The Wellness Hub Program: Design of a theoretically-rooted support strategy to leverage facilitators and overcome barriers facing Long-Term Care and Retirement Homes in Ontario during the COVID-19 pandemic

Abstract

Background Long-term care and retirement homes (LTCH/RH) faced systemic challenges that were exacerbated by the COVID-19 pandemic. Following a comprehensive needs assessment with 91 LTCH and RH leaders from 47 LTCH/RH in Ontario, Canada, we identified three major challenges facing homes: infection prevention and control (IPAC), vaccine confidence and uptake, and staff well-being. We aimed to co-create an evidence-based, theoretically-rooted support program titled the Wellness Hub to support LTCH and RH to navigate real-time challenges. Methods We identified evidence-based interventions to address identified LTCH/RH challenges, which included: IPAC protocol implementation, COVID-19 vaccine uptake among staff in accordance with Canadian public health guidance, and a well-being program to support staff mental health and wellness. We used the Knowledge to Action model to guide Wellness Hub program development. Barriers and facilitators to implementation were mapped to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address barriers and leverage facilitators were identified via a process of co-creation with LTCH/RH stakeholders and guided by the COM-B rooted SELECT tool and the CFIR-ERIC mapping tool. Results Twelve TDF domains and 18 CFIR constructs were identified as barriers and/or facilitators to implementation, reflecting the complexity of challenges facing homes during the pandemic. Via the SELECT tool, we identified six intervention functions and 14 implementation strategies to target individual-level change. An additional four strategies for organizational and systems-level implementation change were identified via the CFIR-ERIC mapping tool. The following implementation strategies were used to facilitate implementation of our evidence-based practices: town halls, implementation coaches, promotion for LTCH/RH wellness days, creation of infographics and educational resources (including an open-access resource repository), a weekly newsletter with LTCH/RH directives, a vaccine champions program and e-learning course, modelled change, an IPAC-self-assessment tool, seed funding, vaccine incentives, access to off-site COVID-19 testing, monthly community of practice meetings and use of opinion leaders. Conclusion We demonstrate the use of implementation science methods to rapidly address real world, real-time problems. Our methods and protocols provide a blueprint for rapidly engaging LTCH/RH communities to co-create and implement a comprehensive, multipronged program during health emergencies. Trial Registration : https://osf.io/hkfae