Dissemination and implementation research in dementia care: a systematic scoping review and evidence map

Abstract

Background: The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.

Methods: We sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.

Results: Eighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.

Conclusion: This scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.

Keywords: Dementia care; Dissemination; Implementation; Scoping review; Strategies.

Fig. 1

Flow chart of study selection process

Fig. 2

Bubble plot for the frequency of the 55 implementation strategies identified within included studies based on ERIC importance and feasibility ratings. The range of the x and y axes reflect values obtained for the 73 discrete implementation strategies for each of the rating scales during the ERIC rating tasks.¹⁸ The plot is divided into quadrants on the basis of the overall mean values for each of the rating scales. Strategies in quadrant I are those with the highest consensus regarding their relative high importance and feasibility. Strategies in quadrant III are those where there was consensus regarding their relative low importance and feasibility. Strategies in quadrant II were relatively high in feasibility but low in importance, and strategies in quadrant IV were relatively high in importance but low in the feasibility scale