Implementing professional behaviour change in teams under pressure – results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)

Abstract

Objectives: to evaluate implementation of a new procedure for screening and treatment of malnutrition for older people in community settings; to identify factors promoting or inhibiting its implementation as a routine aspect of care.

Design: prospective process evaluation using mixed methods with pre/post-implementation measures.

Setting and participants: community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre and post-implementation surveys.

Main outcome measures: NoMad survey for pre-post intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.

Methods: data 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 (sub-group comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using Normalization Process Theory.

Results: high 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 sub-groups (training participants vs. non-participants). Implementation barriers included: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance; lack of access to dietetic support.

Conclusion: greater 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: 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.

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Identifiers

ORCID for Mike Bracher: orcid.org/0000-0001-5861-2657

ORCID for Carl R. May: orcid.org/0000-0002-0451-2690

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