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Strategies to Implement Pet Robots in Long-Term Care Facilities for Dementia Care: A Modified Delphi Study

Published:November 01, 2022DOI:https://doi.org/10.1016/j.jamda.2022.09.010

      Abstract

      Objectives

      Pet robots are technology-based substitutes for live animals that have demonstrated psychosocial benefits for people living with dementia in long-term care. However, little research has been conducted to understand how pet robots should be implemented in routine care. This study aims to identify, contextualize, and achieve expert consensus on strategies to implement pet robots as part of dementia care in long-term care facilities.

      Design

      A 2-round modified Delphi study.

      Settings and Participants

      An international panel of 56 experts from 14 countries, involving care professionals, organizational leaders, and researchers.

      Methods

      A list of potentially relevant strategies was identified, contextualized, and revised using empirical data and through stakeholder consultations. These strategies constituted statements for Round 1. Experts rated the relative importance of each statement on a 9-point scale, and free-text fields allowed them to provide justifications. Consensus was predefined as ≥75% agreement. Statements not reaching an agreement were brought forward to Round 2. Quantitative data were analyzed using descriptive statistics, and textual data were analyzed using inductive content analysis.

      Results

      Thirteen strategies reached consensus; 11 were established as critical: (1) assess readiness and identify barriers and facilitators, (2) purposely reexamine the implementation, (3) obtain and use residents' and their family's feedback, (4) involve residents and their family, (5) promote adaptability, (6) conduct ongoing training, (7) conduct educational meetings, (8) conduct local consensus discussions, (9) organize clinician implementation team meetings, (10) provide local technical assistance, and (11) access new funding. Other strategies received differing extents of agreement. Reasons for variations included contextual differences, such as resource availability, organizational structures, and staff turnover.

      Conclusions and Implications

      This study identified the most relevant strategies that can be used by technology developers, care providers, and researchers to implement pet robots in long-term care facilities for dementia care. Further development, specification, and testing in real-world settings are needed.

      Keywords

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      References

        • World Health Organization
        Dementia 2021 [updated 2 September 2021.
        • Hoffmann F.
        • Kaduszkiewicz H.
        • Glaeske G.
        • et al.
        Prevalence of dementia in nursing home and community-dwelling older adults in Germany.
        Aging Clin Exp Res. 2014; 26: 555-559
        • Prince M.
        • Knapp M.
        • Guerchet M.
        • et al.
        Dementia UK: update.
        King's College London, 2014
        • Selbæk G.
        • Kirkevold Ø.
        • Engedal K.
        The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes.
        Int J Geriatr Psychiatry. 2007; 22: 843-849
        • Smit D.
        • De Lange J.
        • Willemse B.
        • et al.
        Activity involvement and quality of life of people at different stages of dementia in long term care facilities.
        Aging Ment Health. 2016; 20: 100-109
        • Shiells K.
        • Pivodic L.
        • Holmerová I.
        • et al.
        Self-reported needs and experiences of people with dementia living in nursing homes: a scoping review.
        Aging Ment Health. 2020; 24: 1553-1568
        • Olsen C.
        • Pedersen I.
        • Bergland A.
        • et al.
        Differences in quality of life in home-dwelling persons and nursing home residents with dementia–a cross-sectional study.
        BMC Geriatr. 2016; 16: 1-11
        • Cohen-Mansfield J.
        • Dakheel-Ali M.
        • Marx M.S.
        • et al.
        Which unmet needs contribute to behavior problems in persons with advanced dementia?.
        Psychiatry Res. 2015; 228: 59-64
        • McDermott O.
        • Charlesworth G.
        • Hogervorst E.
        • et al.
        Psychosocial interventions for people with dementia: a synthesis of systematic reviews.
        Aging Ment Health. 2019; 23: 393-403
        • Jøranson N.
        • Pedersen I.
        • Rokstad A.M.M.
        • et al.
        Effects on symptoms of agitation and depression in persons with dementia participating in robot-assisted activity: a cluster-randomized controlled trial.
        J Am Med Dir Assoc. 2015; 16: 867-873
        • Petersen S.
        • Houston S.
        • Qin H.
        • et al.
        The utilization of robotic pets in dementia care.
        J Alzheimer Dis. 2017; 55: 569-574
        • Thodberg K.
        • Sørensen L.U.
        • Videbech P.B.
        • et al.
        Behavioral responses of nursing home residents to visits from a person with a dog, a robot seal or atoy cat.
        Anthrozoös. 2016; 29: 107-121
        • Koh W.Q.
        • Ang F.X.H.
        • Casey D.
        Impacts of low-cost robotic pets for older adults and people with dementia: scoping review.
        JMIR Rehabil Assist Technol. 2021; 8: e25340
        • Koh W.Q.
        • Whelan S.
        • Heins P.
        • et al.
        The usability and impact of a low-cost pet robot for older adults and people with dementia: qualitative content analysis of user experiences and perceptions on consumer websites.
        JMIR Aging. 2022; 5: e29224
        • Curran G.M.
        • Bauer M.
        • Mittman B.
        • et al.
        Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.
        Med Care. 2012; 50: 217
        • Bauer M.S.
        • Williford W.O.
        • Dawson E.E.
        • et al.
        Principles of effectiveness trials and their implementation in VA Cooperative Study# 430: ‘Reducing the efficacy-effectiveness gap in bipolar disorder’.
        J Affect Disord. 2001; 67: 61-78
        • Koh W.Q.
        • Felding S.A.
        • Budak K.B.
        • et al.
        Barriers and facilitators to the implementation of social robots for older adults and people with dementia: a scoping review.
        BMC Geriatr. 2021; 21: 351
        • Damschroder L.J.
        • Aron D.C.
        • Keith R.E.
        • et al.
        Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
        Implement Sci. 2009; 4: 1-15
        • Koh W.Q.
        • Toomey E.
        • Flynn A.
        • et al.
        Determinants of implementing pet robots in nursing homes for dementia care.
        BMC Geriatr. 2022; 22: 457
        • Murphy M.
        • Black N.
        • Lamping D.
        • et al.
        Consensus development methods, and their use in clinical guideline development.
        Health Technol Assess. 1998; 2 (1–88): i-iv
        • Koh W.Q.
        • Casey D.
        • Hoel V.
        • et al.
        Strategies for implementing pet robots in care homes and nursing homes for residents with dementia: protocol for a modified Delphi study.
        Implement Sci Commun. 2022; 3: 58
        • Powell B.J.
        • Waltz T.J.
        • Chinman M.J.
        • et al.
        A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.
        Implement Sci. 2015; 10: 21
        • Waltz T.J.
        • Powell B.J.
        • Matthieu M.M.
        • et al.
        Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.
        Implement Sci. 2015; 10: 1-8
        • Waltz T.J.
        • Powell B.J.
        • Fernández M.E.
        • et al.
        Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions.
        Implement Sci. 2019; 14: 42
        • Jünger S.
        • Payne S.A.
        • Brine J.
        • et al.
        Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review.
        Palliat Med. 2017; 31: 684-706
        • Baker J.
        • Lovell K.
        • Harris N.
        How expert are the experts? An exploration of the concept of ‘expert’ within Delphi panel techniques.
        Nurse Res. 2006; 14: 59-70
        • Dajani J.S.
        • Sincoff M.Z.
        • Talley W.K.
        Stability and agreement criteria for the termination of Delphi studies.
        Technol Forecast Soc Change. 1979; 13: 83-90
        • Scheibe M.
        • Skutsch M.
        • Schofer J.
        IV. C. Experiments in Delphi methodology. The Delphi Method: Techniques and Applications.
        2002: 257-281
        • Heiko A.
        Consensus measurement in Delphi studies: review and implications for future quality assurance.
        Technol Forecast Soc Change. 2012; 79: 1525-1536
        • Holey E.A.
        • Feeley J.L.
        • Dixon J.
        • et al.
        An exploration of the use of simple statistics to measure consensus and stability in Delphi studies.
        BMC Med Res Methodol. 2007; 7: 1-10
        • Hsieh H.-F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • House of Commons Health and Social Care Committee
        Workforce burnout and resilience in the NHS and social care.
        2021: 1-66
        • Costello H.
        • Cooper C.
        • Marston L.
        • et al.
        Burnout in UK care home staff and its effect on staff turnover: MARQUE English national care home longitudinal survey.
        Age Ageing. 2020; 49: 74-81
        • Australian Government
        2020 Aged Care Workforce Census Report.
        in: Department of Health. Health Aff (Millwood), 2020: 1-68
        • Gandhi A.
        • Yu H.
        • Grabowski D.C.
        High nursing staff turnover in nursing homes offers important quality information: study examines high turnover of nursing staff at US nursing homes.
        Health Aff. 2021; 40: 384-391
        • Bennett S.
        • Laver K.
        • MacAndrew M.
        • et al.
        Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies.
        Int Psychogeriatr. 2021; 33: 947-975
        • Teper M.H.
        • Godard-Sebillotte C.
        • Vedel I.
        Achieving the goals of dementia plans: a review of evidence-informed implementation strategies.
        Healthc Policy. 2019; 14: 10
        • Yaffe M.J.
        • Orzeck P.
        • Barylak L.
        Family physicians’ perspectives on care of dementia patients and family caregivers.
        Can Fam Physician. 2008; 54: 1008-1015
        • Lourida I.
        • Abbott R.A.
        • Rogers M.
        • et al.
        Dissemination and implementation research in dementia care: a systematic scoping review and evidence map.
        BMC Geriatr. 2017; 17: 147
        • Karasvirta S.
        • Teerikangas S.
        Change organizations in planned change–a closer look.
        J Chang Manag. 2022; 18: 1-39
        • Alagoz E.
        • Chih M.-Y.
        • Hitchcock M.
        • et al.
        The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review.
        BMC Health Serv Res. 2018; 18: 1-13
        • Rehman N.
        • Mahmood A.
        • Ibtasam M.
        • et al.
        The psychology of resistance to change: The antidotal effect of organizational justice, support and leader-member exchange.
        Front Psychol. 2021; 12: 678952
        • Watson D.P.
        • Adams E.L.
        • Shue S.
        • et al.
        Defining the external implementation context: an integrative systematic literature review.
        BMC Health Serv Res. 2018; 18: 1-14
        • Mjørud M.
        • Engedal K.
        • Røsvik J.
        • et al.
        Living with dementia in a nursing home, as described by persons with dementia: a phenomenological hermeneutic study.
        BMC Health Serv Res. 2017; 17: 1-9
        • Tak S.H.
        • Kedia S.
        • Tongumpun T.M.
        • et al.
        Activity engagement: perspectives from nursing home residents with dementia.
        Educ Gerontol. 2015; 41: 182-192
        • Rapaport P.
        • Livingston G.
        • Murray J.
        • et al.
        Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia.
        BMJ Open. 2017; 7: e014177
        • Proctor E.K.
        • Powell B.J.
        • McMillen J.C.
        Implementation strategies: recommendations for specifying and reporting.
        Implement Sci. 2013; 8: 1-11
        • Li J.
        • Smyth S.S.
        • Clouser J.M.
        • et al.
        planning implementation success of syncope clinical practice guidelines in the emergency department using CFIR framework.
        Medicina. 2021; 57: 570
        • Weir A.
        • Presseau J.
        • Kitto S.
        • et al.
        Strategies for facilitating the delivery of cluster randomized trials in hospitals: a study informed by the CFIR-ERIC matching tool.
        Clin Trials. 2021; 18: 398-407