eHealth interventions to support caregivers of people with dementia may be proven effective, but are they implementation-ready?

Abstract

ObjectivesA variety of health services delivered via the Internet, or “eHealth interventions,” to support caregivers of people with dementia have shown evidence of effectiveness, but only a small number are put into practice. This study aimed to investigate whether, how and why their implementation took place.MethodsThis qualitative study followed up on the 12 publications included in Boots et al.'s (2014) widely cited systematic review on eHealth interventions for informal caregivers of people with dementia, in order to explore further implementation into practice. Publicly available online information, implementation readiness (ImpRess checklist scores), and survey responses were assessed.FindingsTwo interventions were freely available online, two were available in a trial context, and one was exclusively available to clinical staff previously involved in the research project. The remaining seven were unavailable. All scores on the ImpRess checklist were at 50% or lower of the total, indicating that the interventions were not ready to implement at the time of the Boots et al. (2014) review, though some interventions were scored as more implementation-ready in subsequent follow-up publications. Responses to the survey were received from six out of twelve authors. Key learnings from the survey included the importance of the involvement of stakeholders at all stages of the process, as well as the flexible adaptation and commercialization of the intervention.ConclusionsIn general, low levels of implementation readiness were reported and often the information necessary to assess implementation readiness was unavailable. The only two freely available interventions had long-term funding from aging foundations. Authors pointed to the involvement of financial gatekeepers in the development process and the creation of a business model early on as important facilitators to implementation. Future research should focus on the factors enabling sustainable implementation.

Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease: An Integrative Review

“…The use of digital devices increases patients’ ability to follow a medical regime and recommended lifestyle through the integration of these forms into the daily activities of the patient [ 57 ] while supporting the functions of reminder, feedback, knowledge creation, and self-care [ 14 ]. As a result, patients’ routine decision-making becomes smoother, building patients’ self-confidence [ 14 , 15 , 59 , 60 , 61 , 62 , 63 ] and highly dynamic [ 63 , 64 , 65 ].…”

“…Research on patient empowerment to date from a public health management perspective has focused on individual patient enablers without substantiating them as potential patient knowledge enablers: digital health technologies [ 14 , 15 ], availability of reliable information, digital health communities, and others. Knowledge management theory discusses knowledge sharing extensively and in detail, distinguishing preconditions that ensure knowledge sharing: supportive organizational culture [ 16 ], organizational member motivation [ 17 ], mutual trust [ 18 ], less centralized organizational culture [ 19 ], etc.…”

The Feasibility of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident’s Perspective

“…For successful implementation, there are many important determinants that need to be operationalized to the specific intervention and setting, including knowledge and cognition, attitude, routines, social influence, organizational characteristics and resources [85]. Additionally, recent research has shown that developed interventions in the care sector are in need of self-sustaining business models and therefore it is important to develop a suitable business model for Connecting Conversations, keeping its contextual factors into consideration [86]. For high completeness rates, it is important to clearly communicate with the participating interviewers and nursing homes, have clear protocols in place, follow-up in a timely manner and continuously be available to answer questions and provide support.…”

Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study

“…This lack of successful implementation is an important missed opportunity for the health care system, as advantages of eHealth interventions for health care include the potential to widen access to more remote areas, lower thresholds for participation, improve quality through increased opportunities for personalization, improve service efficiency, and reduce costs [ 22 , 29 ]. To facilitate the sustainable success of these promising interventions, it has been argued that the development of a business model is paramount [ 30 ]. Here, a business model is defined as “the rationale of how an organization creates, delivers, and captures value” [ 31 ].…”