Site-level factors affecting nursing home implementation of a personalized music intervention: Qualitative analyses from Music & Memory: A Pragmatic Trial for Nursing Home Residents with Alzheimer's Disease (METRIcAL)

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2024-10-21 DOI:10.1002/trc2.70006

Davoodi Natalie, Olson Miranda, Uth Rebecca, Baier Rosa, Rudolph James, Zediker Esme, Shield Renee, Ellen McCreedy

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引用次数: 0

Abstract

BACKGROUND

Non-pharmacological interventions (NPIs) are preferred alternatives to using antipsychotic medications to manage disruptive behaviors in nursing home (NH) residents living with dementia. However, the implementation of these interventions is often complex in the NH environment. In this qualitative analysis of data from an embedded pragmatic clinical trial (ePCT) of a personalized music intervention, we describe NH-level implementation barriers and facilitators.

METHODS

In a 54-facility trial, we randomized 27 NHs from four US corporations to the personalized music intervention. In this qualitative analysis, we analyzed barriers and facilitators at 9 of the 27 intervention NHs, using (1) routinely collected data collector observations and (2) semi-structured interviews with NH staff. We iteratively developed codes to best describe these data and generated themes.

RESULTS

We found five qualitative themes related to the variation of intervention implementation across NHs: (1) turnover and institutional changes interfered with implementation; (2) consistent with pragmatic implementation, delivery strategies varied across NHs; (3) family members influenced residents’ participation; (4) non-clinical program champions needed clinical buy-in, which was challenging and required demonstrating the intervention's clinical benefits; and (5) technological barriers among staff and residents impeded implementation.

CONCLUSIONS

Qualitative results from nine facilities participating in a NH ePCT of personalized music intervention highlight the importance of identifying an intervention's key components to ensure fidelity, while allowing the flexibility necessary for pragmatic implementation. Engaging family caregivers may improve the implementation of NPIs in the NH setting. Results may be helpful to other researchers implementing NPIs to manage neuropsychiatric symptoms for people living with dementia in NHs.

Highlights

This was a real-world trial of a personalized music for nursing home (NH) residents with dementia.
Pragmatic adaptations to intervention delivery may have compromised fidelity.
Family caregivers are important to the success of behavioral interventions in NHs.

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影响疗养院实施个性化音乐干预的现场因素：音乐与记忆》定性分析：针对老年痴呆症疗养院居民的实用试验（METRIcAL）

背景非药物干预（NPIs）是使用抗精神病药物来控制养老院（NH）痴呆症患者干扰行为的首选替代方法。然而，在养老院环境中实施这些干预措施往往十分复杂。在这篇对个性化音乐干预的嵌入式实用临床试验（ePCT）数据进行的定性分析中，我们描述了养老院层面的实施障碍和促进因素。方法在一项由 54 家医院参与的试验中，我们将来自四家美国公司的 27 家 NH 随机分配到个性化音乐干预中。在这项定性分析中，我们使用（1）日常收集的数据收集员观察结果和（2）对疗养院员工进行的半结构化访谈，分析了 27 家干预疗养院中 9 家的障碍和促进因素。我们反复编写代码，以最好地描述这些数据并生成主题。结果我们发现了五个与各 NH 实施干预措施的差异有关的定性主题：（1）人员流动和机构变化干扰了干预措施的实施；（2）与务实实施一致，各 NH 的实施策略各不相同；（3）家庭成员影响了住院患者的参与；（4）非临床项目倡导者需要临床支持，这具有挑战性，并且需要证明干预措施的临床益处；以及（5）员工和住院患者之间的技术障碍阻碍了干预措施的实施。结论九家机构参与了国家卫生研究院个性化音乐干预 ePCT 项目，其定性结果凸显了确定干预措施关键组成部分以确保其忠实性的重要性，同时允许务实实施所需的灵活性。让家庭照顾者参与进来可以改善 NPI 在 NH 环境中的实施。研究结果可能会对其他研究人员实施 NPIs 以管理养老院中痴呆患者的神经精神症状有所帮助。亮点这是一项针对养老院痴呆症患者的个性化音乐的真实世界试验。对干预措施的实用性调整可能会影响其忠实性。家庭护理人员对疗养院行为干预的成功非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.