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Table 4 Enablers and barriers of the PECAN implementation strategy

From: Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial

Categories Enablers Barriers
Overall strategy • Stepwise training of facilitators (i.e., facilitators’ workshop, peer-mentor visit, peer-mentoring via telephone) (F) • Lack of systematic involvement of all the different stakeholders (i.e., management, social workers, relatives, and therapists) (F, R, T, SW)
• Clear defined PECAN content (F) • Available time period too short to complete implementation (F)
• Personal contact initiated by the management or the facilitators to provide the different stakeholders with information on PECAN (T, F) • Difficulties in the implementation for residents with severe physical and cognitive impairment (F)
Facilitators’ workshop • Practical elements (e.g., training on the use of technical and medical aids) (M) • Unbalanced ratio between theory and practice (i.e., more active participation during workshop required) (F, RT)
Information session • Use of plain language when addressing the different participant groups (RT) • Lack of systematic involvement of the nursing staff (e.g., no presentation within the nursing team) (F)
• Diverse groups of participants could be reached and informed about PECAN in one session (F, SW) • Invitation to the session (i.e., poster at the entrance area) did not reached all potential participants (F, T, R, SW, RT)
Peer-mentoring • The peer-mentor visit was highlighted as a useful introduction to the implementation of PECAN (F) • Facilitators were usually not directly available via e-mail or telephone (e.g., appointments via the head nurse were necessary) (F, PM)
• Continuous availability of the peer-mentors via telephone (F)
• Standardised procedure of peer-mentoring via telephone (F, PM)
 - Routines for communication and regular appointments (F, PM)
 - Specific objectives based on the last counselling (PM)
Supportive materials • Supportive materials tailored for the target population (F, T, SW)
 - Training folder for facilitators (F)
 - Posters for the nursing wards (T, SW, F)
 - Materials for nursing team training (F)
 - Specific leaflets for relatives, therapists and physicians (F)
 - Article regarding PECAN published in nursing home journal (SW)
• Lack of supportive materials with a simple and practical design (F, R)
• Lack of supportive materials to guide the implementation (e.g., no standardised documentation forms, no overview of potential intervention measures) (F)
• Leaflets should have more focus on personal tasks (R)
• Supportive materials did not reach the targeted population (R, T, SW)
 - Posters or other reminders in the nursing wards were not noticed (R)
 - Leaflets were not handed out (R, T, SW)
  1. Abbreviations: RT research team, F facilitators, R relatives, T therapists, SW social workers, PM peer-mentors
  2. Data base: Statements from the research team based on documentation forms (2 protocols for the facilitators’ workshop, 2 protocols for the information session); statements from the facilitators based on problem-centred interviews (9 participants) and one group discussion (4 participants); statements from relatives (5 participants), therapists (4 participants) and social workers (4 participants) based on problem-centred interviews; statements from the peer-mentors based on problem-centred interviews (2 participants)