WHELD

Qualitative Approach and Methods

Aim of the qualitative component

To generate an evidence-informed, person-centred psychosocial intervention for people with dementia in care homes and to understand how the intervention could be effectively optimised, implemented, and sustained in routine care settings.

Qualitative methodology

A multi-phase qualitative research programme combining qualitative evidence synthesis, intervention development research, embedded qualitative implementation studies, and longitudinal qualitative sustainability research.

Which qualitative methods were used?

Across programme phases, methods included:

• Systematic review and meta-synthesis of qualitative research on psychosocial interventions and person-centred care training manuals in care homes.
• Focus groups with care home staff to inform intervention design and implementation strategies.
• Qualitative implementation study embedded within pilot and factorial intervention trial.
• Post-trial qualitative follow-up focus groups examining sustainability of intervention practices.
• Stakeholder consultation and participatory input from care providers and service users.

Sampling & recruitment

Participants included care home staff, managers, intervention trainers, and stakeholders across participating care homes involved in the WHELD pilot, factorial, and trial phases. Sampling aimed to capture variation in organisational context, professional roles, and levels of engagement with the intervention.

Data analysis: how the team made sense of the data

Qualitative datasets were analysed using thematic approaches, supported by constant comparison and iterative programme-level integration of findings to inform intervention refinement, training models, and implementation strategies across successive phases of the programme.

Findings, Learning & Impact

Summary of main findings

Qualitative research demonstrated that successful implementation of psychosocial interventions in care homes depends on organisational culture, staff engagement, leadership support, and ongoing supervision rather than training alone. Findings informed the development of a “champion” model of intervention delivery, embedding trained staff within care homes to support implementation and sustain practice change. Follow-up qualitative work showed that sustained use of intervention approaches was most likely where staff recognised the value of the programme, received sufficient support during implementation, and developed ownership of the intervention within routine care.

Why were qualitative methods used in this project, and what did they enable?

Qualitative research enabled the programme to:

• Identify key mechanisms supporting successful implementation of psychosocial interventions.
• Shape intervention training models and implementation strategies.
• Inform iterative optimisation of the intervention prior to definitive trial evaluation.
• Understand long-term sustainability of intervention practices following trial completion.

Lessons learnt / reflections?

• Effective psychosocial interventions require implementation strategies that address organisational and workforce contexts.
• Embedding qualitative research across programme phases enables continuous optimisation of complex interventions.
• Sustainability of intervention impact depends on staff ownership, leadership support, and continued skill consolidation.

Impact & influence

The WHELD programme generated one of the largest trials of psychosocial interventions in dementia care homes, demonstrating improvements in quality of life, agitation, and neuropsychiatric symptoms alongside cost savings. The qualitative programme played a central role in shaping intervention design, implementation models, and sustainability strategies, influencing dementia-care training approaches and national policy guidance.

Links, Outputs & Resources

Links to publications

• Fossey, J., Garrod, L., Tolbol Froiland, C., Ballard, C., Lawrence, V., & Testad, I. (2019). What influences the sustainability of an effective psychosocial intervention for people with dementia living in care homes? A 9 to 12-month follow-up of the perceptions of staff in care homes involved in the WHELD randomised controlled trail. International Journal of Geriatric Psychiatry, 34(5), 674–682. Available here.
• Fossey, J., Garrod, L., Lawrence, V., Testad, I., Stafford, J., & Murray, J. (2020). “We should see her like part of the team”: An investigation into care home staff’s experiences of being part of an RCT of a complex psychosocial intervention. Aging & Mental Health, 24(1), 178–185. Available here.
• Lawrence, V., Fossey, J., Ballard, C., Ferreira, N., & Murray, J. (2016). Helping staff to implement psychosocial interventions in care homes: Augmenting existing practices and meeting needs for support. International Journal of Geriatric Psychiatry, 31(3), 284–293. https://doi.org/10.1002/gps.4322 Available here.
• Fossey, J., Masson, S., Stafford, J., Lawrence, V., Corbett, A., & Ballard, C. (2014). The disconnect between evidence and practice: A systematic review of person‐centred interventions and training manuals for care home staff working with people with dementia. International Journal of Geriatric Psychiatry, 29(8), 797–807. https://doi.org/10.1002/gps.4072 Available here.
• Lawrence, V., Fossey, J., Ballard, C., Moniz-Cook, E., & Murray, J. (2012). Improving quality of life for people with dementia in carehomes: Making psychosocial interventions work. The British Journal of Psychiatry, 201(5), 344–351. Lawrence V, Fossey J, Ballard C, Moniz-Cook E, Murray J. Improving quality of life for people with dementia in care homes: making psychosocial interventions work. Br J Psychiatry. 2012 Nov;201(5):344-51. doi: 10.1192/bjp.bp.111.101402.

Links to reports or briefs

• Ballard, C., Orrell, M., Moniz-Cook, E., Woods, R., Whitaker, R., Corbett, A., Aarsland, D., Murray, J., Lawrence, V., Testad, I., Knapp, M., Romeo, R., Zala, D., Stafford, J., Hoare, Z., Garrod, L., Sun, Y., McLaughlin, E., Woodward-Carlton, B., … Fossey, J. (2020). Improving mental health and reducing antipsychotic use in people with dementia in care homes: The WHELD research programme including two RCTs. NIHR Journals Library. Available here.