Effective Chronic Disease Interventions in Nursing Homes: A Scoping Review Based on the Knowledge-to-Action Framework

ABSTRACT

Objectives: The purpose of this scoping review was two-fold: 1) to identify effective intervention studies addressing chronic disease for seniors living in nursing homes (e.x. chronic heart failure, diabetes, dementia, etc.), and 2) to describe how consistently the studies’ reported their stages of the Knowledge-to-Action framework (2006).

Methods: This scoping review involved a systematic search of CINAHL, EMBASE, PubMed and Scopus of intervention studies, published in English and French between 1997 and 2018, that focused on the development, implementation and/or evaluation of a chronic disease management guideline or best practice for older adults 65+ residing within a nursing home (NH). Authors abstracted information specific to the seven stages of the Knowledge-to-Action framework (identifying problem, tailoring to local context, barriers and facilitators to intervention delivery, implementation, monitoring, outcome criteria, and sustainability).

Results: Six studies met the inclusion criteria. Procedures for monitoring knowledge use and outcome evaluation were thoroughly described. Other stages of the Knowledge-to-Action framework were not consistently reported, including problem identification related to older adults’ needs and within the context of NHs, intervention implementation, evaluation, and sustainability. Of the six studies included, only two met all the pre-defined evaluation outcomes.

Conclusions: Given the need for chronic disease management in NHs, researchers are encouraged to report on intervention studies using the Knowledge-to-Action framework to optimize the likelihood that interventions will be suitable for the context of their delivery and introduce sustainable change.

Clinical implications: To answer what interventions should be introduced to residents in long-term care, research must clearly demonstrate efficacy, provide enough detail for methods to be reproducible in applied contexts, and consider strategies for sustainability and the holistic needs of residents.

KEYWORDS:

• Seniors
• long-term care
• nursing homes
• intervention research
• knowledge-to-action
• chronic care
• scoping review

Clinical Implications

• There is a clear need for evidence-based management of chronic diseases among older adults in long-term care.

• Strategies for ensuring results are generalizable and reproducible include using systematic reporting frameworks such as the KTA cycle (Straus et al., 2009) from the outset of conducting a study, targeting adults over age 80 who are historically excluded from studies, describing with sufficient detail how their intervention may interact with existing care regimens, and how common barriers to implementation were addressed (such as insufficient staffing, etc.).

• Interventions are more likely to be applied in practice if they are sustainable. Studies should include strategies of how common barriers to implementation can be overcome and provide clear criteria for clinical decision-makers and clients when evaluating if the intervention is of benefit to them.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Ministry of Health and Long-Term Care’s 2017-2020 Health System Research Fund (HSRF; Grant #255). The sponsor had no role in any of the aspects of the review including study design, collection, analysis, writing of the report and decision to submit for publication.