The development of a multi-level intervention to improve data quality of the national quality indicators in Swiss long-term care facilities using an Intervention Mapping approach

Introduction: Quality indicators (QIs) are used internationally to monitor performance and support continuous quality improvement. Their usefulness is dependent on the quality of the underlying data. Research indicates multiple barriers to reliable and accurate data collection in long-term care facilities (LTCFs). This paper describes the systematic development of an intervention to improve quality of QI data in LTCFs. Methods: The 6-step Intervention Mapping (IM) protocol guided the development process. 1) Needs assessment was done with an ethnographic study. 2) Intervention objectives were formulated followed by the selection of behavioral determinants. 3) Intervention design was based on evidence reviews, focus groups with LTCF staff and behavioral change methods. 4) Intervention materials and messages were developed in collaboration with stakeholders and external experts. We also developed 5) the implementation and 6) evaluation plan. Results: The needs assessment identified lack of awareness and knowledge, negative attitudes towards QI measurement, and environmental barriers. Having a person responsible for the topic, as well as monitoring and using QI data were seen as facilitators for data quality. The designed intervention uses a train-the-trainer approach. It consists of a training concept and support materials. The training aims to prepare champions to support their teams and lead data quality improvement activities: data quality monitoring, feedback, and internal staff trainings. The developed materials include a training handbook, lesson plans, presentations, factsheets, posters, and checklists. Other support measures included adapting QI measurement and providing an email contact for QI-related questions. Conclusion: The program theory and design rationale for this intervention will support the planned evaluation study, facilitate comparisons across similar interventions, and potentially inform the development of other interventions in LTCFs.