Development of a theoretical model for tracing facilitators and barriers in adaptive implementation of innovative practices in dementia care.

The implementation of innovations in the care sector that have been proven effective is not always easy. The implementation of innovative care programs frequently requires adaptive implementation, modified to suit local and regional circumstances. So far there has been very little research into the strategies and factors that facilitate or impede adaptive implementation processes. In the context of a study of the conditions for successful nationwide implementation of meeting centers for people with dementia and their carers, we developed a theoretical model to trace facilitators and barriers in adaptive implementation. We proceeded on the basis of a literature study, previous experiences with setting up meeting centers, and consulting with experts. The theoretical model we constructed distinguishes different phases of implementation, and describes activities and factors that can influence implementation on the micro-, meso- and macro-level for each phase. In addition,the model distinguishes characteristics of the innovation and other preconditions that may facilitate or impede implementation during the entire process. If the model is satisfactory for the study of the implementation of meeting centers, perhaps it can also be used to study other types of care innovations that would benefit from adaptive implementation.