Perspectives From Municipality Officials on the Adoption, Dissemination, and Implementation of Electronic Health Interventions to Support Caregivers of People With Dementia: Inductive Thematic Analysis

Abstract

Background Very few evidence-based electronic health (eHealth) interventions for caregivers of people with dementia are implemented into practice. As part of a cross-border collaboration focusing on dementia and depression in older people, two eHealth interventions for caregivers of people with dementia (“Myinlife” and “Partner in Balance”) were adopted by nine municipalities in the Euregion Meuse-Rhine. Objective This study aimed to (1) identify determinants for the implementation of eHealth interventions for caregivers of people with dementia in a municipality context and (2) formulate implementation strategies for these interventions. Methods Eight municipality officials were interviewed using open-ended, semistructured interviews about their background, thoughts on the implementation of the intervention, recommended strategies, and thoughts on eHealth in general. One additional municipality discontinued the implementation project and submitted answers to the interview questions via email. The interviews were transcribed and independently analyzed using inductive thematic analysis. Results The interviews provided information on the perspectives of municipality officials on implementing eHealth for caregivers of people with dementia in their local communities. Key findings from the inductive thematic analysis included the importance of face-to-face interviews in developing tailor-made implementation plans, the need for regular meetings, the enthusiasm of municipality officials to implement these interventions, the need for long-term sustainability planning through collecting data on the required resources and benefits, and the effect of name brand recognition in adoption. Conclusions The findings contribute toward filling the previously identified gap in the literature on the implementation context of eHealth interventions for caregivers of people with dementia. Municipality officials’ views indicated which implementation determinants they expected would influence the adoption, dissemination, and future implementation of eHealth interventions for caregivers of people with dementia in a municipal context. These insights were applied to tailored implementation strategies to facilitate the future implementation of interventions such as Myinlife and Partner in Balance.

The implementation of EHealth in dementia care

“…The results of this search strategy show that only two of the included 46 references were implementation studies 20,21 . The results of this search strategy show that only one of the included 46 references used the term 'implementation' in the title22 and one study used the term 'process evaluation' in the title 23 . Four more studies were designed as retrospective evaluations of barriers and facilitators to the development and implementation of eHealth interventions for caregivers of people with dementia [24][25][26][27] .…”

“…Although this was not mentioned by our survey respondents, it also important to take into consideration that factors unrelated to implementation issues might be influencing the long-term success of some of the interventions. For instance, despite the overall positive effects discovered in the review of Boots, et al 1 , the specific challenges associated with eHealth for elderly populations (including changes in motor, cognitive, and perceptive abilities with age, as well as unfamiliarity with new technologies and motivational barriers) may also have contributed to some of the interventions having been discontinued 23,42 .…”

“…The subsequent research has produced evidence of the effectiveness of these interventions in improving a wide range of outcomes for caregivers of people with dementia, including increased self-efficacy and dementia caregiving knowledge, as well as the reduction of symptoms of depression and anxiety [17][18][19][20][21][22][23] . Regarding which types of eHealth interventions for dementia caregivers are most effective, interventions that are tailored to the individual and multicomponent interventions (interventions with two or more intervention components24) have been shown to be more effective than both untailored and single-component interventions 25 .…”

“…The five follow-up studies found through the PubMed and Google Scholar search achieved an average ImpRess total score of 27 (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], with an average improvement of 5 points with the original article's score ( Table 2).…”

“…Decision-makers looking to implement these interventions also find there is a lack of public awareness and confidence in eHealth, limited evidence of the cost-effectiveness of interventions, lack of legal clarity (especially with regard to data protection and reimbursement), and high start-up costs 22 . Moreover, implementing eHealth interventions for ageing populations has specific challenges, including changes in motor, cognitive, and perceptive abilities with age, in combination with the continuing, fast-paced evolution of modern technologies 23 . These implementation barriers hinder the use of eHealth interventions across various fields in practice 24 .…”