Abstract
BACKGROUND AND OBJECTIVES: As the population ages there is an increasing need for caregiver training programs, but little is known about how to deliver implementation support for diverse sites in large-scale implementation efforts. External group-based implementation facilitation may be one promising approach. This study's objective is to detail the development and delivery of a pragmatic implementation facilitation approach to support the national rollout of caregiver training, Caregivers FIRST, at over 140 Veterans Health Administration (VHA) sites. RESEARCH DESIGN AND METHODS: Using administrative, survey, and project data, we describe the process of developing and delivering enhanced support to 13 VHA sites unable to meet adoption benchmarks as part of a national mandate. Enhanced support consisted of 4 group-based calls delivered within a 12-week period that used tailored external facilitation to address barriers, facilitators, and strategies for program implementation. We present key implementation barriers, implementation strategies, and sites' perceptions of highly valued elements of enhanced support. RESULTS: Enhanced support calls focused on 3 implementation barriers commonly identified by implementing staff (n = 25) in a site-level needs assessment survey: recruiting and retaining caregivers (83%), balancing program delivery alongside competing demands (57%), and support from other departments in program delivery (44%). Sites attended a median of 3 out of 4 enhanced support calls. In postimplementation quantitative surveys, the average response of perceived helpfulness of enhanced support (ranging from 1 to 5) was 3.4 at 6 months, increasing to 4.2 at 12 months. Respondents valued collaborative problem-solving and the ability to learn best practices from other implementing sites during enhanced support calls. DISCUSSION AND IMPLICATIONS: Describing the process of developing and delivering enhanced support via group-based external facilitation for Caregivers FIRST in VHA may provide useful information to guide similar efforts in other healthcare systems as they broadly disseminate interventions to support caregivers across diverse sites. CLINICAL TRIAL REGISTRATION: NCT05319535.