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36 Australian Journal of Dementia Care June/July 2016 Vol 5 No 3
respondents were again more
likely than the Workshop
participants to have initiated
changes (iPhone Plus 56%,
Consultancy 47.5%, Workshop
37%).
Lower rates for Consultancy
than iPhone Plus respondents
may be explained by the
nature of the planned
interventions; more ‘new
builds’ and larger
modifications were being
planned by Consultancy
respondents who were still in
the process of planning or
commissioning alterations at
the time of the follow-up
evaluation.
From the interviews, it was
evident that the modifications
planned by workshop
participants were more likely
to be minor changes to the
RACF environment, rather
than larger refurbishments or
new builds.
Of those who hadn’t made
any modifications, most still
said they intended to do so
(Workshop 87%, Consultancy
85%, iPhone Plus 78%). This is
a strong indication that
respondents believed that it
was important to take action, ie
move to the Adoption stage of
the KT process.
Adherence
There is evidence from the
interviewees in all
interventions that participation
had influenced their ongoing
practice and those of others in
their workplaces. This
included not only repeated use
of the EAT to inform specific
environmental modifications
in other facilities but also the
more subtle influence of the
philosophy of care within the
RACFs.
The Consultancy service
appeared to support
Adherence through a ‘top
down’ approach, ie providing
the managers with the
information and resources they
needed to make changes to
policies and processes.
Adherence in the other
intervention groups appeared
to be promoted by the
participants influencing their
managers, a more ‘bottom up’
strategy.
Barriers to knowledge
translation
Barriers to the translation of
environmental design
knowledge into practice were
most frequently identified by
Workshop survey respondents.
They most commonly included
a lack of authority to either
audit or make changes in their
workplaces, or a lack of
confidence or perceived ability
to use the EAT (or the feedback
obtained from use of the EAT)
to modify the environment.
This is likely to relate to the
nature of the respondents who
attended the Workshops, most
of whom were relatively junior
or allied health staff. Common
barriers experienced by
respondents in all interventions
included: financial barriers,
incompatible or non-existent
philosophy of care, staff
attitudes and culture, and lack
of organisational support.
Facilitators of knowledge
translation
Whilst Awareness-raising
activities within the Workshop
intervention were described as
being ‘transformative’ for
some of the Workshop
interviewees, the new
knowledge was adopted
mainly through use of the EAT.
Using the tool gave
interviewees confidence that
their design endeavours were
evidence-based. The data they
gathered was also used to
advocate for change at an
organisational level.
iPhone Plus interviewees
particularly valued the tool’s
ease of use, including its user-
friendly language and
portability.
Interviewees appreciated the
nature of the recommendations
from the audit report
generated from the
Consultancy and iPhone Plus
services. These were
appreciated as they were
considered practical to
implement within a range of
time frames and budgets.
A team approach involving
communication and
collaboration at multiple levels
within a facility or organisation
was also highlighted as a
facilitator of change.
Consultancy interviewees
emphasised the role of the
expert in assisting them to
translate the recommendations
report into practical, site-
specific and workable
strategies. Respondents
believed the expert advice led
them to make specific changes
they would never have
thought about had they been
left to respond to the
recommendations report on
their own. They emphasised
the positive impact this had on
producing results.
Both the iPhone Plus and
Consultancy service
interviewees also appeared
more ‘ready for change’ than
those who attended the
Workshops.
This state of readiness was
associated with their
perception that they were
likely to receive support from
their organisations to make
environmental changes – with
most either preparing for, or in
the process of, making
environmental changes, ie they
were primed for Adoption.
Conclusion
The evaluation of the
Workshop, Consultancy and
iPhone Plus interventions has
revealed a high level of
engagement by those who
have accessed them with the
aim of modifying the built
environment to improve
quality of life for people with
dementia.
The interventions have all
been shown to be effective
ways of providing education
and support to staff in RACFs
and to introduce change to the
organisations that own the
facilities.
While perhaps it is not
surprising that the intensive
Consultancy intervention
produced a high level of
knowledge translation it is
surprising that the much less
intensive, and much cheaper to
offer, iPhone Plus rivalled it in
supporting all four stages of
the knowledge translation
process fromAwareness and
Agreement to Adoption and
Adherence of the
environmental design
principles.
References
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Acknowledgment
The evaluation referred to in this
article was funded by a grant from
the Dementia Collaborative
Research Centre for Assessment
and Better Care (DCRC-ABC).
Professor Richard Fleming is
Director of the NSW/ACT
Dementia Training Study
Centre, Adjunct Professor of the
Wicking Dementia Research and
Education Centre and Executive
Editor of the Australian Journal
of Dementia Care; Dr Lyn
Phillipson is an NHMRC-ARC
Dementia Fellow at the
Australian Health Services
Research Institute, University of
Wollongong; Kirsty Bennett is
an architect andManager of the
NSW/ACT Dementia Training
Study Centre Environmental
Design Education Services. To
follow up on this article contact
Professor Fleming at:
.