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Table 2 Insights from review and evaluation

From: In-PREP: a new learning design framework and methodology applied to a relational care training intervention for healthcare assistants

Self-reported impacts:
 • Self-reported impacts were drawn from n = 81 evaluation form responses and 12 follow-up interviews with attendees. A few HCAs commented that they thought the training would be most appropriate for new HCAs, but all learning new things.
 • On evaluation forms from day 1 and day 2, 85 and 92% of HCAs, respectively, reported that as a result of the training they planned to make changes to the way they related to older people.
 • During follow-up interviews most interviewees were able to give us specific examples of changes they had made in their care practices since attending the training.
 • HCAs interviewees also reported changes in attitudes. They spoke about realising ‘how important the person underneath is’; the value of a good welcome; how much older people had lived through; and the effort and concentration many older people needed to do everyday tasks.
 • Six of the interviewees reported changes in the way they felt about their role: how important it was; what a difference they could make to people; how the recognition the training gave them made them feel more valued.
The delivery of Older People’s Shoes:
 • Using trust-based trainers to deliver the training gave credibility, and their use of examples from their own experience on the ward and knowledge of the organizational context was well received.
 • Giving HCAs time off the ward to reflect on their work, discuss difficulties and share good practice with peers was regarded as a positive experience; and the assets-based approach made HCAs feel valued.
 • Trainers and HCA learner interviewees reported that the 2-day ‘layered curriculum’ structure worked well. One week’s gap between the days allowed for reflection and practice, which helped deeper learning.
 • Evaluation forms indicated that HCAs enjoyed the variety of learning approaches. They commented positively on being able to participate in discussions, the videos, the practical elements, the interactive approach and learning from others’ experiences.
 • During training HCAs commented on the professional quality of the course book and appeared to read this as a signifier of the value that was being placed on them.
 • Our observations within and across training centres were invaluable for monitoring the fidelity of implementation. We identified 21 deviations from fidelity. Most related to practical issues such as time-keeping and use of IT and other resources; or to general delivery and deviation from the trainer manual.
 • Not all deviations were negative. The trainers had a wealth of experience, and some of their innovations were evaluated as enhancing the training intervention as designed. The monitoring of fidelity meant we were able to take mitigating actions during implementation (as part of our continuous review and evaluation) and propose further changes for any future re-design.
  1. Patient and HCA outcomes were formally tested as part of a feasibility cluster-randomised controlled trial reported elsewhere [3]