The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

Claire A Surr, Sahdia Parveen, Sarah J Smith, Michelle Drury, Cara Sass, Sarah Burden, Jan Oyebode, Claire A Surr, Sahdia Parveen, Sarah J Smith, Michelle Drury, Cara Sass, Sarah Burden, Jan Oyebode

Abstract

Background: The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change.

Methods: A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis.

Results: Barriers and facilitators were analysed according the COM-B domains. "Capability" factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff "motivation" included skilled facilitation of training, trainees' desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). "Opportunity" factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential.

Conclusions: A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

Keywords: Alzheimer’s disease; Behaviour change; Care homes; Education; Hospitals; Mental health services; Training; Workforce development.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of data included in analysis

References

    1. All-Party Parliamentary Group on Dementia . Prepared to Care. Challenging the dementia skills gap. London: The Stationary Office; 2009.
    1. Department of Health . Prime Minister's challenge on dementia 2020. London: Department of Health; 2015.
    1. Surr C, Gates C, Irving D, Oyebode J, Smith SJ, Parveen S, et al. Effective dementia education and training for the health and social care workforce: a systematic review of the literature. Rev Educ Res. 2017;87(5):966–1002.
    1. Featherstone K, James IA, Powell I, Milne D, Maddison C. A controlled evaluation of a training course for staff who work with people with dementia. Dementia. 2015;3(2):181–194.
    1. Fossey J, Garrod L, Tolbol Froiland C, Ballard C, Lawrence V, Testad I. What influences the sustainability of an effective psychosocial intervention for people with dementia living in care homes? A 9 to 12-month follow-up of the perceptions of staff in care homes involved in the WHELD randomised controlled trail. Int J Geriatr Psychiatry. 2019;34(5):674–682.
    1. Lee L, Weston WW, Hillier LM. Developing memory clinics in primary care: an evidence-based Interprofessional program of continuing professional development. J Contin Educ Heal Prof. 2013;33(1):24–32.
    1. Danylyshen-Laycock T, Morgan D, Stewart N, O’Connell M, Goodridge D. The impact of leadership and culture in sustainability of a dementia trainign program in long-term care. Innov Aging. 2018;2(Suppl 1):726.
    1. Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42.
    1. Richardson M, Khouja CL, Sutcliffe K, Thomas J. Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews. BMJ Open. 2019;9(6):e024950.
    1. Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.
    1. Phillips JL, Heneka N, Lovell M, Lam L, Davidson P, Boyle F, et al. A phase III wait-listed randomised controlled trial of novel targeted inter-professional clinical education intervention to improve cancer patients’ reported pain outcomes (The Cancer Pain Assessment (CPAS) Trial): study protocol. Trials. 2019;20(1):1–2.
    1. Khong LAM, Berlach RG. K.D. H, Hill AM. Design and development of a theory-informed peer-led falls prevention education programme to translate evidence into practice: a systematic approach. Int J Health Promot Educ. 2018;56(4–5):195–210.
    1. Warsi S, Elsey H, Boeckmann M, Noor M, Khan A, Barua D, et al. Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan. BMC Health Serv Res. 2019;19(1):1–14.
    1. Khong LAM, Berlach RG, Hill KD, Hill AM. Can peer education improve beliefs, knowledge, motivation and intention to engage in falls prevention amongst community-dwelling older adults? Eur J Ageing. 2017;14(3):243–255.
    1. Smith SJ, Parveen S, Sass C, Drury M, Oyebode J, Surr C. Cross sector audit of dementia education and training in the UK: a comparison with national benchmark standards. BMC Health Serv Res. 2019;19:711. 10.1186/s12913-019-4510-6.
    1. Surr C, Sass C, Burnley N, Drury M, Smith S, Parveen S, Burden S, Obeyode J. Components of impactful dementia training for general hospital staff: a collective case study. Aging Ment Health. 2020;24(3):511–21. 10.1080/13607863.2018.1531382.
    1. Surr CA, Sass C, Drury M, Burnley N, Dennison A, Burden S, et al. A collective case study of the features of impactful dementia training for care home staff. BMC Geriatr. 2019;19(1):175.
    1. Sass C, Burnley N, Oyebode J, Drury M, Surr C. Factors associated with successful dementia education for practitioners in primary care: an in-depth case study. BMC Med Educ. 2019;19:393. 10.1186/s12909-019-1833-2.
    1. O'Cathain A, Murphy E, Nicholl J. Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study. BMC Health Serv Res. 2007;7(1):85.
    1. Health Education England, Skills for Health, Skills for Care . Dementia core skills education and training framework. London: Health Education England; 2015.
    1. Taylor N, Parveen S, Robins V, Slater B, Lawton R. Development and initial validation of the influences on patient safety Behaviours questionnaire. Implementation Sci. 2013;8(1):81.
    1. King N. Template analysis. In: Symon G, Cassell C, editors. Qualitative methods and analysis in organizational research: a practical guide. Thousand Oaks: Sage Publications Ltd; 1998. pp. 118–134.
    1. Brooks J, McClusky S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qualitative Res Psychol. 2015;12(2):202–222.
    1. Tomesko J, Touger-Decker R, Dreker M, Zelig R, Parrott JS. The effectiveness of computer-assisted instruction to teach physical examination to students and trainees in the health sciences professions: a systematic review and meta-analysis. J Med Educ Curric Dev. 2017;4:2382120517720428.
    1. Vaona A, Banzi R, Kwag KH, Rigon G, Cereda D, Pecoraro V, et al. E-learning for health professionals. Cochrane Database Syst Rev. 2018;1:Cd011736.
    1. Richmond H, Copsey B, Hall AM, Davies D, Lamb SE. A systematic review and meta-analysis of online versus alternative methods for training licensed health care professionals to deliver clinical interventions. BMC Med Educ. 2017;17(1):227.
    1. Sinclair PM, Kable A, Levett-Jones T, Booth D. The effectiveness of internet-based e-learning on clinician behaviour and patient outcomes: a systematic review. Int J Nurs Stud. 2016;57:70–81.
    1. Horn K, Pilkington L, Hooten P. Pediatric staff Nurses’ conceptualizations of professional development. J Pediatr Nurs. 2019;45:51–56.
    1. Pool IA, Poell RF, Berings MG, Ten Cate O. Motives and activities for continuing professional development: an exploration of their relationships by integrating literature and interview data. Nurse Educ Today. 2016;38:22–28.
    1. Ramani S, McMahon GT, Armstrong EG. Continuing professional development to foster behaviour change: from principles to practice in health professions education. Med Teach. 2019;41(9):1045–52. 10.1080/0142159X.2019.1615608.
    1. Brooks HL, Pontefract SK, Vallance HK, Hirsch CA, Hughes E, Ferner RE, et al. Perceptions and impact of mandatory eLearning for foundation trainee doctors: a qualitative evaluation. PLoS One. 2016;11(12):e0168558.
    1. Fossey J, Garrod L, Lawrence V, Testad I, Stafford J, Murray J. “We should see her like part of the team”: an investigation into care home staff’s experiences of being part of an RCT of a complex psychosocial intervention. Aging Ment Health. 2020;24(1):178–85. 10.1080/13607863.2018.1525603.
    1. Sweet L, Broadbent J. Nursing students’ perceptions of the qualities of a clinical facilitator that enhance learning. Nurse Educ Pract. 2017;22:30–36.
    1. Buscaj E, Hall T, Montgomery L, Fernald DH, King J, Deaner N, et al. Practice facilitation for PCMH implementation in residency practices. Fam Med. 2016;48(10):795–800.
    1. Yee HY, Radhakrishnan A, Ponnudurai G. Improving PBLs in the international Medical University: defining the ‘good’ PBL facilitator. Med Teach. 2006;28(6):558–560.
    1. Couto LB, Bestetti RB, Restini CB, Faria M, Jr, Romao GS. Brazilian medical students’ perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment. Med Educ Online. 2015;20:26893.
    1. Cooper E, Spilsbury K, McCaughan D, Thompson C, Butterworth T, Hanratty B. Priorities for the professional development of registered nurses in nursing homes: a Delphi study. Age Ageing. 2017;46(1):39–45.
    1. Gulla C, Flo E, Kjome RLS, Husebo BS. Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS) BMC Geriatr. 2019;19(1):130.
    1. Griffiths AW, Kelley R, Garrod L, Perfect D, Robinson O, Shoesmith E, et al. Barriers and facilitators to implementing dementia care mapping in care homes: results from the EPIC trial process evaluation. BMC Geriatr. 2019;19:37.
    1. Toivonen M, Lehtonen L, Ahlqvist-Bjorkroth S, Axelin A. Key factors supporting implementation of a training program for neonatal family- centered care - a qualitative study. BMC Health Serv Res. 2019;19(1):394.
    1. Tan WS, Car J, Lall P, Low CK, Ho AHY. Implementing advance care planning in acute hospitals: leading the transformation of norms. J Am Geriatr Soc. 2019;67(6):1278–1285.
    1. Rokstad AMM, Vatne S, Engedal K, Selbæk G. The role of leadership in the implementation of person-centred care using dementia care mapping: a study in three nursing homes. J Nurs Manag. 2015;23(1):15–26.
    1. Valizadeh L, Zamanzadeh V, Dewar B, Rahmani A, Ghafourifard M. Nurse’s perceptions of organisational barriers to delivering compassionate care: a qualitative study. Nurs Ethics. 2018;25(5):580–590.

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