Process evaluation of an intervention to reduce sleep problems in people living with dementia in nursing homes: a mixed-methods study

Abstract

Background People living with dementia often suffer from sleep disturbances. The MoNoPol-Sleep (multimodal, nonpharmacological intervention for sleep disturbances in people with dementia living in nursing homes) study aimed to develop and evaluate a multimodal, nonpharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes. Objectives To investigate implementation fidelity, adoption, barriers and facilitators of the multimodal, nonpharmacological intervention. Design Mixed-methods process evaluation alongside an exploratory cluster-randomised controlled trial. Setting Twenty-two nursing homes in three regions in Germany. Subjects Nursing staff, nursing home managers, sleep nurses and other target groups of the intervention from the participating nursing homes. Methods Questionnaires, qualitative interviews and documentation of the intervention’s implementation. Results The intervention was predominately implemented as planned, but implementation fidelity varied between the clusters. The most frequently planned and implemented sleep-promoting interventions were daytime activities. There is some evidence that person-centredness slightly increased in the intervention group. The commitment of nursing home managers, the motivation of nurses and good cooperation with the main contact persons of the research team were identified as facilitating context factors. Identified barriers were financial and time resources and low motivation of the nurses. The results of the cRCT have been published elsewhere. Conclusions For a successful implementation, involvement of nurses from day and night shifts and other stakeholders is crucial. Based on the results of this process evaluation conducted alongside an exploratory trial, the intervention can be adapted and further developed to evaluate its effectiveness in a future full trial. Clinical Trial Registration ISRCTN No ISRCTN36015309.