A 5-Year Examination of CAPABLE Implementation Using RE-AIM and CFIR Frameworks

Deborah Paone^1,2*Jeanne Schuller³Matthew Lee Smith⁴Laura Gitlin⁵Sarah L Szanton²

• ¹Independent researcher, Paone & Associates, LLC, Minneapolis, Minnesota, United States
• ²School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States
• ³Paone & Associates, LLC, Minneapolis, United States
• ⁴School of Public Health, Texas A&M University, College Station, Texas, United States
• ⁵College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, United States

Background: Examining the experience of organizations implementing evidence-based programs can help future programs address barriers to effective implementation, sustainment, and scaling. CAPABLE is an evidence-based 4-to-6-month program that improves daily function of older adults and modifies their home environments in modest ways to support their goal attainment. Through a guided process, utilizing an occupational therapist, nurse, and handy worker, the older adult sets goals and a personal action plan. In this paper, we examined factors that advanced or impeded implementation and sustainability of CAPABLE by 65 organizations over 5 years. We chose the RE-AIM and CFIR frameworks based on their robust use in the U.S. for examining implementation of older adult programs. Data sources included licensure records, an annual survey, and additional notes collected ad hoc. The key informants were program administrators who replied to an annual survey regarding the level of ease or difficulty of components required for implementation. Notes from monthly office-hours calls provided additional contextual information. We performed qualitative thematic and descriptive analysis on the notes and reviewed published studies on CAPABLE's outcomes. The unit of analysis was the organization.The following factors were consistently reported as supporting ease of implementation: getting leadership support, accessing technical assistance, and maintaining fidelity to the program. Conversely, common challenges reported included difficulty with recruitment, hiring/finding the required personnel, and sustainability funding. Internal factors supporting readiness and adoption were perceived value of the program and program manager knowledge and commitment. External factors that supported adoption were initial funding to start a pilot, and alignment with "aging in community" strategic goals.Implication: This examination revealed positive and impeding forces for implementation and sustainment. Findings are guiding the development of additional technical support by the CAPABLE National Center. In addition, efforts are underway to improve funding and policy to support CAPABLE for sustainment and scaling. This study provides a use case for employing the RE-AIM and CFIR frameworks together to track ongoing implementation. This helps address a gap in the literature concerning practical ways to monitor, evaluate, and report on ongoing implementation of evidence-based programs.