PDF(Pubmed)
Abstract：
This process evaluation was conducted in parallel to the randomised controlled feasibility trial of NIDUS-Professional, a manualised remote dementia training intervention for homecare workers (HCWs), delivered alongside an individualised intervention for clients living with dementia and their family carers (NIDUS-Family). The process evaluation reports on: (i) intervention reach, dose and fidelity; (ii) contexts influencing agency engagement and (iii) alignment of findings with theoretical assumptions about how the intervention might produce change.
We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6-8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data.
32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners.
NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial.
We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6-8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data.
32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners.
NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial.
摘要：
背景：该过程评估与NIDUS-Professional的随机对照可行性试验平行进行，针对家庭护理工作者(HCWs)的手动远程痴呆症培训干预措施，为痴呆症患者及其家庭照顾者（NIDUS-Family）提供个性化干预。过程评估报告：(一)干预范围，剂量和保真度；（ii）影响代理参与的背景；（iii）将研究结果与有关干预措施如何产生变化的理论假设保持一致。
方法：我们报告接受任何干预（范围）的合格HCWs的比例，参加会议的次数(剂量；参加≥4/6次主要会议被预定为坚持)，客户和护理人员对NIDUS-Family的干预忠实度和依从性(参加所有6-8次计划的会议)。我们采访了HCWs，经理,家庭照顾者和促进者。我们进行了整合和主题分析，在家庭护理机构层面，定性访谈和干预记录数据。
结果：32/141（23％）的合格HCWs和7/42（17％）的家庭护理人员接受了任何干预；大多数坚持干预的人（89％和71％）。干预的保真度很高。我们分析了20/44HCWs的采访，3/4经理和3/7家庭照顾者，以及涉及32/44HCWs的干预记录。所有机构都报告了在支持干预措施交付方面的结构性挑战。管理层较多的机构有更高的剂量和覆盖面。HCW重视NIDUS-Professional，以实现组反射和对等支持，提供实用，可操作的护理策略，并增加他们作为从业者的信心。
结论：NIDUS-Professional被HCWs重视。机构管理，文化和优先事项是实施的主要障碍;我们将讨论如何在未来的试验中解决这些问题.
方法：我们报告接受任何干预（范围）的合格HCWs的比例，参加会议的次数(剂量；参加≥4/6次主要会议被预定为坚持)，客户和护理人员对NIDUS-Family的干预忠实度和依从性(参加所有6-8次计划的会议)。我们采访了HCWs，经理,家庭照顾者和促进者。我们进行了整合和主题分析，在家庭护理机构层面，定性访谈和干预记录数据。
结果：32/141（23％）的合格HCWs和7/42（17％）的家庭护理人员接受了任何干预；大多数坚持干预的人（89％和71％）。干预的保真度很高。我们分析了20/44HCWs的采访，3/4经理和3/7家庭照顾者，以及涉及32/44HCWs的干预记录。所有机构都报告了在支持干预措施交付方面的结构性挑战。管理层较多的机构有更高的剂量和覆盖面。HCW重视NIDUS-Professional，以实现组反射和对等支持，提供实用，可操作的护理策略，并增加他们作为从业者的信心。
结论：NIDUS-Professional被HCWs重视。机构管理，文化和优先事项是实施的主要障碍;我们将讨论如何在未来的试验中解决这些问题.
