A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme

Jo Hockley, Katherine Froggatt, Lieve Van Den Block, Bregje Onwuteaka-Philipsen, Marika Kylänen, Katarzyna Szczerbińska, Giovanni Gambassi, Sophie Pautex, Sheila Alison Payne, Borja Arrue, Ilona Baranska, Luc Deliens, Yvonne Engels, Harriet Finne-Soveri, Viola Kijowska, Maud Ten Koppel, Federica Mammarella, Tinne Smets, Mariska Oosterveld-Vlug, Roeline Pasman & 7 others Ruth Piers, Lara Pivodic, Jenny Van Der Steen, Nele Van Den Noortgate, Hein Van Hout, Anne Wichmann, Myrra Vernooij-Dassen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.
Original languageEnglish
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 24 Oct 2019

Cite this

Hockley, Jo ; Froggatt, Katherine ; Van Den Block, Lieve ; Onwuteaka-Philipsen, Bregje ; Kylänen, Marika ; Szczerbińska, Katarzyna ; Gambassi, Giovanni ; Pautex, Sophie ; Payne, Sheila Alison ; Arrue, Borja ; Baranska, Ilona ; Deliens, Luc ; Engels, Yvonne ; Finne-Soveri, Harriet ; Kijowska, Viola ; Ten Koppel, Maud ; Mammarella, Federica ; Smets, Tinne ; Oosterveld-Vlug, Mariska ; Pasman, Roeline ; Piers, Ruth ; Pivodic, Lara ; Van Der Steen, Jenny ; Van Den Noortgate, Nele ; Van Hout, Hein ; Wichmann, Anne ; Vernooij-Dassen, Myrra. / A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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title = "A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme",
abstract = "Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.",
keywords = "Cross-cultural adaptation, Development, End-of-life care, Implementation, Intervention, Long-term care facilities, Nursing home, Palliative care",
author = "Jo Hockley and Katherine Froggatt and {Van Den Block}, Lieve and Bregje Onwuteaka-Philipsen and Marika Kyl{\"a}nen and Katarzyna Szczerbińska and Giovanni Gambassi and Sophie Pautex and Payne, {Sheila Alison} and Borja Arrue and Ilona Baranska and Luc Deliens and Yvonne Engels and Harriet Finne-Soveri and Viola Kijowska and {Ten Koppel}, Maud and Federica Mammarella and Tinne Smets and Mariska Oosterveld-Vlug and Roeline Pasman and Ruth Piers and Lara Pivodic and {Van Der Steen}, Jenny and {Van Den Noortgate}, Nele and {Van Hout}, Hein and Anne Wichmann and Myrra Vernooij-Dassen",
year = "2019",
month = "10",
day = "24",
doi = "10.1186/s12913-019-4587-y",
language = "English",
volume = "19",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",

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Hockley, J, Froggatt, K, Van Den Block, L, Onwuteaka-Philipsen, B, Kylänen, M, Szczerbińska, K, Gambassi, G, Pautex, S, Payne, SA, Arrue, B, Baranska, I, Deliens, L, Engels, Y, Finne-Soveri, H, Kijowska, V, Ten Koppel, M, Mammarella, F, Smets, T, Oosterveld-Vlug, M, Pasman, R, Piers, R, Pivodic, L, Van Der Steen, J, Van Den Noortgate, N, Van Hout, H, Wichmann, A & Vernooij-Dassen, M 2019, 'A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme' BMC Health Services Research, vol. 19, no. 1. https://doi.org/10.1186/s12913-019-4587-y

A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme. / Hockley, Jo; Froggatt, Katherine; Van Den Block, Lieve; Onwuteaka-Philipsen, Bregje; Kylänen, Marika; Szczerbińska, Katarzyna; Gambassi, Giovanni; Pautex, Sophie; Payne, Sheila Alison; Arrue, Borja; Baranska, Ilona; Deliens, Luc; Engels, Yvonne; Finne-Soveri, Harriet; Kijowska, Viola; Ten Koppel, Maud; Mammarella, Federica; Smets, Tinne; Oosterveld-Vlug, Mariska; Pasman, Roeline; Piers, Ruth; Pivodic, Lara; Van Der Steen, Jenny; Van Den Noortgate, Nele; Van Hout, Hein; Wichmann, Anne; Vernooij-Dassen, Myrra.

In: BMC Health Services Research, Vol. 19, No. 1, 24.10.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme

AU - Hockley, Jo

AU - Froggatt, Katherine

AU - Van Den Block, Lieve

AU - Onwuteaka-Philipsen, Bregje

AU - Kylänen, Marika

AU - Szczerbińska, Katarzyna

AU - Gambassi, Giovanni

AU - Pautex, Sophie

AU - Payne, Sheila Alison

AU - Arrue, Borja

AU - Baranska, Ilona

AU - Deliens, Luc

AU - Engels, Yvonne

AU - Finne-Soveri, Harriet

AU - Kijowska, Viola

AU - Ten Koppel, Maud

AU - Mammarella, Federica

AU - Smets, Tinne

AU - Oosterveld-Vlug, Mariska

AU - Pasman, Roeline

AU - Piers, Ruth

AU - Pivodic, Lara

AU - Van Der Steen, Jenny

AU - Van Den Noortgate, Nele

AU - Van Hout, Hein

AU - Wichmann, Anne

AU - Vernooij-Dassen, Myrra

PY - 2019/10/24

Y1 - 2019/10/24

N2 - Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.

AB - Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.

KW - Cross-cultural adaptation

KW - Development

KW - End-of-life care

KW - Implementation

KW - Intervention

KW - Long-term care facilities

KW - Nursing home

KW - Palliative care

UR - http://www.mendeley.com/research/framework-crosscultural-development-implementation-complex-interventions-improve-palliative-care-nur

U2 - 10.1186/s12913-019-4587-y

DO - 10.1186/s12913-019-4587-y

M3 - Article

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

ER -