Use of implementation science methods to design Wellness Hub, a responsive program to address long-term care and retirement homes’ challenges during the COVID-19 pandemic

Long-term care and retirement homes (LTCH/RH) faced systemic challenges that were exacerbated by the COVID-19 pandemic. Homes faced three major challenges over the course of the pandemic: implementing infection prevention and control (IPAC) practices, facilitating COVID-19 vaccine uptake and confidence, and addressing staff well-being and burnout. This manuscript describes the use of implementation science methods to design an evidence-based, theoretically-rooted program titled the Wellness Hub to support LTCH and RH to navigate real-time COVID-19 challenges. Challenges facing homes were categorized to theoretical constructs using the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Implementation mapping was used to identify strategies to mitigate barriers and leverage facilitators at the individual level using the SELECT tool (rooted in Michie’s Behaviour Change Wheel) and at the organizational level using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool. A multidisciplinary project team and steering committee reviewed the results and contextualized identified strategies to design the Wellness Hub Program components. Twelve TDF domains and 18 CFIR constructs were identified as barriers and/or facilitators to implementation of IPAC protocols, COVID-19 vaccine uptake, and staff well-being programs. Via the SELECT tool, we identified 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 resulting Wellness Hub Program included: 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 summarizing 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. Use of implementation science methods facilitated the design of a responsive support program to address LTCH and RH’s real-time, evolving COVID-19 challenges. https://osf.io/hkfae.