Facilitators and barriers in the implementation of the meeting centres model for people with dementia and their carers

Abstract

The implementation of care innovations that have been proven effective is not matter-of-course. In this study, we traced facilitating and impeding factors in the implementation of thirteen meeting centres for people with dementia and their carers in five different regions in The Netherlands. To guide the data collection and analyses, a theoretical model was developed that distinguishes different phases of implementation, and factors at the level of characteristics of the innovation and other preconditions. Qualitative methods were used, including interviews with 23 key figures and other written materials gathered. The interview data were double coded and analyzed, using the computer programme NVivo. Several factors proved to play a facilitating role in all phases of implementation, for example: motivated people, financial resources, continuous and varied PR-activities, and cooperation between organizations. Other important facilitating characteristics of the meeting centres were: the surplus value of the integrated support programme as compared to the local support offer, and the fact that several centres were already available as an example for new initiators. The findings were used, among other things, to develop an implementation guide, to facilitate the implementation of meeting centres.

Introduction

Research showing that an innovation is effective and the people involved are satisfied with it, does not automatically imply its large-scale implementation. That takes more than writing about positive research results. The innovation will have to be implemented. Some innovations benefit from adaptive implementation [1], which takes into account the local situation, to which the innovation is tuned and, if necessary, adapted. Which are the most effective strategies in the implementation of innovations is not always or immediately clear [2], [3], [4]. Various systematic literature reviews show that the strategies that are proven effective in one study are not necessarily proven effective in another. Furthermore, the effectiveness of strategies turns out to depend on the type of innovation and the phase in the implementation process. Multiple (multi-faceted) strategies that take into account facilitators and barriers in implementation, are expected to be the most effective strategies [2], [5]. Gaining insight into facilitating and impeding factors in implementation is therefore considered an important step in the process of effective implementation.

In the study that is reported on in this article, we traced facilitating and impeding factors in the adaptive implementation of the meeting centres programme to support people with dementia and their carers. This support programme was developed in 1992–1994 [6] and it was proven effective in a controlled study in 1994–1996 [7]. The present study was part of an extensive multi-centre study into the preconditions of successful implementation of meeting centres in The Netherlands [8]. To guide the data collection and analyses, a theoretical search model was developed [9] on the basis of a survey of the literature, previous experiences with setting up meeting centres and information from experts that were consulted (see Fig. 1). With this model, we investigated which characteristics of the innovation and other preconditions either facilitated or impeded the implementation of the meeting centres, and which factors at the micro, meso and macro levels of the successive phases of the implementation process had facilitated or impeded the implementation. The results will be used to compile an implementation guide to facilitate the nationwide implementation of meeting centres and its evaluation.