P.J. van der Laag1, D.-J. Barten2, B. Dorhout2, A. Heeren2, C. Veenhof3, L. Schoonhoven1
1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, 2Utrecht University of Applied Sciences, Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht, Netherlands, 3University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, Netherlands
Background: A combined lifestyle intervention focusing on nutrition and exercise is an effective intervention for community-dwelling older adults to improve physical functioning and prevent from healthcare risks due to loss in muscle mass. However, the potential of these interventions is not being fully exploited due to insufficient implementation. Having insight into which determinants could hinder or facilitate the implementation of a nutrition and exercise intervention could improve the development of implementation strategies and enhance the implementation of such lifestyle interventions for community-dwelling older adults.
Purpose: The aim of this study is to identify barriers and facilitators for a successful implementation of a nutrition and exercise intervention for community-dwelling older adults.
Methods: We conducted a scoping review according to the framework for scoping reviews described by Arksey & O’Malley. A literature search was conducted in four electronic databases, references were checked for additional inclusion. Two researchers screened if studies met the inclusion criteria. Healthcare professionals (physical therapists, dieticians, lifestyle coaches) and community-dwelling older people were interviewed to validate the results of the literature search. Barriers and facilitators were categorized into the constructs of the Consolidated Framework for Implementation Research (CFIR). The CFIR framework describes 39 constructs that could influence implementation, categorized in five domains (i.e. inner setting, outer setting, process, innovation characteristics, individual characteristics). Finally, healthcare professionals ranked the constructs by importance for implementation.
Results: The literature search identified 10001 studies, 22 were found eligible for inclusion in the review. Determinants were categorized into the CFIR framework. Four focusgroups with 13 healthcare professionals and three face-to-face interviews with community-dwelling older adults were conducted. The interviews were transcribed and deductively coded into the constructs of the CFIR framework.
In total, 654 determinants were identified and categorized into the constructs of the CFIR framework, resulting in determinants for 32 of the 39 CFIR constructs. Most determinants were categorized in the domain ‘outer setting’. Community-dwelling older adults gave further insight into why they would (not) participate in a nutrition and exercise intervention.
The most cited determinants were also ranked by healthcare professionals as important determinants for implementation.
The five most cited constructs influencing implementation of a nutrition and exercise intervention were: Cosmopolitanism (i.e. network with external organizations), patient needs and resources, readiness for implementation, costs, and knowledge and beliefs about the intervention.
In total, 654 determinants were identified and categorized into the constructs of the CFIR framework, resulting in determinants for 32 of the 39 CFIR constructs. Most determinants were categorized in the domain ‘outer setting’. Community-dwelling older adults gave further insight into why they would (not) participate in a nutrition and exercise intervention.
The most cited determinants were also ranked by healthcare professionals as important determinants for implementation.
The five most cited constructs influencing implementation of a nutrition and exercise intervention were: Cosmopolitanism (i.e. network with external organizations), patient needs and resources, readiness for implementation, costs, and knowledge and beliefs about the intervention.
Conclusions: A broad range of barriers and facilitators across all domains of the CFIR framework emerged in this study. To successfully implement a nutrition and exercise intervention for community-dwelling older adults, implementation strategies should at least focus on costs, readiness for implementation, networking with external organizations, knowledge and beliefs about the intervention, and patient need and resources. The next step is development of implementation strategies aiming at the identified determinants, which can be investigated in pilot and effectiveness studies.
Implications: This research give insight which determinants could hinder or facilitate the implementation of a nutrition and exercise intervention for community-dwelling older adults. To enhance a successful implementation, physical therapists and dieticians could anticipate on this determinants while preparing for implementation to overcome these barriers.
Funding acknowledgements: This research was financially supported by a grant from the Regiodeal Foodvalley (162135).
Keywords:
Older adults
Lifestyle intervention
Implementation
Older adults
Lifestyle intervention
Implementation
Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Older people
Health promotion & wellbeing/healthy ageing/physical activity
Older people
Did this work require ethics approval? No
Reason: In this research there is no question of medical scientific research and participants are not subject to actions or being imposed on specific rules of behaviour
All authors, affiliations and abstracts have been published as submitted.
