title: Identifying the determinants of use of the G&G interventions for older adults in health and social care: protocol of a multilevel approach.
abstract: BACKGROUND
  Despite aging-related losses, many older adults are able to maintain high levels of subjective well-being. However, not all older adults are able to self-manage and adapt. The GRIP&GLEAM [Dutch: GRIP&GLANS] (G&G) interventions have shown to significantly improve self-management ability, well-being and loneliness in older adults. Actual use of the evidence-based G&G interventions, however, remains limited as long as the interplay between implementation factors at different hierarchical stakeholder levels is poorly understood. The aim of the study is to identify the determinants of successful implementation of the G&G interventions.
  
  
  METHODS
  The study is performed in health and social care organizations in the northern part of the Netherlands. The degree of implementation success is operationalized by four parameters: use (yes/no), pace (time to initial use), performance (extent of use) and prolongation (intention to continue use). Based on the Fleuren model, factors at four hierarchical stakeholder levels (i.e. target group, professionals, organizations and financial-political context) are assessed at three measurement points in 2 years. The nested data are analyzed applying multilevel modeling techniques.
  
  
  CONCLUSIONS
  In this study, health and social care organizations are considered to be part of multilevel functional systems, in which factors at different hierarchical stakeholder levels impede or facilitate use of the G&G interventions. Strengths of the study are the multifaceted measurement of use, and the multilevel approach in identifying the determinants. The study will contribute to the development of ecologically valid implementation strategies of the G&G interventions and comparable evidence-based practices.
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. d.kuiper@umcg.nl.
authors.forename: Daphne
authors.initials: D
authors.lastname: Kuiper
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.m.goedendorp@umcg.nl.
authors.forename: Martine M
authors.initials: MM
authors.lastname: Goedendorp
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. r.sanderman@umcg.nl.|Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. r.sanderman@umcg.nl.
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. s.a.reijneveld@umcg.nl.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. b.j.m.steverink@rug.nl.|Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands. b.j.m.steverink@rug.nl.
authors.forename: Nardi
authors.initials: N
authors.lastname: Steverink
mesh_terms: D000368:Aged; D003695:Delivery of Health Care; D006801:Humans; D009426:Netherlands; D012947:Social Work