,Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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11
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Chang SF, Yang RS, Lin TC, Chiu SC, Chen ML, Lee HC. The Discrimination of Using the Short Physical Performance Battery to Screen Frailty for Community-Dwelling Elderly People. J Nurs Scholarsh 2014; 46:207-15. [DOI: 10.1111/jnu.12068] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Shu-Fang Chang
- Associate Professor, Department of Nursing, College of Nursing; National Taipei University of Nursing and Health Sciences; Taiwan
| | - Rong-Sen Yang
- Professor, Department of Orthopedic Surgery; National Taiwan University Hospital; Taipei Taiwan
| | - Tsung-Ching Lin
- Instructor, Department of Physical Medicine and Rehabilitation; Far Eastern Memorial Hospital; Taipei Taiwan
| | - Shu-Ching Chiu
- Instructor, General Education Center; Central Taiwan University of Science and Technology; Taichung Taiwan
| | - Mei-Li Chen
- Instructor, Department of Nursing, College of Nursing; National Taipei University of Nursing and Health Sciences; Taiwan
| | - Hui-Chen Lee
- Instructor, Department of Nursing, College of Nursing; National Taipei University of Nursing and Health Sciences; Taiwan
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