Supporting mealtime participation among people living with dementia at home: Challenges and strategies for caregivers

BACKGROUND AND OBJECTIVES

Approximately 60% of people living with dementia at home are unable to routinely participate in mealtime activities (e.g., eating, safe food preparation), warranting assistance to ensure people with dementia meet their health and nutritional needs. The purpose of this study was to characterize these barriers to mealtime participation and identify potential caregiver-led strategies to enhance mealtime activities.

RESEARCH DESIGN AND METHODS

We used a qualitative descriptive approach and obtained semi-structured interview data from (a) allied health professionals and (b) community-based nutrition program providers who frequently serve people with dementia. Interview data were examined by means of directed content analysis and framework methodology until data saturation was reached. Codes from our analysis were categorized according to constructs drawn from the Socio-Ecological Model for Developing and Implementing Comprehensive Dementia Care.

RESULTS

Data were obtained from 20 participants who attributed common mealtime participation barriers to: impairments in functional status, cognitive status deficits, a lack of caregiver knowledge and skills, and unsafe living conditions. Caregiver-led strategies to overcome these barriers included: reducing auditory and visual distractions, providing written cues to perform mealtime activities, eliminating clutter and fall risk hazards, and leveraging community-based nutrition program providers (e.g., home-delivered meal providers).

DISCUSSION AND IMPLICATIONS

People with dementia face several eating and mealtime participation obstacles. Caregiver-led strategies implemented by family, friends, or community-based nutrition program providers may enhance mealtime activities at home. Findings point to opportunities to develop decision-making tools and resources for caregivers to optimize the health and nutrition of people with dementia.

Partnering with social service staff to implement pragmatic clinical trials: an interim analysis of implementation strategies

BACKGROUND

With recent growth in the conduct of pragmatic clinical trials, the reliance on frontline staff to contribute to trial-related activities has grown as well. Active partnerships with staff members are often critical to pragmatic trial implementation, but rarely do research teams track and evaluate the specific "implementation strategies" used to support staff's involvement in trial procedures (e.g., participant recruitment). Accordingly, we adapted implementation science methodologies and conducted an interim analysis of the strategies deployed with social service staff involved in one multi-site pragmatic clinical trial.

METHODS

We used a naturalistic, observational study design to characterize strategies our research team deployed with staff during monthly, virtual meetings. Data were drawn from meeting notes and recordings from the trial's 4-month Preparation phase and 8-month Implementation phase. Strategies were mapped to the Expert Recommendations for Implementing Change taxonomy and categorized into nine implementation clusters. Survey data were also collected from staff to identify the most useful strategies the research team should deploy when onboarding new staff members in the trial's second year.

RESULTS

A total of 287 strategies were deployed. Strategies in the develop stakeholder interrelationships cluster predominated in both the Preparation (35%) and Implementation (31%) phases, followed by strategies in the use iterative and evaluative approaches cluster, though these were more prevalent during trial Preparation (24%) as compared to trial Implementation (18%). When surveyed on strategy usefulness, strategies in the provide interactive assistance, use financial approaches, and support staff clusters were most useful, per staff responses.

CONCLUSIONS

While strategies to develop stakeholder interrelationships were used most frequently during trial Preparation and Implementation, program staff perceived strategies that provided technical assistance, supported clinicians, and used financial approaches to be most useful and should be deployed when onboarding new staff members. Research teams are encouraged to adapt and apply implementation strategy tracking methods when partnering with social service staff and deploy practical strategies that support pragmatic trial success given staff needs and preferences.

TRIAL REGISTRATION

NCT05357261. May 2, 2022.

Career development in pragmatic clinical trials to improve care for people living with dementia

The growing number of people living with dementia (PLWD) requires a coordinated clinical response to deliver pragmatic, evidence-based interventions in frontline care settings. However, infrastructure to support such a response is lacking. Moreover, there are too few researchers conducting rigorous embedded pragmatic clinical trials (ePCTs) to make the vision of high quality, widely accessible dementia care a reality. National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease and Related Dementias Clinical Trials (IMPACT) Collaboratory seeks to improve the pipeline of early career researchers qualified to lead ePCTs by funding career development awards. Even with support from the Collaboratory, awardees face practical and methodological challenges to success, recently exacerbated by the COVID-19 pandemic. We first describe the training opportunities and support network for the IMPACT CDA recipients. This report then describes the unique career development challenges faced by early-career researchers involved in ePCTs for dementia care. Topics addressed include challenges in establishing a laboratory, academic promotion, mentoring and professional development, and work-life balance. Concrete suggestions to address these challenges are offered for early-career investigators, their mentors, and their supporting institutions. While some of these challenges are faced by researchers in other fields, this report seeks to provide a roadmap for expanding the work of the IMPACT Collaboratory and initiating future efforts to recruit, train, and retain talented early-career researchers involved in ePCTs for dementia care.

Developing a multimodal maternal infant perinatal outpatient delivery system: the MOMI PODS program

Progress in maternal child health has been hampered by poor rates of outpatient follow up for postpartum individuals. Primary care after delivery can effectively detect and treat several pregnancy-related complications and comorbidities, but postpartum linkage to primary care remains low. In this manuscript, we share the experience of implementing a novel mother-infant dyad program, the Multimodal Maternal Infant Perinatal Outpatient Delivery System (MOMI PODS), to improve primary care linkage and community resource access postpartum via integration into pediatric care structures. With a focus on providing care for people who are publicly insured, we designed a program to mitigate maternal morbidity risk factors in postpartum individuals with chronic disease or pregnancy complications. We discuss the systematic process of designing, executing, and evaluating a collaborative clinical program with involvement of internal medicine/pediatric, family medicine, and obstetric clinicians via establishing stakeholders, identifying best practices, drawing from the evidence base, designing training and promotional materials, training partners and providers, and evaluating clinic enrollment. We share the challenges encountered such as in achieving sufficient provider capacity, consistent provision of care, scheduling, and data tracking, as well as mitigation strategies to overcome these barriers. Overall, MOMI PODS is an innovative approach that integrates outpatient postpartum care into traditional pediatric structures to increase access, showing significant promise to improve healthcare utilization and promote postpartum health.

Rehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care

OBJECTIVE

To explore rehabilitation professionals' experiences and perspectives of barriers and facilitators to implementing the Rehabilitation Treatment Specification System (RTSS) in research, education, and clinical care.

DESIGN

A cross-sectional survey with free text and binary responses was completed by rehabilitation professionals. Survey data were analyzed with a deductive approach of directed content analysis using 2 implementation science frameworks: Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC).

SETTING

Rehabilitation professionals across research, educational, and clinical settings.

PARTICIPANTS

One hundred and eleven rehabilitation professionals-including speech-language pathologists, occupational therapists, physical therapists, physicians, psychologists, researchers, and clinic directors-who explored possible uses or applications of the RTSS for clinical care, education, or research (N=111).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Frequency of reported CFIR barriers and facilitators, as well as keywords related to CFIR and ERIC constructs.

RESULTS

The barriers and facilitating strategies differed according to the end-users' intended use, that is, research, education, or clinical. Overall, the 4 most frequently encountered CFIR barriers were the RTSS's complexity, a lack of available RTSS resources, reduced access to knowledge and information about the RTSS, and limited knowledge and beliefs about the RTSS. The ERIC-CFIR matching tool identified 7 ERIC strategies to address these barriers, which include conducting educational meetings, developing and distributing educational materials, accessing new funding, capturing and sharing local knowledge, identifying and preparing champions, and promoting adaptability.

CONCLUSIONS

When attempting to use the RTSS, rehabilitation professionals commonly encountered barriers to understanding and skillfully using the framework. Theory-driven implementation strategies have been identified that have potential for addressing the RTSS's complexity and lack of educational and skill-building resources. Future work can develop the identified implementation strategies and evaluate their effects on RTSS implementation.

Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients

Introduction

Frailty is a complex condition that is highly associated with health decline and the loss of independence. Home-delivered meal programs are designed to provide older adults with health and nutritional support that can attenuate the risk of frailty. However, home-delivered meal agencies do not routinely assess frailty using standardized instruments, leading to uncertainty over the longitudinal impact of home-delivered meals on frailty levels. Considering this knowledge gap, this study aimed to facilitate home-delivered meal staff's implementation of a standardized frailty instrument with meal clients as part of routine programming. This article (a) describes the use of Implementation Mapping principles to develop strategies supporting frailty instrument implementation in one home-delivered meal agency and (b) examines the degree to which a combination of strategies influenced the feasibility of frailty instrument use by home-delivered meal staff at multiple time points.

Methods and materials

This retrospective observational study evaluated staff's implementation of the interRAI Home Care Frailty Scale (HCFS) with newly enrolled home-delivered meal clients at baseline-, 3-months, and 6-months. The process of implementing the HCFS was supported by five implementation strategies that were developed based on tenets of Implementation Mapping. Rates of implementation and reasons clients were lost to 3- and 6-month follow-up were evaluated using univariate analyses. Client-level data were also examined to identify demographic factors associated with attrition at both follow-up time points.

Results

Staff implemented the HCFS with 94.8% (n = 561) of eligible home-delivered meal clients at baseline. Of those clients with baseline HCFS data, staff implemented the follow-up HCFS with 43% of clients (n = 241) at 3-months and 18.0% of clients (n = 101) at 6-months. Insufficient client tracking and documentation procedures complicated staff's ability to complete the HCFS at follow-up time points.

Discussion

While the HCFS assesses important frailty domains that are relevant to home-delivered meal clients, its longitudinal implementation was complicated by several agency- and client-level factors that limited the extent to which the HCFS could be feasibly implemented over multiple time points. Future empirical studies are needed to design and test theoretically derived implementation strategies to support frailty instrument use in the home- and community-based service setting.

Implementing the Better Starts For All Pilot Mobile and Telehealth Intervention in Ohio Appalachia: Improving Access to Maternal Healthcare

INTRODUCTION

Women in Ohio Appalachia experience greater maternal health disparities relative to the general U.S. population, resulting in poorer health outcomes. This paper describes the Ohio Better Starts for All (BSFA) program that provides mobile maternal health services in rural Ohio.

METHODS

This three-year intervention was delivered through a community-clinical partnership in Ohio Appalachia. The program's preliminary evaluation and opportunities were informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

RESULTS

Over six months, 86 patients were referred to the BSFA program, 54 (62.8 %) were seen by the maternal care team, and 14 out of 19 scheduled clinic days were held. Five clinics were canceled due to inclement weather, mobile unit breakdown, or provider COVID-19 infection.

DISCUSSION

Maternal care providers must provide equitable care to patients, with particular attention to those who face substantial challenges accessing obstetric services. The BSFA program offers one promising solution to help women overcome barriers to accessing care.

Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design

As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.

Leveraging academic initiatives to advance implementation practice: a scoping review of capacity building interventions

Background

Academic institutions building capacity for implementation scholarship are also well positioned to build capacity in real world health and human service settings. How practitioners and policy makers are included and trained in implementation capacity-building initiatives, and their impact on building implementation practice capacity is unclear. This scoping review identified and examined features of interventions that build implementation practice capacity across researchers and practitioners or practitioners-in-training.

Methods

Five bibliographic databases were searched. Eligible studies (a) described an implementation capacity building intervention with a connection to an academic institution, (b) targeted researchers and practitioners (including practitioners-in-training, students, or educators), and (c) reported intervention or participant outcomes. Articles that only described capacity building interventions without reporting outcomes were excluded. Consistent with Arksey and O’Malley’s framework, key study characteristics were extracted (target participants, core components, and outcomes) and analyzed using open coding and numerical analysis.

Results

Of 1349 studies identified, 64 met eligibility for full-text review, and 14 were included in the final analysis. Half of the studies described implementation capacity building interventions that targeted health or behavioral health researchers, practitioners, and practitioners-in-training together, and half targeted practitioners or practitioners-in-training only. The most common components included structured didactic activities offered in person or online, mentorship and expert consultation to support implementation, and practical application activities (e.g., field placements, case studies). Knowledge sharing activities and technical assistance were less common. All studies reported favorable outcomes related to knowledge attainment, increased ability to implement evidence, productivity, and satisfaction.

Conclusions

Building implementation capacity among practitioners is critical for integrating insights from implementation science into the field and preventing the “secondary” implementation research-to-practice gap. This scoping review identified several promising implementation practice capacity building interventions that tend to build practitioner capacity via expert led activities which may be relevant for academic institutions seeking to build implementation practice capacity. To avoid widening the implementation research-to-practice gap, implementation capacity building interventions are needed that target policy makers, expand beyond multiple practice settings, and leverage university/community partnerships or on-site academic medical centers. Future studies will also be needed to test the impact on service quality and public health outcomes.

Development and Refinement of the American Occupational Therapy Association's Knowledge Translation Toolkit

IMPORTANCE

Occupational therapy practitioners are expected to translate promising discoveries from empirical research into routine practice with their clients. However, complex barriers can influence practitioners' knowledge translation (KT) efforts, leading the American Occupational Therapy Association's Evidence-Based Practice (EBP) group to develop the KT Toolkit tailored to the perceived needs of occupational therapists and occupational therapy assistants.

OBJECTIVE

To identify common barriers to implementing EBPs and potential strategies to support EBP uptake.

DESIGN

Cross-sectional survey.

SETTING

United States.

PARTICIPANTS

Occupational therapy practitioners.

OUTCOMES AND MEASURES

Data underwent descriptive and directed content analysis, the latter of which was guided by the Consolidated Framework for Implementation Research.

RESULTS

Occupational therapy survey respondents (N = 818) identified common EBP implementation barriers (e.g., lack of time and resources, difficulty understanding research findings). Initial KT Toolkit content was developed to address these barriers and included resources for searching for, analyzing, and applying evidence in practice.

CONCLUSIONS AND RELEVANCE

Survey findings have informed the development of the KT Toolkit, which includes resources designed to support occupational therapy practitioners' EBP implementation efforts. This KT Toolkit is available at AOTA.org and will be continuously revised and updated on an ongoing basis. What This Article Adds: Several barriers limit the extent to which occupational therapy practitioners can implement evidence with their client populations. The KT Toolkit is directly informed by practitioner input and provides resources to support practitioners in their efforts to translate knowledge into real-world practice.

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients

Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.

Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

BACKGROUND

Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs).

METHODS

A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes.

RESULTS

The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were "distribute educational materials" (n = 11), "assess for readiness and identify barriers and facilitators" (n = 11), and "conduct educational outreach visits" (n = 10). "Adoption" was the most frequently measured implementation outcome, while "cost" was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies.

CONCLUSIONS

This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field's ability to draw conclusions about effective implementation strategies across diverse practice settings.

Translating Knowledge to Optimize Value-Based Occupational Therapy: Strategies for Educators, Practitioners, and Researchers

With the continued evolution of health care reform and payment models, it is imperative that the occupational therapy profession consistently and clearly articulate its distinct value. As payment models shift from paying for the volume of services provided to paying for the value of services, the field of occupational therapy must be sure to implement high-quality care by translating evidence into practice and facilitating improvements in client outcomes. Yet the process of translating evidence-based interventions and programs to real-world settings can be quite complex, and successful implementation often requires active collaboration across occupational therapy stakeholders. In this Health Policy Perspectives article, we provide occupational therapy educators, practitioners, and researchers with key recommendations for how the profession can translate evidence into practice, ultimately leading to the improvement of client outcomes and the provision of value-based care.

Individual- and group-level network-building interventions to address social isolation and loneliness: A scoping review with implications for COVID19

PURPOSE

Worldwide mandates for social distancing and home-quarantine have contributed to loneliness and social isolation. We conducted a systematic scoping review to identify network-building interventions that address loneliness and isolation, describe their components and impact on network structure, and consider their application in the wake of COVID19.

METHODS

We performed forward and backward citation tracking of three seminal publications on network interventions and Bibliographic search of Web of Science and SCOPUS. We developed data charting tables and extracted and synthesized the characteristics of included studies, using an iteratively updating form.

FINDINGS

From 3390 retrieved titles and abstracts, we included 8 studies. These interventions focused on building networks at either individual- or group-levels. Key elements that were incorporated in the interventions at varying degrees included (a) creating opportunities to build networks; (b) improving social skills; (c) assessing network diagnostics (i.e. using network data or information to inform network strategies); (d) promoting engagement with influential actors; and (e) a process for goal-setting and feedback. The effect of interventions on network structures, or the moderating effect of structure on the intervention effectiveness was rarely assessed.

CONCLUSIONS

As many natural face-to-face opportunities for social connection are limited due to COVID19, groups already at risk for social isolation and loneliness are disproportionately impacted. Network-building interventions include multiple components that address both the structure of individuals' networks, and their skills and motivation for activating them. These intervention elements could be adapted for delivery via online platforms, and implemented by trained facilitators or novice volunteers, although more rigorous testing is needed.

Evaluating the Implementation of Fall Risk Management Practices within Home-delivered Meal Organizations

Falls remain a major public health issue, particularly for frail older adults, such as those who receive home-delivered meals (HDMs). Social workers who assess the needs of HDM clients and routinely monitor their care are uniquely positioned to address fall prevention; however, the degree to which HDM social workers currently manage fall risk is unknown. To close this knowledge gap, we conducted a retrospective chart review and evaluated HDM social workers' current practices relative to identifying clients at risk for falling and the client characteristics associated with social workers' perceptions of fall risk. A total of 230 client charts were included in our analysis. Thirty-eight percent of HDM clients were determined to be at risk of falling. Advanced age, activity limitations, and specific health conditions (e.g., diabetes mellitus) were associated with social workers' fall risk concerns. However, over 80% of our sample presented with well-established fall risk factors (e.g., mobility impairment) suggesting that HDM social workers might be under-identifying fall-risks. Though HDM social workers are well positioned to play a critical role in fall risk management, systematic efforts are needed to optimize social workers' capacity for effectively identifying HDM clients at risk for falling.

Adapting Interventions for Occupational Therapy Practice: Application of the FRAME Coding Structure

Occupational therapy practitioners often adapt evidence-based interventions for implementation into practice, yet these adaptations are seldom captured systematically. The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe adaptations to one intervention modified for teletherapy in the wake of COVID-19. An embedded multiple case study design was used to track adaptations made to a vestibular and bilateral integration (VBI) protocol-traditionally delivered in-person-that was implemented via teletherapy in a pediatric outpatient clinic. The "Modification and Adaptation Checklist" was used to track protocol adaptations. Data were examined through descriptive analyses; 63 adaptations were made to the VBI protocol. The most frequently noted adaptation was "Repeating protocol activities," whereas the "Integrating another treatment approach with the VBI protocol" was the least common adaptation. The FRAME may be useful for tracking adaptations and evaluating how adaptations influence intervention effectiveness.

Advancing the management of upper extremity musculoskeletal conditions: Insights from the field of implementation science

INTRODUCTION

The development of effective interventions in hand and upper extremity rehabilitation is critically important; yet even the most promising interventions may not successfully be implemented in practice. Occupational and physical therapists who provide specialized hand and upper extremity rehabilitation services ("hand therapists") can face extensive, multi-level barriers when attempting to use research findings in real-world settings, widening the long-standing research-to-practice gap. Concepts from the field of implementation science can be leveraged to address this gap and expedite the application of research discoveries that can maximize treatment outcomes of the musculoskeletal upper extremity client. As the intersection of hand and upper extremity rehabilitation and implementation science draws growing attention, there is a great need for researchers and clinicians to infuse implementation science into the hand and upper extremity rehabilitation research and practice contexts.

PURPOSE

The purpose of this article is to define implementation science and synthesize several studies from the hand and upper extremity rehabilitation field that have examined the effect of implementation strategies (eg, chart audit and feedback techniques; implementation teams) on implementation outcomes (eg, acceptability, fidelity). We also present recommendations for how (1) hand and upper extremity rehabilitation researchers can design studies to examine both patient outcomes and implementation outcomes relative to interventions for the musculoskeletal upper extremity and (2) hand and upper extremity rehabilitation specialists and administrators can develop implementation teams to facilitate the use of evidence in practice.

CONCLUSION

Collaboration between researchers and clinicians has great potential to advance the entirety of the hand and upper extremity rehabilitation profession, especially when such collaborations are guided by the implementation science field.

Implementing Intergenerational Best Practices in Community-Based Settings: A Preliminary Study

Evidence-based intergenerational (IG) programs bring youth and older adults together in shared activities and promote socioemotional health across age-groups. The core components of these IG programs include 14 IG "best practices" that should be implemented during IG program sessions to optimize program effectiveness for both youth and older adult participants. Despite the proliferation of IG programs across the United States, it is unclear the extent to which these IG best practices have been implemented in the community. This preliminary study assesses the implementation of IG best practices at two community-based sites by program leaders who participated in a multifaceted professional education intervention for IG best practice use. Implementation of best practices was measured through the Best Practices Checklist completed by program leaders and trained coders as well as through narrative written comments. Program leaders indicated that they were able to consistently implement six out of the 14 IG best practices in 46 IG sessions, whereas the best practice named "Adaptations to equipment were made" was least likely to be implemented. Analysis of narrative comments indicated that (a) the group arrangement of participants and (b) program leaders' familiarity with activities also influenced implementation. While many IG best practices can be implemented in the community, some best practices can be implemented with greater ease and consistency. Training resources can support IG best practice implementation; however, our multifaceted professional education intervention may benefit from the addition of case examples or vignettes to depict potential strategies for optimizing evidence-based IG practices.

Addressing Children's Nutritional Needs with Community-Based Participatory Action Research

BACKGROUND

The absence of consistent, reliable, culturally appropriate access to nutritious food places children's development at risk. Nutrition education programming that is delivered using intergenerational strategies may help optimize children's access, consumption, and knowledge of healthy foods.

OBJECTIVES

The purpose of this article is to present the development, implementation and lessons learned from the first year of Food for a Long Life (FFLL) programming-an intergenerational community-based participatory action research (CBPAR) project joining Extension staff, researchers, and community partners to increase families' knowledge, access, and consumption regarding healthy food in a food insecure community. Preschoolers, their family members, and older adults were recruited from two preschools and one adult day services center.

METHODS

Collaborations with community stakeholders informed the development and implementation of intergenerational nutrition education delivered during FFLL programming. Preschoolers, families, and older adults participated in twenty-six nutrition education sessions during the programming year. Parents of preschoolers completed the Household Food Security Survey (HHFS) and the Healthy Kids measure. Semistructured interview data from staff were also collected upon the conclusion of programming.

RESULTS

Preschoolers and their families were found to have marginal food security but relatively healthy eating behaviors. Staff believed FFLL programming enhanced preschoolers' eating behaviors (e.g., increased willingness to try new foods). Continued collaborations with community partners were viewed as essential to program success.

CONCLUSIONS

Relationship-building among intergenerational community members, Extension staff, and university researchers strengthens trust and may expand the reach of FFLL programming and research components.

Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting

Background and Objectives

Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations.

Research Design and Methods

Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study.

Results

We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff.

Discussion and Implications

Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.

Implementing Nutrition Education Programs in Congregate Dining Service Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Nutrition education programs implemented in congregate dining service (CDS) settings have the potential to improve healthy eating behaviors among older adult populations. However, little is understood about the types of nutrition education programs that are implemented at CDS sites and the factors that impede or promote implementation efforts. The purpose of this scoping review was to examine the characteristics of CDS nutrition education programs, barriers and supports to program implementation, and opportunities to enhance implementation of programming.

RESEARCH DESIGN AND METHODS

We adopted a scoping review methodology to assess the relevant literature published January 2000 - January 2020 by accessing CINAHL, SocINDEX, MEDLINE, AgeLine, and Academic Search Complete.

RESULTS

We identified 18 studies that met our inclusion criteria. The majority of nutrition education programs were led by trained facilitators, included the use of interactive activities, and also incorporated written or video materials. Programs that were adapted to the needs of older participants were perceived as supports to implementation whereas participants' needs and resources (e.g., lack of resources, lower health literacy) were occasionally found to limit effective implementation of programming.

DISCUSSION AND IMPLICATIONS

As the older adult population continues to access CDS sites to address their health and nutritional needs, purposeful efforts are needed to examine the specific approaches that can support nutrition education program implementation. Future research is needed to assess strategies that are effective for mitigating barriers to implementing nutrition education programming in the CDS setting.

Evidence-Based Practice Implementation in Stroke Rehabilitation: A Scoping Review of Barriers and Facilitators

IMPORTANCE

Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services.

OBJECTIVE

To synthesize research related to occupational therapy practitioners' implementation of EBPs in adult stroke rehabilitation.

DATA SOURCES

We searched four electronic databases-CINAHL, MEDLINE, PubMed, and Academic Search Complete-and the peer-reviewed journal Implementation Science to identify relevant research studies.

STUDY SELECTION AND DATA COLLECTION

Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O'Malley (2005). Thematic analysis identified themes that emerged from the included studies.

FINDINGS

Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs.

CONCLUSION AND RELEVANCE

Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed.

WHAT THIS ARTICLE ADDS

This article summarizes the contextual factors and effective strategies that may influence practitioners' implementation of stroke research findings in real-world practice.

Narrowing the Gap: An Implementation Science Research Agenda for the Occupational Therapy Profession

Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr's (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementation-related outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.

Implementing Fall Prevention Guidelines with Vulnerable Older Adults: The Social Work Role

Falls are the leading cause of injury among the older adult population, resulting in costly and devastating aftermaths. National fall prevention guidelines (FPGs) have been established to assist healthcare professionals with addressing fall risk, but little is understood about the extent to which FPGs have been implemented by social workers. Social workers, however, may beuniquely positioned to implement FPGs with older adults due to their expertise in care coordination and home- and community-based service settings. This conceptual paper addresses the timely issue of fall prevention and social workers' potential role in implementing FPGs to address fall risk.

The Occupational Therapy Approach to Addressing Food Insecurity among Older Adults with Chronic Disease

The older adult population is one of the fastest growing age groups in the United States. Various components influence productive aging, and current research has identified nutrition and healthy eating as key factors that impact older adults' overall health status. While consumption of nutritious meals can help minimize the risk of health decline, the growing rate of food insecurity inhibits older adults' abilities to access healthy food regularly. Additionally, the high prevalence of chronic disease and disability in older adults can also limit independent participation in food-related activities, such as shopping, self-feeding, and meal preparation. A lack of food access and difficulties engaging in food-related activities place older adults with chronic disease at an increased risk of malnutrition, disability, and losing independence, thereby threatening social participation, healthy aging, and quality of life. Due to their expertise in promoting health and independent living, occupational therapy practitioners may be uniquely positioned to enhance older adults' healthy eating behaviors through the use of client-centered interventions tailored to food-related activities. This position paper reviews the scope of the occupational therapy profession, the consequences of food insecurity among older adults with chronic conditions, and strategies to enhance food-related activity participation in later life.

Implementing Evidence-Based Interventions With Community-Dwelling Older Adults: A Scoping Review

OBJECTIVE

With the rapid growth of the community-dwelling older adult population, evidence-based occupational therapy interventions targeting older clients need to be effectively implemented. However, little is understood about the factors influencing effective intervention implementation into practice.

METHOD

We performed a scoping review to explore what strategies and factors relate to the uptake of older adult interventions into practice. Concepts from implementation science literature guided our review.

RESULTS

Our review yielded 13 articles that met our search criteria. Study designs examined barriers, facilitators, and strategies related to the implementation of evidence-based older adult interventions into practice. Effective implementation strategies included training sessions, workshops, consultations, and outreach meetings.

CONCLUSION

Our findings suggest that practitioners, administrators, and researchers should adopt strategies such as workshops, consultations, fidelity vignettes, peer mentoring, and standardized training to effectively implement research into practice with older adults.