A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework.

BACKGROUND: Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings. AIMS: This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions. METHODS: In 2013, a qualitative focus group study was conducted in five purposively sampled residential care facilities in western Canada. A convenience sample of 24 HCAs agreed to participate in five focus groups. Concurrent with data collection, two researchers coded the transcripts and identified themes by consensus. They jointly determined when saturation was achieved and took steps to optimize the trustworthiness of the findings. Five HCAs from the original focus groups commented on the resulting conceptual framework. RESULTS: HCAs were cautious about accepting a role that might alienate them from their co-workers. They emphasized feeling comfortable with the peer reminder role and identified circumstances that would optimize their comfort including: effective implementation strategies, perceptions of the role, role credibility and a supportive context. These intersecting themes formed a peer reminder conceptual framework. LINKING EVIDENCE TO ACTION: We identified HCAs' perspectives of a new peer reminder role designed specifically for them. Based on their perceptions, a conceptual framework was developed to guide the implementation of a peer reminder role for HCAs. This role may be a strategic implementation strategy to optimize the sustainability of new practices in residential care settings, and the related framework could offer guidance on how to implement this role.

Knowledge translation interventions to sustain direct care provider behaviour change in long-term care: A process evaluation.

RATIONALE, AIMS, AND OBJECTIVES: Process evaluation can be used to understand the factors influencing the impact of knowledge translation (KT) interventions. The aim of this mixed methods process evaluation was to evaluate the processes and perceived outcomes of eight KT interventions that were used with healthcare aides (HCAs) to introduce a mobility innovation into their daily care practices. The study examined the perceived effectiveness of various KT interventions in sustaining daily performance of the sit-to-stand mobility innovation by HCAs with residents in long-term care. METHOD: In-person interviews were conducted with four leaders across three long-term care facilities. Seven focus groups with 27 HCAs were conducted across the three facilities. All participants were asked to rank the eight interventions involved in the trial according to their perceived effectiveness and, for the leaders, their perceived ease of implementation. Focus group and interview questions asked participants to discuss the relative merits of each KT intervention. Two research assistants coded all of the transcripts independently using content analysis. RESULTS: Both HCAs and their leaders perceived reminders, followed by discussion groups, to be the most effective KT interventions to sustain practice change. Healthcare aide champions were deemed least effective by both leaders and HCAs. Leaders identified both the focus group discussion and audit and feedback posters in the study as the most difficult to implement. Participants valued interventions that were strategically visible, helped to clarify misconceptions about the new care innovation, supported teamwork, and made visible the resident benefits of the care innovation. Logistical issues, such as staff scheduling and workload, influenced the perceived feasibility of the various KT interventions. CONCLUSIONS: Understanding how care staff in long-term care settings perceive KT interventions can inform the choice of future use of these interventions to move research evidence into practice.

Correlates and preferences of resistance training among older adults in Alberta, Canada.

OBJECTIVE: The prevalence of resistance training among older adults in Alberta, Canada, has never been measured. Hence, there is no clear understanding of the demographic and health-related factors associated with resistance training, or older adults' resistance training programming preferences. The purpose of this study was to gain a better understanding of resistance training behaviours among older adults in Alberta. METHODS: Older adults (>55 years) from across Alberta were invited to participate in this study. Participants completed self-reported measures of resistance training behaviours, demographics, health-related information, and resistance training program interest and preferences. RESULTS: A total of 358 (of 393) participants returned a completed survey, for a response rate of 91.1%. Overall, 53.1% met Canadian resistance training guidelines. On average, participants engaged in resistance training on 1.8 (SD = 1.9) days per week for an average of 1.6 hours (SD = 1.3). Preferences included resistance training in a fitness club (45.7%) and morning training times (51.7%). Indicating an ability to participate in a resistance training program for older adults was associated with being age 65 years or older (OR = 2.4; 95% CI, 0.69 to 8.0, p = 0.017) and being male (OR = 2.2; 95% CI, 0.73 to 6.69, p = 0.016). Those meeting resistance training guidelines were significantly less likely to have a chronic disease (OR = 0.60; 95% CI, 0.39 to 0.95, p = 0.03). CONCLUSION: Older adults had unique preferences for receiving resistance training counseling and programming. These preferences were associated with specific demographic and health-related variables.

Profiles of resistance training behavior and sedentary time among older adults: Associations with health-related quality of life and psychosocial health.

BACKGROUND: The primary objective of this study was to gain a better understanding of the associations of health-related quality of life (HRQoL) and psychosocial factors (e.g., satisfaction with life, level of self-esteem, anxiety, depression) with resistance training and sedentary behavior profiles. METHODS: For this cross-sectional study, 358 older adults (≥ 55 years of age) across Alberta, Canada, completed self-reported measures of resistance training behavior, sedentary time, HRQoL, and psychosocial health (e.g., depression, anxiety, self-esteem, satisfaction with life). Participants were placed into one of four profiles with respect to their sedentary and resistance training behaviors. Data were collected in Alberta, Canada between August 2013 and January 2014. RESULTS: Pairwise comparisons indicated that those in the low SED/low RT group had a higher mental health composite (MHC) score compared to those in the high SED/low RT group (M diff = 3.9, p = 0.008). Compared to those in the high SED/low RT group, those in the low SED/high RT groups had significantly higher MHC scores (M diff = 4.8, p < 0.001). Those in the low SED/high RT group reported significantly higher physical health composite scores (PHC) (M diff = 3.7, p = 0.019), compared to the high SED/low RT group. Lower depression symptom scores were observed in the low SED/high RT groups compared to the high SED/low RT group, (M diff = - 0.60, p < 0.001). CONCLUSION: Resistance training, regardless of sedentary time, was significantly associated with HRQoL and psychosocial health.

Mobility of Vulnerable Elders study: effect of the sit-to-stand activity on mobility, function, and quality of life.

OBJECTIVES: The aim of this study is to assess the effect of the sit-to-stand activity on the mobility, function, and health-related quality of life of nursing home residents with dementia. DESIGN: A longitudinal quasi-experimental intervention study with intervention and control groups. SETTING: The study was conducted in 7 nursing homes (4 intervention; 3 control) in Edmonton, Canada. PARTICIPANTS: Eligible residents had a diagnosis of dementia and were able to transfer independently, or with the assistance of 1 person. INTERVENTION: Health care aides prompted residents to repeat the sit-to-stand activity daily during care routines on day and evening shifts. MEASUREMENTS: Mobility was measured using the 30-second sit-to-stand test and the time to complete one sit-to-stand. Function (Functional Independence Measure), health status (Health Utilities Index Mark 2 & 3) and disease-specific quality of life (Quality of Life-Alzheimer's Disease instrument) were also measured. Outcome measures were collected at baseline, and at 3 and 6 months. The covariates cognition, depression, and medical instability were derived from the Resident Assessment Instrument Minimum Data Set (Version 2.0), and the facility context covariate was measured using the Alberta Context Tool. RESULTS: A total of 111 residents completed the 6-month trial (56 intervention; 55 control). Residents in the intervention facilities maintained mobility, as measured by the time to complete one sit-to-stand (P = .01), and experienced a slower functional decline, as measured by the Functional Independence Measure (P = .01), from baseline to 6 months compared with residents in the control facilities, after adjusting for age, sex, cognition, depression, medical instability, and context. CONCLUSIONS: Maintaining the ability to transfer using the sit-to-stand activity is a promising means of optimizing the mobility and function for residents with dementia in nursing homes.