title: Challenges to intervention implementation: lessons learned in the Bathing Persons with Alzheimer's Disease at Home study.
abstract: BACKGROUND
  The pressing need for interventions to improve outcomes for vulnerable caregivers of individuals with Alzheimer's disease (AD) is hindered by inadequate knowledge of variables affecting intervention delivery, receipt, and enactment.
  
  
  OBJECTIVE
  To analyze intervention implementation issues encountered within the Bathing Persons with Alzheimer's Disease at Home (BATH) study.
  
  
  METHODS
  The BATH study, a home-based, randomized, controlled trial of interventions to improve behavioral symptoms and caregiver self-efficacy, consisted of 130 intervention visits to 42 care recipients-caregiver dyads. Data include direct observation, nurse interventionist field notes, case analyses, and caregiver journals, reflecting various perspectives. Content analysis was used to identify key treatment process themes.
  
  
  RESULTS
  Issues that affected the delivery, receipt, and enactment of interventions reflect the intersection of in vivo caregiving and research design.
  
  
  CONCLUSIONS
  The primary lessons learned were: (a) early identification of caring dyads prior to crisis must be improved; (b) in vivo observation is essential to individualized interventions targeting behavioral etiologies and developing caregiver skills; (c) intervention delivery depends on the nurse interventionist's skills and a flexible, trusting researcher-dyad relationship; (d) complex caregiver situations affect treatment receipt and enactment; and (e) intervention enactment requires coaching, practice, and support over time. These findings help to explain issues impacting intervention implementation to a vulnerable population. Recommendations for intervention research design to maximize internal and external validity in real-life care contexts can inform future outcome studies, aid in the search for improved care, and lead to supportive public policy for families living with AD.
authors.affiliation: William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. ellen.mahoney@bc.edu
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Mahoney
authors.forename: Scott A
authors.initials: SA
authors.lastname: Trudeau
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Penyack
authors.forename: Carrie E
authors.initials: CE
authors.lastname: MacLeod
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000451:nursing*; D001494:Baths; D017028:Caregivers; D005260:Female; D006266:Health Education; D006284:Health Plan Implementation; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D015399:Nursing Research / Q000379:methods* / Q000458:organization & administration; D019370:Observation; D011368:Professional-Family Relations; D014481:United States