ObjectivesTo evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as a routine aspect of care.DesignProspective process evaluation using mixed methods with pre/post-implementation measures.Setting and participantsCommunity teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre-implemetation and post-implementation surveys.Main outcome measuresNoMAD survey for pre–post-intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.MethodsData prior to implementation of training, baseline (T0—survey and telephone interview) and 2 months following training (T1—follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group and total study sample; analysis using Wilcoxon rank-sum (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation process theory.ResultsHigh support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational and specialist dietetic support. Pre–post-training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and lack of access to dietetic support.ConclusionGreater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are as follows: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions.
IntroductionMalnutrition remains underdetected, undertreated and often overlooked by those working with older people in primary care in the UK. A new procedure for screening and treatment of malnutrition is currently being implemented by a large National Health Service (NHS) trust in England, incorporating a programme of training for staff working within Integrated Community Teams and Older People’s Mental Health teams. Running in parallel, the Implementing Nutrition Screening in Community Care for Older People process evaluation study explores factors that may promote or inhibit its implementation and longer term embedding in routine care, with the aim of optimising sustainability and scalability.Methods and analysisImplementation will be assessed through observation of staff within a single area of the trust, in addition to the procedure development and delivery group (PDDG). Data collection will occur at three observation points: prior to implementation of training, baseline (T0); 2 months following training (T1); and 8 months following training (T2). Observation points will consist of a survey and follow-up semistructured telephone interview with staff. Investigation of the PDDG will involve: observations of discussions around development of the procedure; semistructured telephone interviews prior to implementation, and at 6 months following implementation. Quantitative data will be described using frequency tables reporting by team type, healthcare provider role group, and total study sample (Wilcoxon rank-sum and Wilcoxon signed-rank tests may also be conducted if appropriate. Audio and transcription data will be analysed using Nomarlization Process Theory as a framework for deductive thematic analysis (using the NVIVO CAQDAS software package).Ethics and disseminationEthical approval for the study has been granted through institutional ethical review (Bournemouth University); NHS Research Ethics committee approval was not required. Dissemination will occur through presentations to academic and practitioner audiences and publication results in peer-reviewed academic journals.
The functional or community adaptation approach to curriculum development for the severely handicapped is described using the curriculum characteristics (1) philosophy and research support, (2) content and sequence, and (3) individualization. This curriculum model is further clarified through a wheel design, a complete curriculum example, and guidelines for I.E.P. development.
This article reports the implementation of a new procedure for screening and treatment of malnutrition in a community NHS trust in England. The barriers and facilitators to implementation were assessed with staff from Integrated Community and Older People's Mental Health teams. Data from interviews and surveys were collected at baseline, 2 months after initial training and 16 months after initial training as well as following deployment of a nutrition lead to embed new developments for nutritional care. The adoption of the procedure made screening and treatment of malnutrition simpler and more likely to be actioned. The benefit of a nutrition lead and local nutrition champions to support and empower staff (avoiding reliance on training alone) was shown to drive change for nutritional care across the community. Prioritisation and commitment of leadership at the organisational level are needed to embed and sustain malnutrition screening and treatment in routine practice.
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