Co-design of an implementation plan for a digital holistic assessment and decision support framework for people with dementia in care homes
Juliet is an ESRC PhD training fellow at the Cicely Saunders Institute at King’s College London. She also works as a research assistant on the EMBED-Care programme which stands for ‘EMpowering Better End of life Dementia-Care’. Her research is focusing on implementation of an eHealth intervention to support assessment and decision making for residents with dementia in care homes.
Positive findings around the use of eHealth to support dementia care in care homes are unfortunately insufficient to ensure its adoption in routine practice. A key strategy to promote uptake of eHealth is to co-design the intervention and implementation plan with users and relevant stakeholders. The aim of this study was to develop a plan with people with dementia, family carers and health and social care professionals to implement an eHealth intervention in care homes.
An iterative co-design method was applied through a series of workshops which focused on co-developing implementation strategies, in response to identified determinants of implementation. Participants included family carers of people with dementia and practitioners with direct experience of working in care homes. A deductive thematic analytic approach was taken, guided by the constructs of the Normalisation Process Theory (NPT). Where data did not align, an inductive approach was taken.
Implementation strategies which promoted the constructs of the NPT were selected. To target ‘coherence’, strategies focused on developing materials to promote the value of the eHealth intervention. ‘Cognitive participation’ was targeted through strategies which aim to maximise engagement with the intervention, including identifying champions and engaging care home managers. To promote ‘collective action’, strategies centered around maximising compatibility between routine practice and the intervention, and providing sufficient training and built-in user prompts. Strategies around ongoing adjustment and evaluation of the plan targeted ‘Reflexive monitoring’.
Implementing eHealth into such a complex system is a multifaceted process involving multiple stakeholders. Collaborating with stakeholders provided unique insight and perspective which can only be gained through lived-experience, and allowed us to co-develop a credible implementation plan with real world relevance. The theoretically informed strategies target the constructs of the NPT; mechanisms previously demonstrated to shape implementation process and outcomes. The plan is now ready for feasibility testing in care homes.