Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in Nursing Homes.

BACKGROUND AND OBJECTIVES: Significant quality problems exist in long-term care (LTC). Interventions to improve care are complex and often have limited success. Implementation remains a black box. We developed a program theory explaining how implementation of a complex intervention occurs in LTC settings-examining mechanisms of impact, effects of context on implementation, and implementation outcomes such as fidelity. RESEARCH DESIGN AND METHODS: Concurrent process evaluation of Safer Care for Older Persons in residential Environments (SCOPE)-a frontline worker (care aide) led improvement trial in 31 Canadian LTC homes. Using a mixed-methods exploratory sequential design, qualitative data were analyzed using grounded theory to develop a conceptual model illustrating how teams implemented the intervention and how it produced change. Quantitative analyses (mixed-effects regression) tested aspects of the program theory. RESULTS: Implementation fidelity was moderate. Implementation is facilitated by (a) care aide engagement with core intervention components; (b) supportive leadership (internal facilitation) to create positive team dynamics and help negotiate competing workplace priorities; (c) shifts in care aide role perceptions and power differentials. Mixed-effects model results suggest intervention acceptability, perceived intervention benefits, and leadership support predict implementation fidelity. When leadership support is high, fidelity is high regardless of intervention acceptability or perceived benefits. DISCUSSION AND IMPLICATIONS: Our program theory addresses important knowledge gaps regarding implementation of complex interventions in nursing homes. Results can guide scaling of complex interventions and future research.

Building a national network of student leaders in gerontology: Reflections on the student representative program.

The Canadian Association on Gerontology's Student Connection facilitates a national Student Representative program to promote the field of gerontology at local post-secondary institutions. Student Representatives are expected to host professional development and networking events on their campus to bring together students interested in the field of aging. Student-run groups help foster interest in aging-related careers and research, yet few studies explore how these groups are developed and sustained. As part of this quality improvement project, we examined (1) who participates as a Student Representative; (2) why students choose to participate in the program; and (3) how Student Representatives fulfil their role (including barriers and facilitators). We conclude with a discussion of the challenges that the Student Connection's executive committee has faced supporting this national network and identify opportunities to further enhance the program. Practical implications to support student engagement and promote sustainability of student-driven aginginterest groups are outlined.

Factors Associated With the Intention to Begin Physical Activity Among Inactive Middle-Aged and Older Adults.

Factors that affect physical activity (PA) behavior change are well established. Behavioral intention is a strong psychological predictor of behavior; however, there is less research on the factors that affect the intention to increase PA participation specifically, especially among adults in mid and later life who are inactive. Using data from the Canadian Community Health Survey, which was informed by the transtheoretical model (TTM), this study investigated the relationships between a range of demographic and biopsychosocial factors with the intention to become physically active among 1,159 inactive adults aged 40 years and older. Comparisons were made between participants reporting the intention to begin PA in the next 30 days (TTM Preparation; n = 610), 6 months (TTM Contemplation; n = 216), or not at all (TTM Precontemplation; n = 333). First, multinomial logistic regression identified age, sex, ethnicity, education, restriction of activities, self-perceived health, and community belonging as factors significantly associated with 30-day PA intention, while age and ethnicity were significantly associated with 6-month PA intention, compared with those reporting no intention. Second, binary logistic regression revealed that education was the only factor that differentially associated with intention timeframe as participants with lower levels of education were less likely to report PA intention in 30 days compared with 6 months. Findings demonstrate key demographic, biopsychosocial, and temporal factors that warrant consideration for tailored PA promotion programs that aim to effectively address the constraints and barriers that negatively influence PA intention among middle-aged and older adults.

Pivoting professional development opportunities for students during COVID-19: A gerontology focused knowledge mobilization course.

The Canadian Association on Gerontology Student Connection (CAG-SC) is a national network for students interested in aging. As the CAG 2020 conference was canceled due to COVID-19, the CAG-SC pivoted professional development events for students to an online format. In partnership with the York University Knowledge Mobilization (KMb) unit an eight-week course on Knowledge Mobilization was offered. The course consisted of weekly asynchronous prerecorded videos and synchronous guest speakers who presented gerontology relevant KMb examples. To register for the course, students completed a registration form outlining their training background, experience with KMb, and the reasons for participation. A course feedback form at course completion captured student experience and reflections. A total of 56 interdisciplinary trainees from 18 post-secondary institutions completed the course. Participants found the course fostered a deeper understanding of KMb concepts and how to apply these to future careers in gerontology. This course was the CAG-SC's most successful professional development initiative. Participants recognized the importance of KMb in gerontology and felt the course provided skills needed to disseminate their research more effectively across sectors to improve quality of life for older adults. Reflections on the value of institutional partnership from the CAG-SC and York University Knowledge Mobilization are captured.

Comparing a clinician-assisted and app-supported behavioral activation intervention to promote brain health and well-being in frontline care.

BACKGROUND: Positive psychiatry offers an unique approach to promote brain health and well-being in aging populations. Minimal interventions through behavioral activation to promote wellness are increasingly available using self-guided apps, yet little is known about the effectiveness of app technology or the difference between clinician-supported behavioral activation versus self-guided app methodologies. OBJECTIVES: Investigate the difference in users and outcomes between two methods of the Fountain of Health (FoH) positive psychiatry intervention for behavioral activation to promote brain health and well-being: (1) clinician-assisted and (2) independent app use for behavioral self-management. DESIGN AND SETTING: As part of a larger knowledge translation intervention in positive psychiatry, two specific methods of a behavioral activation intervention were retrospectively compared. PARTICIPANTS: Two subsets of patients were compared; 254 clinician-assisted patients; 333 independent app users. INTERVENTION: A minimal positive psychiatry intervention in frontline care using the FoH health and behavior change clinical tools. MEASUREMENTS: Main outcomes were changes in psychological (health and resilience, well-being scores) and behavioral indices (goal attainment, items of goal SMART-ness). User profiles (age, sex and completion rates) were also compared. RESULTS: Clinician-assisted patients were more likely to be male, older, and have lower health and resilience scores at baseline. Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes (improved health and resilience, and well-being) were similar regardless of intervention method for those who completed the intervention. Behavioral outcomes revealed clinician-assisted patients set goals that better adhered to key goal-setting items. CONCLUSIONS: Clinician-patient relationships appear to be an important factor for intervention completion and behavioral outcomes, while further exploration of best practices for intervention completion using health apps in clinical practice is needed. A preliminary goal-setting methodology for effective behavioral activation, to promote brain health and wellness, is given.

La nécessité des approches interdisciplinaires et collaboratives pour évaluer l'impact de la COVID-19 sur les personnes âgées et le vieillissement: déclaration conjointe de l'ACG / CAG et de la RCV / CJA.

La pandémie de la COVID-19 et l'état d'urgence publique qui en a découlé ont eu des répercussions significatives sur les personnes âgées au Canada et à travers le monde. Il est impératif que le domaine de la gérontologie réponde efficacement à cette situation. Dans la présente déclaration, les membres du conseil d'administration de l'Association canadienne de gérontologie/Canadian Association on Gerontology (ACG/CAG) et ceux du comité de rédaction de La Revue canadienne du vieillissement/Canadian Journal on Aging (RCV/CJA) reconnaissent la contribution des membres de l'ACG/CAG et des lecteurs de la RCV/CJA. Les auteurs exposent les voies complexes par lesquelles la COVID-19 affecte les personnes âgées, allant du niveau individuel au niveau populationnel. Ils préconisent une approche impliquant des équipes collaboratives pluridisciplinaires, regroupant divers champs de compétences, et différentes perspectives et méthodes d'évaluation de l'impact de la COVID-19.

Interdisciplinary and Collaborative Approaches Needed to Determine Impact of COVID-19 on Older Adults and Aging: CAG/ACG and CJA/RCV Joint Statement.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.