"It's what would work for her": An analysis of adaptations to the Individualized Positive Psychosocial Interaction program in US nursing homes.

Abstract

Background and objectives: The Individualized Positive Psychosocial Interaction (IPPI) Program is an adaptable, evidence-based intervention. IPPI trains nursing home care partners to engage residents living with moderate to severe dementia in preference-based, one-to-one interactions using emotion-focused communication. We sought to understand provider-driven adaptations made to the IPPI Program and whether the adaptations made were fidelity-consistent.

Research design and methods: Data were collected from n=78 interviews with n=23 nursing home provider champions who led a quality improvement project (QIP) to implement the IPPI with 3 to 5 residents per care community. Using content analysis, we report quantitative data on the adaptation characteristics according to the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) core modules and participant quotes to illustrate adaptations.

Results: Champions reported 34 adaptations, with an average of 2.6 adaptations per nursing home. The majority of IPPI adaptations pertained to implementation (65%; n=22), while 17% (n=6) were content and 17% (n=6) were context. Motivation for adaptations ranged from organizational (e.g., time constraints) to recipient (e.g., cognitive capacity). Most adaptations made to the IPPI protocol by care partners were fidelity-consistent (92%; n=33).

Discussion and implications: Care partners' adaptations to the IPPI made the intervention more resident-centric. Future healthcare intervention providers must consider the user perspective and encourage adaptations that further tailor to the user, as long as the adaptations are fidelity-consistent.