Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design

Abstract

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge.</jats:p> <jats:p>We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>From 2018 to 2020, clinicians at eight VA medical centers received REP-guided implementation including facilitation, technical assistance, and implementation tools to deliver the training program. The project team used the REP framework to develop activities across four distinct phases – (1) pre-conditions, (2) pre-implementation, (3) implementation, and (4) maintenance and evolution – <jats:bold>a</jats:bold>nd systematically tracked implementation facilitators, barriers, and adaptations.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Within the REP framework, results describe how each medical center adapted implementation approaches to fit local needs. We highlight examples of how sites balanced adaptations and intervention fidelity.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The REP framework shows promise for national expansion of the caregiver training intervention, including to non-VA systems of care, because it allows sites to adapt while maintaining intervention fidelity.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03474380">NCT03474380</jats:ext-link>. Date registered: March 22, 2018.</jats:p> </jats:sec>