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Table 4 Fidelity to intervention

From: A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar

Factors

Type A facilitation

Type B facilitation

Variability in selection, preparation and drop out of IFs

• 7 of the 8 homes selected an IF to attend the 3-day residential programme.

• 1 IF was selected later and completed a shorter development programme

• 2 IFs withdrew shortly after the start of the intervention due to ill-health: 1 was replaced by a buddy (without training), and 1 was replaced by a nurse who did not meet all of the selection criteria, and who completed a shortened development programme.

• 6 of the 8 homes selected an IF to attend the 5-day residential programme (no IFs from one country attended).

• 1 IF was recruited later and months later completed a condensed development programme.

• Of the 6 IFs who participated in the full 5-day programme, 1 withdrew approximately 3 months after the start of the intervention due to ill-health and was replaced by a buddy who did not attend the initial programme or join the teleconferences; 1 other left for a new job and was replaced by someone who did not meet all the selection criteria. Whilst she attended a condensed development programme, she later withdrew from the project.

Variable engagement in the facilitation programme

• Following the residential programme 2 sites only engaged in a limited way. For example, one of the IFs had limited skills and access to IT making engaging in activities such as audit and feedback a challenge.

• IFs from 2 sites participated in all 12 teleconference meetings; 2 sites in 3; attendance by IFs from the other 4 homes varied from 5 to 10 meetings.

• 1 site did not engage in the facilitation intervention and 1 other site in the same country disengaged soon after the start of the programme.

• 18 monthly teleconference support meetings were held. 1 site participated in all 18 teleconferences. Attendance by the other sites varied between 10 and 15 meetings.

Progress according to plan

• None of the 8 homes were able to implement the plans devised at the residential programme, which included audit and feedback activity related to each of the guideline recommendations.

• Partial implementation was achieved with 4 homes completing a baseline audit of the 4 recommendations and devised follow-up action plans

• 4 homes addressed 2 or less of the recommendations

• 4 of the 8 homes created plans for developing more person-centred cultures.

• 1 home made significant progress in advancing this plan and the others made variable progress.

• Only 1 home was able to demonstrate progress in developing the quality of practice.