Healthcare Professionals' Perspectives on the Impact of a Multicomponent Intervention for Older People With Frailty Discharged From Hospital–A Theory-Based Evaluation

Abstract

Rationale

Older people with frailty are at high risk of functional decline, readmissions, and other adverse health outcomes, after acute hospitalisation. Interventions should focus on strength training and nutrition, but knowledge is needed on designing sustainable interventions after discharge.

Aims and Objectives

The aim of this study was to explore what healthcare professionals perceive as central for making a newly developed complex training, social, and nutritional intervention work effectively using theory-based evaluation. The intervention was a RCT study including 119 participants.

Methods

Nine semi-structured interviews and three follow-up meetings were conducted with healthcare professionals (physiotherapists, senior activity employees, dietician) who performed the intervention. Interviews were analysed for Context–Intervention–Mechanism–Outcome configurations, and findings were compared with the initial programme theory.

Results

The training and social elements of the intervention seemed to largely function as intended. According to the healthcare professionals, the mechanisms for the training intervention were successful experiences, the approach of the physiotherapists, and the atmosphere and interactions between participants, leading to increased self-efficacy and motivation for continuing. However, goal setting and test results were used differently as motivational tools. The social intervention was perceived to work through feeling part of a community and well received in the centre. The perceived mechanisms for the nutritional intervention were increased knowledge and feelings of being seen and heard, although it seems that the impact was mixed.

Conclusion

According to the involved healthcare professionals, the complex training, social, and nutritional intervention seemed to work well for older people with frailty, although the nutritional intervention was received differently. The important mechanisms were the social element and the personal approach of the physiotherapists, which perceivably prompted training efforts and results and yielded good mental outcomes. The organisation of a similar multicomponent intervention should consider integrating the nutritional intervention and frame the use of goal setting and testing further. The findings provided novel insights to working mechanisms in multicomponent interventions for older people with frailty, especially regarding the social component, which may inform future interventions.