Article type
Abstract
Background: Poor implementation of evidence-based practices is likely to contribute to the variable quality observed within dementia care. If we are to deliver the best-possible dementia care, we need to have a better understanding of how to implement evidence-based practice. As part of a larger mixed-methods systematic review on implementation within dementia care, we sought to understand what helps and hinders implementation.
Objectives: To present review findings pertaining to qualitative evidence on factors that act as barriers and facilitators to implementation within dementia care.
Methods: Twelve databases were searched from inception to October 2015 supplemented by forward citation chasing and contact with organisations to identify unpublished reports. Two reviewers independently screened titles and abstracts, reviewed full texts, and performed data extraction and quality appraisal (Wallace criteria). Thematic analysis was used to synthesise across studies.
Results: Twenty eight studies of good quality were included. Barriers and facilitators to implementation were clustered into four broad levels: innovation, family and patient, staff, and organisational. Emerging themes highlight multiple factors across levels that can shape and transform implementation within dementia care. Varying levels of receptivity, engagement, professional skills, communication and collaboration, leadership support, resource availability and existing conditions in dementia care settings can impede or facilitate practice change. However, studies reveal limited information about ways to overcome barriers, and the involvement of people with dementia in implementation appears to be minimal.
Conclusions: This qualitative synthesis highlights the multifactorial and complex nature of implementation within dementia care. Our findings indicate that successful implementation requires collaborative efforts that involve actions and support at the family, staff and organisational level. Future research needs to move beyond identifying barriers and facilitators, and examine strategies to address them in order to improve dementia care.
Objectives: To present review findings pertaining to qualitative evidence on factors that act as barriers and facilitators to implementation within dementia care.
Methods: Twelve databases were searched from inception to October 2015 supplemented by forward citation chasing and contact with organisations to identify unpublished reports. Two reviewers independently screened titles and abstracts, reviewed full texts, and performed data extraction and quality appraisal (Wallace criteria). Thematic analysis was used to synthesise across studies.
Results: Twenty eight studies of good quality were included. Barriers and facilitators to implementation were clustered into four broad levels: innovation, family and patient, staff, and organisational. Emerging themes highlight multiple factors across levels that can shape and transform implementation within dementia care. Varying levels of receptivity, engagement, professional skills, communication and collaboration, leadership support, resource availability and existing conditions in dementia care settings can impede or facilitate practice change. However, studies reveal limited information about ways to overcome barriers, and the involvement of people with dementia in implementation appears to be minimal.
Conclusions: This qualitative synthesis highlights the multifactorial and complex nature of implementation within dementia care. Our findings indicate that successful implementation requires collaborative efforts that involve actions and support at the family, staff and organisational level. Future research needs to move beyond identifying barriers and facilitators, and examine strategies to address them in order to improve dementia care.