Abstract

Background: Recent years have seen a rise in digital interventions to improve coordination and information sharing between care homes and community NHS services. These can support sharing of information on the health of care home residents, but issues of training and context-sensitivity have limited implementation into practice. Due to their remote, data sharing functions, such interventions became key components in the response to the COVID-19 pandemic. This paper presents findings from the qualitative component of an evaluation of an implementation of such an intervention, the HealthCall Digital Care Homes application, across several sites in northern England. The implementation commenced prior to the pandemic, and continued throughout to ensure care home had remote means to contact NHS services, beyond using the phone, which can cause staff to be held in a long queue.

Methods: Semi-structured, qualitative interviews were held with stakeholders including the local HealthCall team, a commissioner, NHS community nurses, care home staff and residents, and relatives of care home residents. Interviews were conducted remotely (October 2020 -June 2021), during the COVID-19 pandemic. Data were analysed following the principles of thematic analysis, then considered against Normalization Process Theory (NPT) constructs (coherence, collective action, cognitive participation, and reflexive monitoring) to provide a framework to evaluate implementation success.

Results: Thirty-five participants were recruited, including 16 care home staff, six NHS health care staff, five relatives of care home residents, four members of the HealthCall implementation team, three care home residents, and one commissioner from a linked Local Authority. The application was viewed positively across stakeholder groups. Training and problem solving from the HealthCall team and appreciation of the application from care home and NHS staff were key to achieving coherence, collective action and cognitive participation. The HealthCall team maintained on-going formal and informal engagement, and with other stakeholders, appraising the implementation and engagement of key stakeholders, which resulted in revisions to the intervention and implementation. Key challenges to implementation included apprehension towards digital technology and pockets of low digital literacy among care home staff. Awareness raising among relatives in regard to such interventions could be improved.

Conclusions: While this implementation appears broadly successful, establishing rapport and maintaining on-going support requires significant time, financial backing, and the right individuals in place across stakeholder groups to drive implementation and intervention evolution. The digital literacy of care home staff requires encouragement to enhance their readiness for digital interventions. The COVID-19 pandemic has pushed this agenda forward. Problems with stability across the workforce within care homes need to be addressed to avoid skill loss and support embeddedness of digital interventions.

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