Implementation Profiles of an Online Communication Education Program in the CHATO National Trial Nursing Homes

TL;DR

This study analyzed how nursing homes implemented an online communication training program for dementia care and identified three distinct implementation profiles.

Contribution

The study introduces a novel method for classifying nursing home implementation profiles using latent class analysis.

Findings

Three implementation profiles were identified: self-paced, champion-paced, and leadership-paced.

The self-paced profile was most common, with high staff participation but low discussion and recognition.

Leadership-paced implementation showed the highest probability of using reminders, discussions, and recognition.

Abstract

The Changing Talk (CHAT) communication education program effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes . As part of the nationwide pragmatic clinical trial testing Changing Talk: Online Training (CHATO), a remote implementation design was developed to capture contextual factors, ensure fidelity, and identify effective implementation strategies. Nursing homes implementing CHATO were surveyed upon completion to determine implementation strategies consistent with Expert Recommendations for Implementing Change (ERIC). A national sample of 79 nursing homes from 37 states completed the survey. Remote implementation lasted three months, one month per phase (planning, intervention implementation, and a follow-up). Staff participation rates averaged 51.6% (SD = 31.3%), ranging from 3% to 100%. Latent class analysis in Mplus version 8.10 was used to determine the implementation profiles of nursing home strategies. The three-class model demonstrated the best fit (AIC=652.05, BIC=706.55, and Sample-Size Adjusted BIC=634.03) which classified implementation profiles into (1) self-paced, (2) champion-paced, and (3) leadership-paced. Fifty-four nursing homes (68%) belonged to the Self-Paced dominant class which demonstrated all staff participation, but low participation in discussions and recognition; 22 nursing homes (28%) belonged to the Champion-Paced dominant class which used champions and reminder emails, and three nursing homes (4%) belonged to the Leadership-Paced dominant class which had relatively the highest probability of all staff participation, reminder emails and texts, discussions, and public recognition. Future analysis of these profiles will be combined with MDS data to assess which implementation styles are linked to improved resident outcomes.