Table 1 Framework components
Evidence—what is included in the evidence base of practice, and in the evidence base of the continence care recommendations, which has the potential to influence how care is delivered | |
|---|---|
Practice recommendations, including their sharing and dissemination (through standard dissemination intervention) | |
Practitioner experience | |
Resident experience of continence care | |
Local data/information about continence care/practice (including supplies) | |
Context—factors that may interact to mediate intervention implementation and the response of recipients | |
Organisation and infrastructure of homes | How care and service delivery is organised |
Type of home ownership | |
Culture and philosophy of the home | How leaders and managers create particular environments |
Orientation to learning | |
How staff are valued | |
Attitudes and approach to residents | |
Relationships and connections between people | |
Macro context | Political factors—health policy, legislation |
Economic factors | |
Societal, e.g. attitudes to older people | |
Education systems | |
Relationships with industry (continence products) | |
Difference in systems across countries | |
Facilitation | Underpinning theories of action |
Type A | • Quality improvement, organisational learning, and humanistic psychology—how individuals learn and apply that knowledge to improvement activities. • Within the PARIHS framework type A represents an approach to facilitation towards the left of the facilitation continuum [21]. |
Type B | • Critical social sciences, focussed on enlightenment, empowerment and emancipation—that enable individuals to develop new understandings about what needs to be changed and how to change it, including (1) understanding, (2) choosing and development appropriate strategies, (3) doing and (4) evaluation. • Within the PARIHS framework, type B represents an approach to facilitation towards the right of the facilitation continuum [21]. |
Internal–external facilitation | The chain of action between internal (IF) and external facilitators (EF) |
Buddy | Relationship and dynamic between internal facilitator and buddy |
Facilitator characteristics | Experience, knowledge and engagement of individual facilitators |
Potential impacts | • Including anticipated and unanticipated, and reach and potential spread • Changes to continence practice - Improved assessment - Appropriate use of products - Revised continence local policy - Introduction of new practices and activities • Positive impact on residents’ and next of kin experiences • Positive impact on practitioners’ experiences, attitudes and learning • Positive impact on internal facilitators’ skills, confidence, experience, knowledge (and values with respect to type B) • Potentially positive impact on care home context (type B) |