Background: Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods: We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n=4). Results: The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions: The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment.
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After the violent disintegration of Yugoslavia, a flourishing cultural scene was established in Croatia’s capital Zagreb. The scene calls itself: independent culture. In this book, Sepp Eckenhaussen explores the history of Zagreb’s independent culture through three questions: How were independent cultures born? To whom do they belong? And what is the independence in independent culture? The result is a genealogy, a personal travel log, a mapping of cores of criticality, a search for futurologies, and a theory of the scene.Once again, it turns out that localist perspectives have become urgent to culture. The untranslatability of the local term ‘independent culture’ makes it hard for the outsider to get a thorough understanding of it. But it also makes the term into a crystal of significance and a catalyst of meaning-making towards a theory of independent culture.
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The purpose of the design-based research reported here is to show – as a proof of principle – how the idea of scaffolding can be used to support primary teachers in a professional development programme (PDP) to design and enact language-oriented science lessons. The PDP consisted of six sessions of 2.5 h each in which twelve primary school teachers took part over a period of six months. It centralised the language support that pupils need to reason during science lessons. In line with the idea of scaffolding, the structure of the PDP targeted teachers' gradual independence in designing lessons. The first research question is how scaffolding was enacted during the PDP. The analysis of video recordings, field notes, researcher and teacher logs, and teacher design assignments focused on the enactment of three scaffolding characteristics: diagnosis, responsiveness and handover to independence. The second research question concerns what teachers learned from the participation in the PDP that followed a scaffolding approach. The data analysis illustrates that these teachers had learned much in terms of designing and enacting language-oriented science lessons. In terms of diagnosis and responsiveness, our PDP approach was successful, but we problematise the ideal of scaffolding approaches focused on handover to independence.
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