Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention

Megan Shepherd-Banigan; Brystana G Kaufman; Kasey Decosimo; Joshua Dadolf; Nathan A Boucher; Elizabeth P Mahanna; Rebecca Bruening; Caitlin Sullivan; Virginia Wang; S Nicole Hastings; Kelli D Allen; Nina Sperber; Cynthia J Coffman; Courtney H Van Houtven

doi:10.1111/jnu.12511

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention

J Nurs Scholarsh. 2020 Jan;52(1):23-33. doi: 10.1111/jnu.12511. Epub 2019 Sep 9.

Authors

Affiliations

¹ Research Health Scientist, Durham VA Health Care System, and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA.
² Postdoctoral Research Fellow, Margolis Center for Health Policy, Duke University, Durham, NC, USA.
³ Research Health Scientist Specialist, Durham VA Health Care System, Durham, NC, USA.
⁴ Clinical Social Worker/Intervention Specialist, Durham VA Health Care System, Durham, NC, USA.
⁵ Research Health Scientist, Durham VA Health Care System, and Assistant Research Professor, Sanford School of Public Policy, Duke University, Durham, NC, USA.
⁶ Core Faculty, Margolis Center for Health Policy, Duke University, Durham, NC, USA.
⁷ Research Health Scientist, Durham VA Health Care System, and Associate Professor, Department of Population Health Sciences, Duke University, and Associate Professor, Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
⁸ Research Health Scientist, Durham VA Health Care System, and Associate Professor, Division of Geriatrics, Department of Medicine, Duke University, and Associate Professor, Department of Population Health Sciences, Duke University, and Senior Fellow, Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA.
⁹ Research Health Scientist, Durham VA Health Care System, Durham, NC, and Professor, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Research Health Scientist, Durham VA Health Care System, and Associate Professor, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
¹¹ Research Health Scientist, Durham VA Health Care System, and Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA.

Abstract

Purpose: We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FIVES).

Design: Prior to implementation in eight sites, a multidisciplinary study team made systematic adaptations to the curriculum content and delivery process using input from the original randomized controlled trial (RCT); a stakeholder advisory board comprised of national experts in caregiver education, nursing, and implementation; and a veteran/caregiver engagement panel. To address site-specific implementation barriers in diverse settings, we applied the Replicating Effective Programs implementation framework.

Findings: Adaptations to HI-FIVES content and delivery included identifying core/noncore curriculum components, reducing instruction time, and simplifying caregiver recruitment for clinical settings. To enhance curriculum flexibility and potential uptake, site personnel were able to choose which staff would deliver the intervention and whether to offer class sessions in person or remotely. Curriculum materials were standardized and packaged to reduce the time required for implementation and to promote fidelity to the intervention.

Conclusions: The emphasis on flexible intervention delivery and standardized materials has been identified as strengths of the adaptation process. Two key challenges have been identifying feasible impact measures and reaching eligible caregivers for intervention recruitment.

Clinical relevance: This systematic implementation process can be used to rapidly adapt an intervention to diverse clinical sites and contexts. Nursing professionals play a significant role in educating and supporting caregivers and care recipients and can take a leading role to implement interventions that address skills and unmet needs for caregivers.

Keywords: Department of Veterans Affairs; education intervention; family caregiver; implementation and dissemination; veterans.

Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Caregivers*
Family Health
Home Nursing / methods*
Humans
Interdisciplinary Research
Multicenter Studies as Topic*
Pragmatic Clinical Trials as Topic*
Program Development
Research Design
United States
Veterans

Abstract

Publication types

MeSH terms

Grants and funding