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Implementing professional behaviour change in teams under pressure: results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)
  1. Mike Bracher1,2,
  2. Katherine Steward3,
  3. Kathy Wallis4,
  4. Carl R May5,
  5. Annemarie Aburrow4,
  6. Jane Murphy6
  1. 1 School of Health Sciences, University of Southampton, Southampton, UK
  2. 2 Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
  3. 3 Southern Health NHS Foundation Trust, Southampton, UK
  4. 4 Wessex Academic Health Science Network (AHSN), Southampton, UK
  5. 5 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  6. 6 Department of Human Sciences & Public Health, Bournemouth University, Bournemouth, UK
  1. Correspondence to Dr Mike Bracher; m.j.bracher{at}


Objectives To evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as a routine aspect of care.

Design Prospective process evaluation using mixed methods with pre/post-implementation measures.

Setting and participants Community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre-implemetation and post-implementation surveys.

Main outcome measures NoMAD survey for pre–post-intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.

Methods Data prior to implementation of training, baseline (T0—survey and telephone interview) and 2 months following training (T1—follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group and total study sample; analysis using Wilcoxon rank-sum (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation process theory.

Results High support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational and specialist dietetic support. Pre–post-training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and lack of access to dietetic support.

Conclusion Greater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are as follows: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions.

  • nutrition
  • screening
  • process evaluation
  • community care
  • malnutrition
  • normalisation process theory
  • implementation

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  • Contributors JM, KW and KS devised the project (for which CRM and AA also provided advice). JM obtained funding at the host institution, Bournemouth University. JM managed the study as chief investigator. MB was primarily responsible for study design, protocol, data collection and analysis with input from JM, KW, KS, AA and CRM. All authors contributed significant revisions to drafts of the manuscript, and have read and approved the final manuscript.

  • Funding The project is funded by The Burdett Trust for Nursing.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study has been granted through institutional ethical review (Bournemouth University); NHS Heath Research Authority approval (IRAS ID – 223214) was granted on 05/04/2017. NHS Research Ethics committee approval was not required for this study, as it involves only staff.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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