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Abstract

Caring, especially for people with dementia, can be physically and psychologically very burdensome. The municipal communities with their stakeholders and local authorities are one entity responsible for offering adequate support for caring relatives. Although caring relatives of people with dementia are a mainstay of the German and many other care systems, the availability of support services targeting caring relatives of people with dementia within the municipal community shows deficiencies and the implementation of support services needs to be optimised. The first publication of the present dissertation provides an overview of the current research literature to the topic community implementation behaviour or more precisely, the implementation of support services for caring relatives of people with dementia. The literature review shows that there was no research done looking at the implementation behaviour of actors from the community supporting caring relatives of people with dementia. In contrast, there is some research on the implementation determinants in general. Therefore, implementation barriers and facilitators could be systematically identified from eight suitable (inter)national publications. In addition to communication, the participation of the target group and a responsible leader, the literature shows that actors from the community in particular are an important factor in the implementation process. However, little is known about the person- related factors associated with the actors’ implementation behaviour next to structural determinants such as lack of money or human resources. The Theoretical Domains Framework (TDF) focuses exactly on the investigation of person-related determinants influencing the implementation behaviour of actors in healthcare. The aim of this dissertation project is to adapt the TDF for the gerontological context and to apply it to the context of the support for caring relatives of people with dementia in municipal communities. Based on literature, which also deals with the application of the TDF, and an additional consensus process with experts in gerontology as well as experts in community work the TDF domains were adapted to the context of the support of caring relatives of people with dementia. The second publication applies the modified TDF domains in the analysis of qualitative data from a cooperation project (the Town Hall Project) where caring relatives and actors from the community talked, among other things, about the support of caring relatives of people with dementia. The publication explores the following question: which domains are addressed by actors from the community in a public dialogue and what results are achieved with regard to the implementation of support services for caring relatives of people with dementia? The data analysis suggests that addressing the domains in a public dialogue positively influences the actors and their awareness in terms of improving support for the target group. Thus, initial indications of the relevance of exploring the domains emerge. It became clear that a more detailed examination of actors from the community and the domains is needed. Therefore, a quantitative Community Implementation Behaviour Questionnaire (CIBQ) was developed based on the domains and the existing TDF questionnaires. To ensure that the questionnaire was valid, the psychometric properties of the CIBQ were calculated. In the third publication, the content of the CIBQ and its psychometric properties are presented in detail. The model fit of the CIBQ shows satisfactory results in terms of internal consistency (CMIN/DF = 1.63; SRMR = 0.05; RMSEA = 0.07; CFI = 0.92) and construct validity (Cronbach’s alpha 0.74–0.89; inter-item correlation 0.38–0.88). Furthermore, the content of this cross-sectional observational study was analysed and prepared in a fourth publication. A survey among 205 actors from 16 municipal communities across Germany shows a positive and significant (p<.001) association between the agreement with the CIBQ and the implementation behaviour of the actors from the community within the last two years. A higher score on the CIBQ indicates a higher chance that actors from the community have implemented support services for the target group in the last two years. All in all, communities can use the CIBQ to examine the determinants of the implementation behaviour of their actors and can influence it according to the detected incongruities. Thus, the support of caring relatives of people with dementia can be improved. Furthermore, the tool might be applicable to other target groups in the community as caring relatives of people with dementia are only one example of several possible target groups.