Reducing cardiovascular disease in a rural community.

In this case report, we describe the one-year formative phase of a five-year study to develop, implement, and test a community health worker (CHW)-delivered cardiovascular disease (CVD) prevention intervention. The purpose of the formative phase was to engage community partners in the adaptation of an existing evidence-based CVD prevention intervention to fit the needs and preferences of a rural, predominantly African-American community. The formative work was guided by a framework for adapting evidence-based interventions and involved engaging stakeholders in assessing the intervention's fit with the local context and then applying assessment findings to iteratively adapt the intervention's contents, materials, and delivery methods. Findings from the formative work were then applied to develop CHW position descriptions, workflow diagrams, and a training plan. Findings also were applied to adapt intervention materials and protocols to fit the needs of the community. This case report illustrates how community-engaged formative work can be applied to adapt an evidence-based intervention to fit community needs and resources.

Developing an evidence-based fall prevention curriculum for community health workers.

This perspective paper describes processes in the development of an evidence-based fall prevention curriculum for community health workers/promotores (CHW/P) that highlights the development of the curriculum and addresses: (1) the need and rationale for involving CHW/P in fall prevention; (2) involvement of CHW/P and content experts in the curriculum development; (3) best practices utilized in the curriculum development and training implementation; and (4) next steps for dissemination and utilization of the CHW/P fall prevention curriculum. The project team of CHW/P and content experts developed, pilot tested, and revised bilingual in-person training modules about fall prevention among older adults. The curriculum incorporated the following major themes: (1) fall risk factors and strategies to reduce/prevent falls; (2) communication strategies to reduce risk of falling and strategies for developing fall prevention plans; and (3) health behavior change theories utilized to prevent and reduce falls. Three separate fall prevention modules were developed for CHW/P and CHW/P Instructors to be used during in-person trainings. Module development incorporated a five-step process: (1) conduct informal focus groups with CHW/P to inform content development; (2) develop three in-person modules in English and Spanish with input from content experts; (3) pilot-test the modules with CHW/P; (4) refine and finalize modules based on pilot-test feedback; and (5) submit modules for approval of continuing education units. This project contributes to the existing evidence-based literature by examining the role of CHW/P in fall prevention among older adults. By including evidence-based communication strategies such as message tailoring, the curriculum design allows CHW/P to personalize the information for individuals, which can result in an effective dissemination of a curriculum that is evidence-based and culturally appropriate.

Implementing person-centered care in nursing homes.

BACKGROUND: Charged with caring for frail and disabled elders, nursing homes are complex organizations that operate under high regulatory scrutiny and low public opinion. Despite efforts to improve, many nursing home residents receive poor care. By focusing on residents' relationships, life experiences, abilities, and preferences, person-centered care represents an innovation in nursing home care. Because person-centered care requires organization-wide change, implementation can be challenging. PURPOSE: The purpose of this research is to apply innovation implementation theory to understand factors and conditions that help or hinder the implementation of person-centered care in nursing homes. METHODOLOGY: Data come from the Person-Centered Care Program conducted by the Carolinas Center for Medical Excellence. Eight nursing homes participated in the Person-Centered Care Program for 1 year. A multiple-case-study design and pattern-matching logic were employed to examine organizational factors associated with implementation effectiveness. Data sources included semistructured key informant interviews, archival documents, surveys, and expert rankings of nursing homes' implementation effectiveness. FINDINGS: On the basis of this research, we suggest that effective implementation of organization-wide change in nursing homes is associated with high-quality management communications about the change, organizational readiness for change, and favorable perceptions from direct care providers about the priority of the innovation to the organization. Notably, neither the amount of training nor the financial resources dedicated to person-centered care were associated with implementation effectiveness. PRACTICE IMPLICATIONS: Effective implementation of person-centered care in nursing homes is most likely when management follows through with plans as advertised, when leadership teams have confidence in their ability to meet goals for change, and when change fosters smooth operations in the daily routines of direct care providers.