Preliminary Implementation of a Dementia-Focused Risk Negotiation Conversation Tool Into Aged Care Practice

Abstract

A key principle of best practice dementia care is providing access to support for making, communicating and participating in decisions affecting a person's life, whether for day-to-day activities or more complex decisions. Implementing a fit-for-purpose tool into routine care has challenges and requires careful planning to ensure success and sustainability. This project aimed to utilise implementation science principles to embed a dementia-focused risk negotiation conversation tool (Enabling Choices), into an Australian community aged care service. A mixed methods exploratory design was employed. Co-design workshops identified contextual barriers and enablers, and developed behaviour change strategies for implementation support. Following training to build knowledge and skills in Enabling Choices, community aged care workers were expected to use the tool three times over 4-months with people with dementia and care-partners. Two geographic regions received formal implementation support while another two did not. Implementation outcomes of feasibility, acceptability and appropriateness, reach and adoption, were evaluated via interviews and audit of clinical records. Contextual barriers and enablers were identified. Implementation strategies aligned with capability, opportunity and motivation for behaviour change. Training was delivered to 62 care managers who used the tool with people with dementia or care-partners (n = 31). Interview themes for care managers (across all regions) were (1) augmenting care; (2) flexible and supportive training; (3) articulating target audience; and (4) overcoming hesitancy. Interviews with people with dementia/care-partners provided further insights. Synthesised findings highlighted that implementation support was beneficial, and feasibility of Enabling Choices likely impacted reach and adoption. Implementation of Enabling Choices into routine community aged care practice offered valuable insights into the critical role of inner and outer contextual barriers and enablers. Sufficient attention on capability, opportunity and motivational components of behaviour change was important, with the link identified between acceptability, feasibility and appropriateness, for reach and adoption of an innovation.

Keywords: aged care; behaviour change; community; decision-making; implementation science.