Early development of a contextually appropriate psychological intervention for skilled nursing facilities: a qualitative study.

Abstract

Objectives: This study describes the application of the Designing for Accelerated Translation (DART) and Intervention Mapping (IM) frameworks to the early development of a psychological intervention for depression in short-term subacute/post-acute skilled nursing facility (SNF) care.

Method: We conducted five focus groups with 32 SNF staff and individual interviews with 28 residents and 18 care partners. Data were analyzed using a hybrid inductive-deductive coding structure to map themes onto the DART framework (i.e. eliciting demand, user-centered design, and context-sensitive approaches). Staff and dyad members' findings were triangulated. Then, IM was used to translate qualitative findings into intervention components.

Results: Participants reported demand for psychological intervention with potential benefits for both residents and care partners during a SNF stay. Second, five themes were identified to guide intervention content: fear and worry; emotional reactions to changes in independence; motivation for rehabilitation; stress and conflict complicating discharge and long-term care; and healthy coping strategies. Third, participants noted context-sensitive approaches for implementation (e.g. session length of 20-30 min). Based on findings, we identified change objectives and methods for psychological intervention.

Conclusion: This study provides an overview of early intervention development processes that consider implementation and dissemination in real-world SNF settings.