Laura N Gitlin, Katherine B Marx, David L Roth, Keith Anderson, Holly Dabelko-Schoeny, Danny Scerpella, Lauren J Parker, Sokha Koeuth, Joseph E Gaugler
{"title":"忠诚至关重要：在多个成人日间服务站点实施基于证据的ADS Plus计划。","authors":"Laura N Gitlin, Katherine B Marx, David L Roth, Keith Anderson, Holly Dabelko-Schoeny, Danny Scerpella, Lauren J Parker, Sokha Koeuth, Joseph E Gaugler","doi":"10.1093/geroni/igaf074","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.</p><p><strong>Research design and methods: </strong>Sixteen ADS sites were randomly assigned to ADS Plus (<i>n</i> = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.</p><p><strong>Results: </strong>Of 102 caregivers, 79.5% were in high (<i>n</i> = 58, 56.9%) or moderate (<i>n</i> = 23, 22.6%), versus 20.6% (<i>n</i> = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (<i>n</i> = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (<i>p</i> < .0001). Sites with higher percentages of White, non-Hispanic families (<i>p</i> = .006) and dementia clients (<i>p</i> = .004) had better fidelity. At three and 12 months but not at 6 months, caregivers in high/moderate fidelity sites had greater reductions in depressive symptoms and stress (<i>p</i><.05) compared to those in low-fidelity sites.</p><p><strong>Discussion and implications: </strong>Most caregivers received ADS Plus with moderate to high fidelity. High/moderate fidelity sites delivered more sessions to more caregivers with substantially stronger caregiver benefits. As fidelity varied by site characteristics, adaptations to staff training and the program appear needed for low-fidelity sites.</p><p><strong>Clinical trial registration number: </strong>NCT02927821.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 8","pages":"igaf074"},"PeriodicalIF":4.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448453/pdf/","citationCount":"0","resultStr":"{\"title\":\"Fidelity matters: implementing ADS Plus, an evidence-based program, in multiple adult day service sites.\",\"authors\":\"Laura N Gitlin, Katherine B Marx, David L Roth, Keith Anderson, Holly Dabelko-Schoeny, Danny Scerpella, Lauren J Parker, Sokha Koeuth, Joseph E Gaugler\",\"doi\":\"10.1093/geroni/igaf074\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.</p><p><strong>Research design and methods: </strong>Sixteen ADS sites were randomly assigned to ADS Plus (<i>n</i> = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.</p><p><strong>Results: </strong>Of 102 caregivers, 79.5% were in high (<i>n</i> = 58, 56.9%) or moderate (<i>n</i> = 23, 22.6%), versus 20.6% (<i>n</i> = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (<i>n</i> = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (<i>p</i> < .0001). Sites with higher percentages of White, non-Hispanic families (<i>p</i> = .006) and dementia clients (<i>p</i> = .004) had better fidelity. 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Fidelity matters: implementing ADS Plus, an evidence-based program, in multiple adult day service sites.
Background and objectives: In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.
Research design and methods: Sixteen ADS sites were randomly assigned to ADS Plus (n = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.
Results: Of 102 caregivers, 79.5% were in high (n = 58, 56.9%) or moderate (n = 23, 22.6%), versus 20.6% (n = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (n = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (p < .0001). Sites with higher percentages of White, non-Hispanic families (p = .006) and dementia clients (p = .004) had better fidelity. At three and 12 months but not at 6 months, caregivers in high/moderate fidelity sites had greater reductions in depressive symptoms and stress (p<.05) compared to those in low-fidelity sites.
Discussion and implications: Most caregivers received ADS Plus with moderate to high fidelity. High/moderate fidelity sites delivered more sessions to more caregivers with substantially stronger caregiver benefits. As fidelity varied by site characteristics, adaptations to staff training and the program appear needed for low-fidelity sites.
期刊介绍：
Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.
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