Barriers and enablers to implementing multifactorial interventions in care homes

Introduction:  

World Falls Guidelines ​(1)​ recommend that a comprehensive, multifactorial falls risk assessment be carried out for every care home resident. However, due to heterogeneity in the care home sector, evidence-based multifactorial tools do not necessarily become integrated into practice and require a multi-faceted and tailored approach built on understanding the barriers and enablers for implementation ​(2)​ 

To better understand the necessary skills, levers and pathways that support the adoption and spread of evidence-based practice, a scoping review was undertaken to identify barriers and enablers to implementing multi-factorial interventions in care homes. 

Methods: The scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews ​(3)​ and reported using the PRISMA-ScR ​(4)​. Data were thematically analysed, coded and grouped into themes and subthemes, which were mapped to the Consolidated Framework for Implementation Research (CFIR). 

Results: 31 papers were selected for review, and 8 enabling key themes with 17 sub-themes, and 7 barrier key themes with 16 sub-themes were identified.  

Communication acted as an enabler when a shared, informal language was used consistently. However, it became a barrier when tensions between staff members undermined effective information transfer, leading to resistance. 

Engagement and buy-in from senior managers and leaders; both for the intervention and its ongoing implementation, were critical to success. Where this support was lacking, implementation was negatively affected. 

Training and education served as enablers when delivered in varied formats and tailored to individual needs. Conversely, insufficient training left staff without the skills required to carry out the intervention. 

Providing adequate resources (financial, physical, and time) supported successful implementation and enabled transformative change. Failure to supply these resources hindered implementation efforts. 

Conclusions: Successful implementation of multi-factorial interventions in care homes depends on a combination of effective communication, strong leadership engagement, provision of appropriate resources and tailored training. 

​​1. Montero-Odasso M, Van Der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Vol. 51, Age and Ageing. Oxford University Press; 2022.  

​2. Vlaeyen. E, Stas J, Leysens G, Van der Elst E, Janssens E, Dejaeger E, et al. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. Int J Nurs Stud. 2017;70:110–21.  

​3. Aromataris E MZ (Editors). JBI Manual for Evidence Synthesis [Internet]. JBI; 2020. Available from: https://jbi-global-wiki.refined.site/space/MANUAL 

​4. Pollock D, Peters MDJ, Khalil H, McInerney P, Alexander L, Tricco AC, et al. Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evid Synth. 2023 Mar 1;21(3):520–32.