WHELD into Practice: improving Wellbeing and mental HEaLth for care home residents with Dementia and reducing unnecessary sedative medications.

Introduction

WHELD is an evidence-based person-centred training programme which, in 4 clinical trials involving 2349 care home residents with dementia, demonstrated benefits in wellbeing, mental health and a reduction in sedative medications across London and Buckinghamshire. The study will introduce WHELD in up to 75 care homes across 6 ARC regions – South West, East of England, Newcastle, North West, East Midlands and Yorkshire and Humber.

Research questions:

1. What contextual factors will impact on how ready a care home is for implementation and what are the key variations that activities might be tailored to address?
2. What contextual factors could enable and hinder effective delivery of activities?
3. What are the characteristics of care homes that will benefit most from ‘standard’ WHELD training, and what characteristics indicate that a care home will be more suited to either WHELD-lite or a more intensive introduction of WHELD activities using an additional module?
4. How will WHELD implementation activities and local delivery methods interact with other existing staff dementia training programmes or initiatives in different types of homes?

Project aims

No care home dementia training programme with a clinical trial evidence base of benefit has been successfully implemented in the UK or elsewhere, and rolling-out this training programme nationally could make a significant difference to the lives of the most vulnerable people with dementia in the UK.

This study is a hybrid implementation and outcome evaluation of WHELD implementation. There is considerable variation across care homes within and between ARC regions in the UK. WHELD implementation activities aim to gel with variations in local context to ensure it is taken up and sustained over time, and that is delivered with fidelity.

To achieve this requires an understanding of those contextual variations that directly interact with WHELD. The implementation evaluation will identify key influential contextual factors across system levels to inform development of:

• A local needs self-assessment proforma for care homes, including organisational readiness, uptake, fidelity, and penetration.
• A suite of implementation activities that can be flexibly tailored to meet the requirements of homes based on the local needs self-assessment’?
• Troubleshooting advice for each component of the self-assessment proforma to help care homes prepare for WHELD implementation, and monitor and adapt implementation to ensure uptake, fidelity, and penetration.

• Produce a clear implementation plan to scale up and spread WHELD to care homes nationally

Project activity

Using different levels of in-person and virtual/digital support in each area, the programme will provide a flexible range of delivery and pricing options. We will continue the extensive public and community involvement that is core to the programme to enrich the findings and ensure they are applicable in real-world settings. Established frameworks (Consolidated Framework for Implementation Research – CFIR, Proctor’s implementation outcomes) will be used to identify key barriers and enablers to implementation at each system level. Interviews and focus groups across the care homes will explore helpers and hindrances to the uptake and reach of WHELD.  Stakeholder consultation with managers and owners, care home groups, commissioners, integrated care systems and AHSNs will explore optimal pathways to implementation in the real world.

Anticipated or actual outputs

In-depth case study findings will inform development of the suite of WHELD implementation options (WHELD-lite, standard, and intense). Particular attention will be paid to exploring diversity of context and variation in type of care home and how these will require adaptations to the training model to ensure successful implementation. For example, we anticipate that there may be pre-WHELD training needed for homes with low skill and knowledge in care of people with dementia and low quality in-house training, and there may be a WHELD-lite (perhaps digital delivery only) option for care homes already providing high-quality person-centred care.