title: Practice Change Interventions in Long-Term Care Facilities: What Works, and Why?
abstract: Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.
authors.affiliation: Toronto Rehabilitation Institute.
authors.forename: Sienna
authors.initials: S
authors.lastname: Caspar
authors.affiliation: Centre on Aging,University of Victoria.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Cooke
authors.affiliation: School of Nursing,University of British Columbia.
authors.forename: Alison
authors.initials: A
authors.lastname: Phinney
authors.affiliation: Faculty of Education,University of British Columbia.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ratner
mesh_terms: D003695:Delivery of Health Care; D055317:Evidence-Based Practice; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D058996:Quality Improvement; D011787:Quality of Health Care
keywords: aging; analyse réaliste; intervention research; quality of care; realist review; recherche interventionniste; residential care; soins de qualité; soins résidentiels; vieillissement