title: Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis.
abstract: BACKGROUND
  Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes.
  
  
  METHODS
  A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1.
  
  
  BACKGROUND
  The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
authors.affiliation: School of Healthcare Sciences, Bangor University School of Health Care Sciences, Bangor, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Rycroft Malone
authors.affiliation: Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
authors.affiliation: Division of Health and Social Care, Department of Ageing and Health, Guys and St Thomas', King's College London, London, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Harari
authors.affiliation: Health Care of Older People Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
authors.forename: Rowan
authors.identifier: http://orcid.org/0000-0002-4920-6718
authors.initials: R
authors.lastname: Harwood
authors.affiliation: Faculty of Health and Social Care, Edge Hill University of Manchester, Manchester, UK.
authors.forename: Brenda
authors.initials: B
authors.lastname: Roe
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Russell
authors.affiliation: Department of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Mandy
authors.initials: M
authors.lastname: Fader
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Marina
authors.initials: M
authors.lastname: Buswell
authors.affiliation: Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, UK.
authors.forename: Vari M
authors.initials: VM
authors.lastname: Drennan
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D002985:Clinical Protocols; D003704:Dementia / Q000150:complications; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000517:prevention & control / Q000523:psychology; D006707:Homes for the Aged; D007326:Institutionalization; D009735:Nursing Homes
keywords: GERIATRIC MEDICINE