Developing a programme theory for dementia training in hospitals : Why we need a critical interpretive synthesis review of current evidence-base?

Ahmed, Faraz and Morbey, Hazel and Kenyon, Jane and Harding, Andrew and Holland, Fiona and Reeves, David and Swarbrick, Caroline and Leroi, Ira and Burrow, Simon and Davies, Linda and Keady, John and Reilly, Siobhan Theresa (2017) Developing a programme theory for dementia training in hospitals : Why we need a critical interpretive synthesis review of current evidence-base? In: HSRUK Symposium 2017, 2017-07-06 - 2017-07-07, Nottingham Conference Centre.

Abstract

Background: There are approximately 850,000 people living with dementia in the UK, with costs estimated currently to be £26 billion a year. Improving the quality of care in hospitals has continued to be one of the key priorities within national dementia strategies. Around 70% of acute hospital beds are occupied by older people, approximately 40% of whom have dementia. Although the field of dementia care training is complex, developing and dynamic there are few robust evaluations. It is neither possible nor desirable to specify a-priori precise review questions, without running the risk of severely limiting the amount of evidence required to address a review question. We want to understand much more about the broader range of structures and dementia initiatives within individual hospitals within the current context of dementia care and awareness training provided in acute NHS hospitals. Methods: The aims of this critical interpretive synthesis of the current evidence base for dementia training in hospitals and/or for staff working in hospitals is: to describe the current training initiatives (process); to evaluate their implementation (outcomes), and to develop a logic model using the principles of programme theory to identify mechanisms, interactions, facilitators and barriers to dementia-related training in the hospital setting. This presentation discusses the development of a preliminary guiding programme theory for dementia training in hospital settings and the development of a critical interpretive synthesis of current evidence dementia training in hospitals. A three-stage approach developed our guiding programme theory; Stage 1: Preliminary review of the dementia training in hospital settings literature. Stage 2: Discussions with researchers and practitioners involved in dementia and health services research, specifically to identify the mechanisms, facilitators and barriers to dementia training in hospital settings. Stage 3: Construction of guiding questions for the critical interpretive synthesis to further support and enhance the quality of interpretations and critical review of the articles included. Results: There are various barriers to and facilitators of dementia training in hospitals and/or for hospital staff, including both surface and deep-seated factors such as lack of resources, abundance of varying training packages/courses available, and willingness/support to develop and implement training initiatives, existing beliefs and assumptions of trainers and trainees, as well as, previous experiences of trainers and staff with people living with dementia and their carers. Implications: In addition to providing the theoretical framework for our critical interpretive synthesis review, our primary programme theory and logic model for dementia training in hospital settings are also valuable to practitioners, trainers, and those involved in evaluating dementia training initiatives. Investigation of processes involved is key to the development of theory-based, programmatic models for dementia training intervention and policies. Further developments to the programme theory will follow our critical interpretive synthesis of the current evidence on dementia training.