Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis

Goodman C1, Rycroft Malone J2, Norton C3, Harari D4, Harwood R5, Roe B6, Russell B1, Fader M7, Buswell M1, Drennan VM8, Bunn F1. BMJ Open. 2015 Jul 10;5(7):e007728. doi: 10.1136/bmjopen-2015-007728.
Author information

1Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK. 2School of Healthcare Sciences, Bangor University School of Health Care Sciences, Bangor, UK. 3Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK. 4Division of Health and Social Care, Department of Ageing and Health, Guys and St Thomas', King's College London, London, UK. 5Health Care of Older People Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK. 6Faculty of Health and Social Care, Edge Hill University of Manchester, Manchester, UK. 7Department of Health Sciences, University of Southampton, Southampton, UK. 8Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, UK.


INTRODUCTION: Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes.

METHODS AND ANALYSIS: A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1.

ETHICS AND DISSEMINATION: The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.

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