Scaling a multimodal mind-body movement intervention for Veterans with dementia in VA nursing homes: A formative evaluation of the Preventing Loss of Independence through Exercise (PLIÉ) program

BackgroundPeople living with Alzheimer's disease and related dementias constitute a substantial proportion of residents in U.S. Veterans Health Administration nursing homes (Community Living Centers, CLCs). Non-pharmacologic interventions have demonstrated positive effects for people living with dementia (PLWD) but face implementation barriers in nursing homes. The Preventing Loss of Independence through Exercise (PLIÉ) program is an evidence-based multimodal mind-body movement program that supports quality of life and function for PLWD.ObjectiveTo identify potential facilitators and barriers that may impact implementation of PLIÉ in CLCs (PLIÉ-CLC) and inform the development of a remote staff training program.MethodsWe conducted a developmental formative evaluation using qualitative methods, guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with 30 CLC staff, directors, and VA health system leaders, explored perspectives on implementing PLIÉ-CLC. Data were analyzed using a template analysis approach.ResultsKey facilitators included PLIÉ's evidence base, adaptability, and alignment with person-centered care. Barriers included staffing constraints, workload demands, and limited accessible space. Participants emphasized the need for both synchronous and asynchronous training components to fit staff schedules and enhance feasibility.ConclusionsThis study highlighted the importance of adaptability and evidence-based support in implementing PLIÉ in VA nursing homes. The findings suggest that a flexible, remote training program incorporating both didactic and experiential learning may facilitate the scalability of PLIÉ. Understanding barriers and facilitators can inform strategies to improve the implementation of non-pharmacologic interventions for residents with dementia, ultimately enhancing care quality and outcomes in nursing homes.