How can web-based training facilitate a more carer friendly practice in community-based health and social care services in Norway? Staff experiences and implementation challenges

How central support built capacity to deliver a health-promoting intervention for older adults in Canada

Most implementation frameworks note that a central support unit (CSU) is key to successful implementation and scale-up of evidence-based interventions (EBIs). However, few studies investigated core functions of CSUs-such as capacity building-to better understand their essential role in implementing EBIs at scale. Therefore, the aims of our study are to (1) describe the role that a CSU plays to build capacity in delivery partner organisations, to enable implementation and scale-up of a health-promoting intervention (Choose to Move [CTM]) for older adults, and (2) identify elements within capacity-building strategies deemed essential to effectively implement CTM in diverse community contexts. CTM is a flexible, scalable, community-based health-promoting physical activity (PA) and social connectedness intervention for older adults. In 2018-2020, eight health and social service societies, rural or remote municipalities or community-based organisations delivered 22 CTM programmes that served 322 older adults. We conducted in-depth interviews with delivery partners (n = 23), and a focus group with the central support system (n = 4). CSU provided a sounding board to organisations to create buy-in (adoption) and plan ahead. Essential elements within capacity-building strategies included: a support unit champion, enhanced delivery partner skills, self-efficacy and confidence; interactive assistance to answer questions and clarify materials. There is a key role for capacity-building under the stewardship of the CSU to promote implementation success. Investigating specific elements within capacity-building strategies that drive implementation success continues to be a relevant question for implementation science researchers, that deserves further attention.

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross-sectional survey

AIMS

To explore care staff knowledge about falls and confidence, motivation and opportunity to undertake fall prevention strategies, in residential aged care (RAC) along with preferences for fall prevention education.

BACKGROUND

Falls account for the majority of adverse clinical events in RAC settings. Care staff in RAC settings are in a key position to influence residents' actions to prevent falls, provided they have the necessary knowledge and skills.

METHODS

A cross-sectional survey design with a purposive sample of 147 care staff at eight RAC facilities was undertaken in 2015. A custom-designed questionnaire examining knowledge, confidence, motivation and opportunity to undertake falls prevention strategies was used.

RESULTS

Only 39 (26.5%) care staff were aware that the residents they cared for were at high risk of falls. Care staff knowledge of intrinsic falls risk factors was very limited, for example, only 18 (13.53%) observed for side effects of medication and just four (1.04%) were aware of continence issues. Conflicting duties also limited care staff time to undertake falls prevention strategies. Preferences for falls prevention education indicated face-to-face interactive discussions in the workplace (n = 98, [66.7%]) with reminder posters displayed around the facility (n = 80, [70.8%]).

CONCLUSIONS

Residential aged care organisations need to engage with care staff to provide tailored falls education incorporating learning preferences and targeting knowledge gaps, to improve awareness of intrinsic risk factor impact and uptake of evidence-based prevention strategies. Despite care staff being highly motivated, they have limited opportunity to assist residents with fall prevention within their workload. RAC management and funding bodies must address opportunity for care staff to fulfil this crucial role to benefit resident safety.

IMPLICATION FOR PRACTICE

This study identified gaps in care staffs' knowledge and skills in undertaking falls prevention strategies in residential aged care settings. These findings will assist residential aged care organisations and health professional educators to design evidence-based falls prevention education tailored to their care staffs' needs and preferences to facilitate adoption.