Post Hoc Consolidated Framework for Implementation Research (CFIR) Analysis of Older Person/Student Nurse Intergenerational Café Implementation

ABSTRACT

Aim

To determine the barriers, facilitators and effectiveness of using an intergenerational café to enable intergenerational learning.

Design

Implementation science using the ‘Consolidated Framework for Implementation Research’ framework.

Methods

Ethical approval for this research was granted by the University of Limerick. Online intergenerational cafés were held with older people and student nurses. Original data were collected through surveys and facilitator reflections. Participants were invited post‐café to participate in the study. Student nurses (n = 50) and older people (n = 49) participated in an anonymous online survey, and facilitators (n = 7) took part in a peer focus group on planning and co‐ordinating the cafés. Post hoc ‘CFIR’ analysis comprised secondary data analysis through mapping descriptive statistics and thematically analysed data to codebooks derived from CFIR domains and constructs.

Results

Barriers and facilitators to café implementation were identified. Organisational factors are important for effective implementation. More students felt that the purpose, topics and running of the café were clear and organised. In contrast, more older people wanted additional time in the discussion groups. Technical difficulties (e.g., computer, logging on) were identified by some as a barrier to participation. Overall, having a clear purpose and topics along with an online approach facilitated implementation. All participants supported the café innovation as a way of increasing intergenerational learning. Facilitators worked effectively as a team to ensure the smooth running of the cafés. The analysis helped determine the effectiveness of the intervention.

Conclusion

These cafés facilitated mutual learning and understanding and were well received by participants.

Implications for the Profession and/or Patient Care

Intergenerational cafés can support intergenerational learning.

Impact

Intergenerational cafés facilitated intergenerational learning.

Reporting Method

SRQR/EQUATOR.

Patient or Public Contribution

There was no patient/public contribution.

Summary.

• What does this paper contribute to the wider global clinical community?

• Intergenerational innovations could be adopted within nurse education, policies and practice.

1. Introduction

The use of implementation science frameworks as a research design within health and education sectors has risen in the last decade (Breimaier et al. 2015; Coffey et al. 2021). Peters et al. (2014) describe implementation research as a way of investigating how research, policies or interventions can be effectively implemented within ‘real‐world’ locations. One such implementation science framework is the Consolidated Framework for Implementation Research (CFIR), which is used to explain the barriers and facilitators to implementing an innovation (Damschroder et al. 2009). This paper initially describes the use of CFIR to undertake a secondary analysis of a data set on the use of intergenerational cafes to promote intergenerational understanding and learning between older people and student nurses. Second, this paper, using the CFIR framework, describes the barriers and facilitators to implementing the café and outlines the effectiveness of the café as an intervention for older person and student learning.

1.1. Background

Worldwide, most countries are experiencing growth in their older population, with people living well past 60 years of age (WHO 2021). However, older people are often seen as a burden, potentially leading to discrimination and the development of ageist attitudes within the wider society (WHO 2022). In order to combat this, The Decade of Healthy Ageing (2021–2030) has identified goals to help reduce health inequalities and enhance the lives of older people, their families and communities through four areas: changing how we think, feel and act towards age and ageism; developing communities in ways that foster the abilities of older people; delivering person‐centred integrated care and primary health services responsive to older people; and providing older people who need it with access to quality long‐term care (WHO 2021).

Therefore, nurses and other healthcare professionals who engage with older people need to be educated on how to positively interact with them about their health needs. Generally, student nurse/older person interactions occur in clinical practice settings when older people are unwell, requiring medical care (Tuohy et al. 2024). More vulnerable older people requiring increased care support may contribute to students having an altered view of older people living independently in the community.

Within nurse education, various educational strategies are used to enhance student nurses' understanding of healthy and positive ageing. These include learning activities that promote intergenerational learning and help reduce ageism towards older people (Drury, Abrams, and Swift 2017; Kuo, Lee, and Yeh 2021). Engagement in clinical placement and a module specialising in older person care comprise a core aspect of the BSc Nursing (General, Mental Health and Intellectual Disability disciplines) programmes in the university where the research was undertaken, enabling students to develop and achieve knowledge and skills that contribute to competence development throughout the 4‐year programme. The gerontological care modules aim to foster and connect students' understanding of healthy ageing and promote person‐centred nursing. This paper reports on one such intergenerational strategy, specifically an exploration of the barriers, facilitators and effectiveness of an intergenerational café, where older people and student nurses meet outside the clinical healthcare setting to stimulate conversations that illuminate life experiences and to help develop an insight of generational diversity. The hope of intergenerational café discussions is that student nurses will see older people as independent individuals living full lives and that older people will see students as people who are also living independent lives.

1.2. The Study

The study aimed to examine the implementation and use of intergenerational discussion cafés to promote learning between older people and student nurses. The survey data set and facilitator group reflection data generated from this study have been previously analysed both quantitatively and qualitatively (descriptive and thematic analyses) and the survey data have been reported elsewhere. This paper aims to report on the secondary analysis of the original data set using post hoc CFIR analysis on the use of the intergenerational café to promote intergenerational learning between older people and student nurses. Specifically, this paper presents research findings on the factors that facilitated and/or impeded the successful implementation of the café and the effectiveness of the café as an intervention to support intergenerational learning.

1.3. Research Question

The research question for the secondary data analysis is ‘what are the barriers, facilitators and effectiveness of using an intergenerational café to enable intergenerational learning?’

The objectives of the secondary analysis study were as follows:

1. Identify implementation barriers and facilitators.

2. Determine whether the café intervention was effective in enabling intergenerational learning to occur.

2. Methods/Methodology

2.1. Design

An implementation science research design using a participatory approach was used for this research. Glasgow et al. (2013: S26) define implementation science as the ‘application and integration of research evidence to practice and policy’. An important aim of implementation science is to understand why an intervention is successfully/unsuccessfully implemented (Kirk et al. 2016). Of the several implementation science frameworks available, the CFIR was used for this research (Damschroder et al. 2009). The integration of 19 implementation science theories led to the creation of this meta‐theoretical framework (Damschroder et al. 2009; Kirk et al. 2016). CFIR consists of five domains (Intervention characteristics, Outer setting, Inner setting, Characteristics of the individual and Process). Within these five domains, there are 39 constructs and subconstructs (Damschroder et al. 2009; Breimaier et al. 2015). These constructs provide a common language when trying to define implementation determinants (Kirk et al. 2016). The data are mapped to the constructs and, through this, provides information on the implementation process of the intervention such as identifying barriers and facilitators (Coffey et al. 2021). While the CFIR framework can be used in data collection and at different stages of intervention implementation (pre, during, post) (Kirk et al. 2016), post‐intervention mapping of data was undertaken in our study. This process (post hoc CFIR analysis) is detailed in the analysis section.

2.2. Study Intervention: Intergenerational Discussion Café

The overall goal of the original educational intervention was to develop connection and understanding between generations. The café participants included older people (n = 49) and third‐year student nurses (n = 59). Three separate online cafés were held during COVID‐19 pandemic in 2021 (hosted through the Microsoft Teams app). Participants attended one café only. The format of the cafés is outlined in Table 1. The guest speaker set the scene regarding the role of intergenerational partnerships within the context of global ageing. Before taking part in the café, welcome packs (tea/coffee/snack) were offered and mailed to potential participants. Participants were given information about the café through the information sheet and consent form. All were offered support on learning how to access, log on and participate in the online café. Students were also provided with information on this in class in their community care module, and the café was aligned to this module. In addition to emailing information, older people were offered the opportunity to have a one‐to‐one session with a facilitator in the days before the café. The research team members facilitated the online cafés, and in preparation for this, they met several times to decide and agree on the café process and format.

TABLE 1.

Online intergenerational café format.

	Online intergenerational café format
1	Café convened with all participants (Introduction, Guest speaker)
2	Student nurses and older people were assigned to small breakout groups to participate in ‘café table’ discussions. A topic guide was available to stimulate discussion (e.g., Breaking the ice with introductions; Getting to know people at my ‘table’; How different/similar are we?; Nursing care from the perspective of receivers and providers of care). Facilitation by team members entailed ‘drop‐ins’ to check that all was in order.
3	The whole group reconvened, and feedback was provided from the smaller group to elicit shared learning.
4	Summary and conclusion with thanks offered.

2.3. Study Setting and Sampling/Recruitment

Recruitment was via purposive and snowballing methods, and older people (aged 65 years and over) living in the community were invited to participate in the café. Access was through gatekeepers in active retirement and senior citizen groups, volunteer groups, churches, daycare centres, older person advocacy groups as well as through word of mouth and both print/electronic media. They were then invited to participate in the research. Year 3 student nurses in the research site shared a module introducing the centrality of health and well‐being across primary and community settings. Placing the café in this year of the curricula maximised opportunities for students to develop knowledge and apply it to different practice and organisational settings. Hence, third‐year student nurses who had registered on a four‐year BSc Nursing (General, Mental Health and Intellectual Disability) programme and enrolled in a community care module had participated in an intergenerational café as part requirement of the module, and they were then invited to participate in the research survey via purposive sampling. Both older people and student nurses were aware that research participation was not a requirement of café attendance. Following café attendance, invitations to participate in an online research survey were emailed to participants. The research team as facilitators had expertise in older person care and had expertise in qualitative, quantitative, participative and reflective research methods. They contributed to the research by engaging in an online peer focus group. This reflective discussion aimed to explore the learning derived from their experience of preparing, organising and facilitating the cafés. These reflections were recorded and thematically analysed.

2.4. Inclusion and Exclusion Criteria

The inclusion criteria for the older person participants were that they were living in the community, were aged 65 years or over and had participated in one of the online intergenerational cafés. The criteria for the third‐year student nurses were that they had participated in one of the online intergenerational cafés as part of a community care module. The inclusion criteria for the facilitators were that they had been involved in the preparation and facilitation of the intergenerational cafés, and all the facilitators were. Exclusion criteria for the older participants were if the older person was not living in the community and was not aged 65 years or over. The exclusion criteria for the student nurses were if they had not attended one of the online cafés and were not enrolled in the community care module. The exclusion criteria for the facilitators were if they were not involved in the preparation and facilitation of the cafés.

2.5. Data Collection

Data were collected through online surveys (student nurses and older people) using Qualtrics survey software and from the facilitators via post‐intervention (café) group reflection during April–May 2021. The tailored survey was created by the research team guided by a designated statistician within the university. The survey incorporated 45 quantitative questions (Likert scale) and five qualitative questions (open‐ended questions to facilitate qualitative comments). There were eight sections that addressed demographic data, intergenerational learning and the effectiveness of the café as a way of developing intergenerational learning (Table 2). Face and content validity tests were done through a survey expert group set up to review the questionnaires. This group comprised four members (two senior lecturers, one student nurse and one older person). Face validity is the degree to which a test seems to measure what it is supposed to measure (Johnson 2021). The group agreed that it did. According to Grove and Cipher (2020, 53), content validity is the ‘extent to which the measurement method includes all the major elements relevant to the concept being measured’. Content validity was determined through the rating of the item content validity indices (I‐CVI) and the scale‐level rating (S‐CVI). The team rated each question within the sections for relevance and clarity. It was agreed that the survey had content validity albeit with some revisions, which were done prior to use.

TABLE 2.

Survey questionnaire sections for older person and student nurse cohorts.

Older person survey	Student nurse survey
Section 1. Demographic data/A little about you, Questions 1–3	Section 1. Demographic data/A little about you, Questions 1–3
Section 2. Getting to know the student nurses in your group, Questions 4–14	Section 2. Getting to know the older people in your group, Questions 4–14
Section 3. Thoughts about the similarities between younger and older people, Questions 15–18	Section 3. Thoughts about the similarities between younger and older people, Questions 15–18
Section 4. My thoughts on student nurses providing care to me, Questions 19–22	Section 4. My thoughts about providing nursing care to Older People, Questions 19–22
Section 5. Organisation of the discussion café, Questions 23–33	Section 5. Organisation of the discussion café, Questions 23–33
Section 6. Your feelings about participating in the discussion café, Questions 34–40	Section 6. Your feelings about participating in the discussion café, Questions 34–40
Section 7. Usefulness of discussion cafés to increase intergenerational learning, Questions 41–45	Section 7. Usefulness of discussion cafés to increase intergenerational learning, Questions 41–45
Section 8. Qualitative questions, Questions 46–50	Section 8. Qualitative questions, Questions 46–50

The five open‐ended questions were used to provide an opportunity for participants to add context to their experiences of taking part in the café and elaborate on their thoughts. The rigour and trustworthiness of the qualitative data (responses to the open‐ended questions and the facilitators' post‐café group reflections) were upheld through the alignment of the process with key aspects of qualitative research (Lincoln and Guba 1985). Auditability/dependability is illustrated through having a clear audit trail; applicability/transferability of the results can be judged by readers through the clear description of these; and the credibility of the findings can be determined by inclusion of direct participants' quotes (Lincoln and Guba 1985). The qualitative data were independently analysed by team members, and following discussion, themes and subthemes were agreed.

2.6. Data Analysis

The original data set examined ‘the use of intergenerational cafes to promote understanding and learning between older people and student nurses’. However, this secondary analysis aimed to determine the barriers, facilitators and effectiveness of using an intergenerational café to enable intergenerational learning. The secondary data analysis was undertaken using the CFIR framework. Post hoc deductive CFIR analysis was completed using three specifically adapted code books for student nurses, older people and facilitators. The data were mapped to the included CFIR constructs and subconstructs. This analysis helped evaluate and explain the findings regarding the implementation of the intervention (café). Barriers and facilitators to implementation were identified. Furthermore, the analysis helped determine the effectiveness of the intervention in facilitating intergenerational learning. The post‐implementation data (descriptive SPSS analysis of quantitative Likert scale responses), thematic analysis of qualitative open‐ended question responses (guided by Braun and Clarke (2006, 2022 framework)) and facilitator reflections were mapped onto the CFIR codebooks derived from CFIR domains and constructs. Not all domains or constructs were used, and this is acceptable as ‘taking a menu‐of‐constructs approach…allows [the researcher(s)] …to flexibly include only constructs that apply to the study’ Damschroder and Lowery (2013, 2). Table 3 outlines the included domains, constructs and subconstructs. An explanation is provided as to which domains and constructs were not included and why. As this research was a funded project, the construct ‘cost’, from ‘Domain I: Intervention’, was excluded. ‘Domain II: Outer Setting’ was also excluded as the outer setting is identified as being the national context in which the intervention was being implemented. Stakeholders at the national policy and strategy development levels were not included as this research is a small‐scale study and so it is beyond its remit to include these. Two constructs were excluded from Domain III: Inner Setting, namely, ‘Structural characteristics’ as the intervention was online and ‘Culture’ as this was not relevant to the older person and student nurse participants, and the facilitators belonged to the research team and therefore were not working with members of the wider organisation to implement the intervention for this study. The constructs and subconstructs of Domains IV and V were unchanged.

TABLE 3.

Domains, constructs and subconstructs of the adapted CFIR framework.

Domain I, intervention characteristics	Domain III, inner setting	Domain IV, characteristics of individuals	Domain V, process
1. Intervention source	1. Networks & communications	1. Knowledge and beliefs about the intervention	1. Planning
2. Evidence strength & quality	2. Implementation climate (subconstructs: tension for change, compatibility, relative priority, organisational incentives & rewards, goals & feedback, learning climate)	2. Self‐efficacy	2. Engaging (subconstructs: opinion leaders, formally appointed internal implementation leaders, champions and external change agents).
3. Relative advantage	3. Readiness for implementation (subconstructs: leadership engagement, available resources, access to knowledge & information)	3. Individual stage of change	3. Executing
4. Adaptability		4. Individual identification with organisation	4. Reflecting & evaluating
5. Trialability		5. Other personal attributes
6. Complexity
7. Design quality and packaging

2.7. Ethical Considerations

Ethical approval for this research was granted by the University of Limerick on 23 December 2020 (Approval number: 2020_12_23_EHS). Following participation in the café, participants were invited to take part in the research through the completion of an anonymous online survey questionnaire (completion time approximately 15 min) using Qualtrics software. An information sheet was provided, and completion of the survey questionnaire implied consent. The data and all participant information were stored electronically in the principal investigator's password‐protected computer according to General Data Protection Regulation (GDPR) (European Parliament and Council of the European Union 2016) and Data Protection Act (2018). Confidentiality was maintained, and no names or identifying statements from or about the participants were used.

3. Results

The primary study used original data in determining the learning that took place. These findings have been reported elsewhere. However, it is relevant for context to identify that both older person and student nurse participants reported intergenerational learning, including similarity of thoughts and views, shared life experiences and reduced preconceptions leading to mutual respect and understanding. The findings of this secondary data analysis are presented under the individual constructs of the four domains used in this adapted CFIR framework. Both quantitative and qualitative findings are contextualised to capture the integrated holistic presentation of the data. Construct exemplars within each of the domains are provided to illustrate the meaning of the findings. The implementation barriers and the facilitators are presented under four domains (I, III, IV and V) from the adapted CFIR framework (Table 3). Abbreviations are used for direct quotes, that is, ‘OP’ for older people, ‘SN’ for student nurses and ‘F' for facilitators. Fifty of the original 59 third‐year BSc Nursing students and all (n = 49) older person participants participated in the original research. There were 46 female and 4 male student nurses and 39 female and 10 male older people. The age profile of student nurses was in the range of 18–25 years (n‐33), 26–35 years (n‐9), 36–45 years (n‐2), 46–55 years (n‐2) and 56–65 years (n‐4). The age profile of the older people ranged from age 65 years (n‐4), 66–75 years (n‐33), 76–85 years (n‐11) and 86–100 years (n‐1).

3.1. Domain I: Intervention Characteristics

All but one of this domain's eight constructs were included (Table 3). The ‘ Cost’ construct was excluded because participants did not incur any financial costs as this was a funded research. Regarding the ‘Intervention source’ construct, the intervention (café) was developed by the facilitator team, and they felt responsible to ensure that it works well. The team was representing their university and wanted the café to be a positive experience.

‘I feel very responsible that things would work out well for the participants, …. We were representing the University so it was really important that it would all be good.’ (F)

The ‘Evidence, strength and quality’ construct determined the stakeholders' perceptions on whether the café achieved its aim. All agreed that the café was useful in supporting intergenerational learning and sharing views and could help break down barriers. Although both groups agreed that they learnt about each other, students' level of agreement was higher (84.45% of the students agreed/strongly agreed in comparison to 60.86% of the older people who agreed/strongly agreed). The ‘Relative advantage’ construct explores whether there is an advantage to implementing this intervention. Intergenerational cafés were a new initiative and were seen as having merit.

‘I think [its] worth doing again.’ (F)

The ‘Adaptability’ construct explores whether the intervention could be adapted if needed. All participants agreed that it would help them get to know each other better if there was more than one café.

‘I would benefit from the experience of another one [café].’ (OP)

‘Would be nice to have two cafes…’ (F)

The intergenerational café was trialled (‘Trialability’ ) to see if it was an effective way to increase intergenerational learning. Generally, it was seen as being useful and a good idea, but some suggestions for improvement included having smaller numbers and more time in the breakout room.

‘45 minutes is really not enough to go through some topics in a nice, calm way.’ (SN).

The ‘Complexity’ construct relates to perceived difficulty of the intervention, and the ‘Design quality and packaging’ construct refers to café organisation. Students agreed that the purpose was clear (89.13%), the online process worked well (86.96%), it was well organised (89.13%), topics for discussion were clear (86.96%), the breakout room purpose was clear (86.96%) and there was enough time for big group discussion (86.96%). In contrast, older people were in less agreement about whether the purpose of the café was clear (61.7%), the online process worked well (65.96%), it was well organised (68.08%), the purpose of the breakout room was clear (55.32%) and the purpose of the big group discussion (56.52%). Some older people reported needing technical help (logging on and participating). Many agreed that having a facilitator was important (71.74% student nurses and 74.47% older people). Facilitators checked with participants during the breakout room discussions that all was going well. However, at times, they felt uncomfortable about joining the online room unannounced.

‘The only place where I felt uncomfortable was when I was dipping in & out of the rooms. When I went back in, …I didn't know how to … reconnect and engage. … I felt I interrupted their little group, that I was the intruder….’ (F)

3.2. Domain III: Inner Setting

Findings were mapped against all three constructs (Table 3). The ‘Networks and communications ’ construct examines the type and quality of formal and informal communications within an organisation. The research team provided both oral and written information on the café and the research to all. Communication during the café was viewed positively.

‘The way each listened to others… as we listened, we realised that people have their own stories and each individual is as important as the next.’ (OP)

The ‘Implementation climate’ construct explored participant receptivity to the café, and it has six subconstructs. The first, ‘tension for change’, showed support for the café's aim, and older people believed it was important that there be a reciprocal understanding between students and older people.

‘I think they [cafés] are a fantastic idea and gives the students a great insight into what the patient expects and hopes for, also helps the older person to try to see things from the nurse's point of view. Getting students to listen to older people tell their stories and realise we have lived full and interesting lives, and that for the most part our outer selves do not reflect our inner selves.’ (OP)

‘I … felt a sense of being energized… It was something very new & very unique.’ (F)

The ‘compatibility’ subconstruct explored the fit between participants' values and the café's purpose, while the third, ‘relative priority’, examined how important it was to implement the café. Participants were supportive of the café and felt it helped intergenerational learning.

‘The café was very good … The energy and appetite of the students to learn stimulated us … to try to impart some of our knowledge and experiences.’ (OP)

‘It allows us to connect with them on a personal level not just professional…’ (SN)

‘It helped me to gain a better understanding of the way they [older people] wish to be approached.’ (SN)

Less data are available regarding the fourth subconstruct, ‘organisational incentives and rewards’; however, the complementary pack of tea/coffee and snacks sent prior to the café was welcomed. The fifth subconstruct, ‘goals and feedback’, elicited positive comments from some students.

‘The discussion guide was useful. (SN)

Facilitator support was needed to assist with technical challenges experienced by some participants.

‘Facilitating the cafés when some older people were unable to see on the screen. I was …able to talk them through the technology to see if they could set up on the screen. (F)

Lastly, facilitators indicated that there was a ‘learning climate’ (the sixth subconstruct) within the organisation, as illustrated by their openness in discussing how they felt about facilitating.

‘I was quite anxious about it, but less so after the first café had been done.’ (F)

This domain's third construct ‘Readiness for implementation’, through its three subconstructs (Table 3), explored how committed the organisation was to the café. Effective leadership within the research team facilitated the café preparation, organisation and execution. Findings mapped to the ‘access to knowledge and information’ subconstruct relate to the organisation and running of the café. There is some overlap between these and those mapped against the ‘complexity’ construct from Domain I, reported earlier. Furthermore, although topic guides were provided during the breakout rooms, this was not evident to some of the older person participants. This suggests that these guides should have been given in advance. However, the facilitators were confident about the process and were well‐prepared.

‘We did a run‐through of the café…. I felt confident we had prepared….’ (F)

3.3. Domain IV: Characteristics of Individuals

Findings were mapped against all five constructs. The first, ‘Knowledge and beliefs about the intervention’, illustrates the participants' views. All agreed that the café was useful (OP: 89.36%, SN: 88.89%), helped mutual sharing of views (OP: 95.66%, SN: 86.67%), could build social networks (OP: 86.95%, SN: 82.22%) and can break down barriers (OP: 89.13%, SN: 86.7%). Students more strongly agreed that they learnt about older people (84.45%) compared to how much older people learnt about students (60.86%). Overall, participants felt positive towards the cafés.

‘A good idea that provides a safe space to get to know each other. The idea of people from different walks of life talking together was inspiring.’ (OP)

‘I thoroughly enjoyed the experience of the Intergenerational Cafe!! It was a very meaningful activity and a different way of learning. Brilliant experience!’ (SN)

The following constructs are described together as the findings are common to all. The ‘Self‐efficacy’ construct focused on whether participants felt capable of participating (older people/student nurses) or facilitating the café (facilitators). The ‘Individual stage of change’ construct looked at participants' levels of enthusiasm and ability to participate. Personal traits of tolerance, motivation, competence, ability and learning style were explored in ‘Other personal attributes’ . Student and older person participants had mixed feelings about participation. Both agreed that they were comfortable about sharing personal information (OP: 87.23%, SN: 82.5%), felt that what they had to say was of interest to the group (OP: 78.72%, SN: 84.78%) and that they had opportunities to share their feelings (OP: 75.09%, SN: 82.62%). Some generational differences were seen in how older participants were more comfortable asking questions (OP: 76.6%, SN: 63.04%), while more students found participating challenging (OP: 25.53%, SN: 32.61%) but empowering (OP: 54.35%, SN: 71.74%). Some older people's technological problems hindered their participation. Facilitators were comfortable with their role, especially knowing that they had collegial support.

‘I felt in control and confident because I had the backup support and people with more expertise.’ (F)

Participants reflected on the personal impact of having taken part in the café and the learning they had gained from this, including the importance of guarding against preconceived ideas.

‘Great idea, needs to be continued as a course over several weeks if that were possible. This would build up trust and allow for more meaningful interactions.’ (OP)

‘This cafe changed my view of the older person and will have a positive impact in how I care for the older person as a student nurse.’ (SN)

The ‘Individual identification with organisation’ construct explores the relationship and level of commitment the participants have with the organisation. Findings related only to the facilitators. All were research team members and had a positive working relationship. This facilitated effective teamwork.

‘We had a relationship already & [this] really helped our teamwork. Our effort & the fact that we all realised we trusted each [other] and the students trusted us.’ (F)

3.4. Domain V: Process

Findings were mapped against all four constructs (Table 3). The ‘Planning’ construct focuses on the tasks and behaviours required for the implementation of the intervention (cafés). The findings reported on in ‘Domain 1: Intervention Characteristics’ constructs ‘Complexity’ and ‘Design quality and packaging’ also relate to this. Students were more positive than older people that the café's purpose was clear, the online process worked well and overall it was well organised. These differences were greater with respect to the purpose of the breakout room being clear, having enough time for big group discussions and clarity of discussion topics. However, there was more participant agreement about having enough time for breakout discussions (SN: 47.83%, OP: 53.19%) and the importance of having a facilitator (SN: 71.74%, OP: 74.47%). As anticipated, the facilitators felt well prepared to facilitate the cafés.

‘We had several meetings, there was trust amongst us and I think the technology and having the people there was critical because then we could look at our other roles as well.’ (F)

The ‘Engaging’ construct examined how the appropriate people are attracted to and involved in implementing café. Its four subconstructs are outlined in Table 3. The available data are from facilitators only and refers to ‘champions’ and ‘external change agents’ subconstructs. Two team members were identified as champions in having technical knowledge and in addition there was a separate team leader for overall project management. ‘External change agents’ are those people outside of the organisation who influence the intervention decisions. It was important to facilitators that the university, through the cafés, would be showcased and that the participants as external agents would have a positive experience.

The third construct, ‘Executing’, relates to actual implementation of the café, and the last construct ‘Reflecting and engaging’ reports on the quality and progress of café implementation. Participants' responses about the implementation have been reported upon previously in the above constructs and domains. The remainder of this section reports on the degree to which intergenerational learning occurred. High percentages of students agreed/strongly agreed about what they knew about older people. Students strongly agreed/agreed that they knew how older people liked to be addressed (71.74%), where they were from (86.96%), their work (91.30%), their family and friends (78.26%), their hobbies (84.78%) and their holidays (60.86%). There was less agreement about what they know of older people's food/drink preferences (30.44%), pets (43.48%), music preferences (19.57%) and transport (47.83%). In contrast, there was much less agreement amongst older people about what they know about students. They agreed/strongly agreed to a lesser degree when asked whether they know how student nurses would like to be addressed (37.5%), their food/drink preferences (2.08%), pets (2.08%), hobbies (2.08%), music (4.17%), holidays (6.25%) and transport (8.34%). However, there was more agreement about what they knew about students' work (58.34%), where they were from (56.25%) and their families and friends (45.83%). Interestingly, findings show that both groups had insights into how similar/dissimilar they were, suggesting that mutual learning had occurred in relation to this. Facilitator reflections indicated the smooth running of the cafés stemmed from rigorous preparation. They also reported their surprise at how open the participants were to the café idea and how quickly they connected in their café.

‘… even though there was a lot of time & energy in the collaboration & clarifying what we were doing, … it seems to have been valuable for the participants, … they were very open & I wouldn't have thought that would have happened as quickly as it did.’ (F)

4. Discussion

This secondary data analysis study explored and identified the implementation barriers, facilitators and effectiveness of using an intergenerational café to enable intergenerational learning. The three main areas that influenced implementation were the organisational requirements for the café, connectivity preparation and facilitator teamwork.

4.1. Organisational Requirements

Findings from this study found this intergenerational activity needed meticulous planning and organisation to support the participants and meet their expectations; this finding is reflective of the wider literature (Bowling et al. 2021; Davies et al. 2013; Eaton 2015; Hwang, Wang, and Lin 2013; Hwang et al. 2014; Reitmaiter et al. 2014). The initial plan was for face‐to‐face intergenerational cafés during the Spring of 2021. This changed due to the COVID‐19 pandemic and resulting public health restrictions, leading to modifying the organisation and planning of the café to an online event. This experience illustrates the importance of having contingency plans when planning research although a global pandemic could not have reasonably been foreseen. This change required preparing student nurses and older person participants on how to access and use Microsoft Teams as an alternative meeting venue. Careful and robust discussion, agreement and division of roles within the team were essential implementation facilitators when organising this intergenerational café event. Using the expertise of each team member aided the successful implementation of the café. The research team included support members with specific informational technology expertise; this was essential in preparing clear ‘log on and access’ instructions, facilitating online movement within the cafés from the big group meeting to breakout rooms as well as resolving technical issues as they arose. These roles are essential in supporting participants to navigate technology and providing support and go beyond providing a set of participant instructions.

The study results identified varied responses to participants' views about the café organisation. Although there were similar levels of agreement that the purpose of the discussion café was clear, this was at different levels of agreement depending on the participant group. More students strongly agreed with this question statement, but more older people disagreed. This may have been because the students were prepared collectively in class, whereas older person participants were provided with individual information. The literature (Bowling et al. 2021; Davies et al. 2013; Hwang et al. 2014) identifies advantages of preparing students for engagement with intergenerational initiatives. Interestingly, this study's older participants felt they would also benefit from preparation in relation to format and purpose albeit they were provided with information and offered a trial run prior to the café.

As part of the café organisation, a conversation/topic guide was introduced to all participants before each Microsoft Teams breakout room; additionally, students were introduced to the topic guide in their classroom preparation. Students identified that the topic guide helped start conversations; however, qualitative findings revealed that some older people would have liked more information on the conversation topics to ‘get the ball rolling’. It was identified during the implementation of this café that it was important to provide all participants with similar conversational guidance prior to and during the café to encourage conversational flow. Furthermore, initial concerns about participants making connections while using an online café approach were identified, and it emerged from this intergenerational café that older people and students can adapt to potentially challenging circumstances for mutual learning to develop.

4.2. Connectivity Preparation

The implementation of this study offered interesting perspectives on using technology when planning for online connections. There were similar levels of agreement among participants, and interestingly, more older people strongly agreed that they were equally comfortable using technology. This supports Sixsmith et al.'s (2022) research, which refutes ageist stereotypes that older people are unable or unwilling to use digital technologies, with many adopting or increasing technology use for their communication needs in 2020.

As part of the implementation preparation plans for this study, all participants were invited to a trial run of using Microsoft Teams; however, some older participants had challenges when using and adapting to technology during the café, for example, accessing, logging on, unpredictable internet connectivity, adjusting sound and negotiating chat functions. These findings support Haase et al. (2021) and Fong et al.'s (2022) studies, where older adults reported needing clearer instructions and having easier access to support staff when using technology. Albrecht et al. (2022) concur that access to reliable internet connectivity, digital devices and support staff are important when developing a world café. When reviewing the implementation of the café, it is crucial that training and support for older people participating in research via online approaches and the importance of technologist support before and during research interventions are emphasised. A learning from implementing the café was providing opportunities to practise using online technology and for this to be an essential element prior to partaking in the event. This helps prepare older person participants manage connectivity issues should they arise as well as reducing the need for troubleshooting episodes during the online café facilitation.

Although the student survey identified comfort in using technologies, similar challenges as older participants emerged from the qualitative findings, for example, internet connectivity and navigating breakout rooms. However, findings revealed that once initial technical difficulties were resolved, virtual links worked well. During the COVID‐19 pandemic, nurse education had to embrace online technologies as a means of providing safe and effective ongoing education for students (Atique et al. 2020). The literature has reported that student nurses adapted well to the rapid technological advancement within healthcare education and developed competence in computer technology and online learning (Godbold et al. 2021; Hsu and Ho 2022). As part of the implementation process, lecturers provided students in this study with guidance on how to engage with older person participants online and on the process of connecting online, professional expectations and communication skills (e.g., turning on cameras, active listening and promoting engagement). Indeed, Warren et al. (2021) recommend providing technical support and knowledge on Microsoft Teams is essential to the successful delivery of online events. Successful implementation occurs when facilitators do not underestimate the importance of preparing students for partaking in online events and reinforcing ground rules on professionalism and online engagement (Warren et al. 2021).

4.3. Facilitator Teamwork

Teamwork was identified as being crucial to the smooth implementation of the café. The facilitators worked well as a team, trusted each other and had confidence that they were well prepared. The strengths of each team member were recognised and valued, building mutual trust within the team. An identified strength of implementing this café was having a diverse skill‐mix of experienced facilitators, with technical ‘know‐how’, which enabled successful transition of an in‐person intergenerational café to an online interface. Within this study, participants (older people and students) agreed that it was important to have a facilitator within each small breakout discussion group. Interestingly, qualitative facilitator findings revealed that minimal facilitation was required for conversations to develop between participants.

During implementation, it emerged that the presence of a facilitator offered support for all participants and was available with advice on managing technical online problems in a timely manner. Furthermore, as nurses and educationalists, café facilitators were experienced in facilitating online student groupwork using andragogical principles as well as engaging with people in the community. Literature concurs that facilitator roles can create ‘equal footing’ for all participants, encouraging open conversations on the topics for discussion, without coming central to group dynamics (Rushton et al. 2021; Rovai et al. 2007). Therefore, the importance of experienced facilitators when implementing and planning for small group facilitation and agreement on facilitator roles ensures their presence does not impede natural group interactions and engagement. This allowed intergenerational café participants to develop spontaneous conversations within each breakout room and encourage/enhanced getting to know each other.

4.4. Strengths and Limitations of the Work

4.4.1. Strengths

Thís secondary analysis research has demonstrated the importance of determining the barriers, facilitators and effectiveness of using an intergenerational café to enable intergenerational learning. This study illustrates what is/is not helpful to the successful implementation of an intergenerational café. The research demonstrates the benefit to the participants of careful planning, organisation and support by the research team. Furthermore, it illustrates the importance of having facilitators to guide and support both large and small group discussions. Having an appropriate skill mix of experienced educationalists and members with specific IT expertise informed the appropriate organisation and facilitation of the cafés.

4.4.2. Limitations

Online events, such as the intergenerational cafés, are dependent on having good internet connectivity. Broadband coverage differed for each participant. The unreliability of internet connectivity had an impact on some participants' ability to contribute to the conversation at times during the café. Limitations to post hoc CFIR analysis is the challenge of mapping existing data to the CFIR code books according to predetermined constructs and domains.

4.5. Recommendations for Further Research

This intergenerational café was originally planned as a face‐to‐face in‐person event, but due to the COVID‐19 pandemic, it was changed to an online event. Since the lifting of restrictions, in‐person intergenerational cafés have been facilitated. It is recommended that research could be undertaken on these. This would provide valuable insights into the in‐person event, and from there, a comparative study of both online and in‐person cafés could be undertaken. It is further recommended that the CFIR research design be used with input from both students and older people from the outset. The use of patient and public involvement (PPI) in research is increasingly recognised as being key to determining relevant and quality outcomes (Jones et al. 2021). It is also recommended for future online research that all participants are provided with preparatory training and support from personnel with technological expertise.

4.6. Implications for Policy and Practice

Since the first online intergenerational cafés of 2021 and following the lifting of the COVID‐19 restrictions, in‐person intergenerational cafés have become an annual event. The café has been embedded into the BSc Nursing (General, Mental Health and Intellectual Disability) curriculum through the third‐year community care module. This implementation science research has resulted in the realisation of a concept into a concrete action within a relatively short period of time. Participant feedback has continued to be positive about both the café as an enjoyable event and the intergenerational learning that has occurred.

Findings from this research indicate the positive effect of intergenerational cafés in facilitating and supporting intergenerational learning for both older people and student nurses. Intergenerational innovations are important within nurse education and within the context of ageing populations. Therefore, implications for policy and practice include promoting intergenerational innovations within nurse education and nursing care of the older person policies and embedding intergenerational innovations within nurse education curricula.

5. Conclusion

Using CFIR, the challenges and opportunities of implementing an online intergenerational café were discussed. The three main points discussed were the organisational requirements, connectivity preparation and facilitator teamwork. When planning an intergenerational café, organisational requirements need to be planned well in advance to allow for flexibility when unexpected circumstances arise, such as a global pandemic, leading to an online café instead of a face‐to‐face event. Ensuring that participants were given clear instructions on how to use technology for online café access and giving guidance on participating in conversations within a virtual environment was crucial. Team members included information technologist support roles, which aided in smooth online access and assisted in troubleshooting technical and connectivity issues as they arose. During implementation, connectivity preparation involved inviting participants to a trial run of using Microsoft Teams to highlight problems before the café began. A learning from this study is to strongly encourage participants to engage in this trial and to explain why it is important that they do so. Facilitators worked well as a team, when each member's role is valued, allowing for mutual trust to develop in each other's abilities. A strength of this team was that most facilitators had vast experience as nurse educationalists, who had experience of communicating/caring for/with people within differing situations (classroom and clinical settings).

Ethics Statement

Ethical approval for this research was granted by the University of Limerick on 23 December 2020 (Approval number: 2020_12_23_EHS).

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16613.

Statistics

The statistics were checked prior to submission by an expert statistician, Dr. Ali Sheikhi, ali.sheikhi@ul.ie.

Supporting information

Supporting Information S1.

Data Availability Statement

Data are available upon considerable request from the corresponding author.