Communities of Practice in Long‐Term Care—Exploring Frameworks, Barriers and Enablers: A Systematic Review

ABSTRACT

Objectives

Communities of Practice (CoPs) offer staff an opportunity to learn with and from one another, and to explore and advance practice. This study aimed to identify the frameworks that underpin the development, operation and evaluation of CoPs, and barriers and enablers to implementing this social learning approach in long term care (LTC).

Methods

This systematic review comprehensively searched four databases (MEDLINE, CINAHL, PsycInfo and Embase) from inception to August 2025, identifying studies focused on supporting LTC staff implementing evidence‐based practice, best practice or quality improvement. Inclusion screening, data extraction and quality assessment using the Quality Assessment with Diverse Studies tool (QuADS) were completed independently. Findings were mapped to the Values Creation Framework.

Results

Fifteen papers represented eight CoP programs ranging from small, standalone groups to large national collaboratives. Frameworks or specific CoP definitions underpinned planning for seven programs. Two programs drew on stakeholder input in development; however, none described formal co‐design. Seven programs were multidisciplinary. Evaluation was qualitative (n = 8), mixed methods (n = 4) or quantitative (n = 3), with limited application of evaluation frameworks. A wide range of enablers and barriers was identified, with structural and cultural challenges affecting sustained CoP engagement and implementation of CoP learning outcomes.

Conclusions

Despite 20 years of CoP implementation in LTC, there are few comprehensive evaluations to guide practice. Community of Practice participation delivers individual learning and peer support; however, system and organisational barriers affect sustained staff participation and translation. Consistent application of existing frameworks and enhanced CoP reporting will better support future CoP development and implementation in LTC.

Practice Impact

Residential aged care organisations and their staff could benefit from the peer support and learning opportunities offered by participation in well‐facilitated and effective Communities of Practice (CoPs). Consistent application of existing planning and evaluation frameworks and enhanced CoP reporting will better support future CoP development and implementation.

Policy Impact

This systematic review suggests that Communities of Practice (CoPs) with residential aged care staff do deliver individual benefits; however, there are ongoing systemic challenges that influence CoPs' potential for wider impact on practice change. To realise the value of this social learning approach, we need to address these systemic barriers.

1. Introduction

When grounded in social learning theory, Communities of Practice (CoPs) offer participants an opportunity to learn with and from one another, share explicit and tacit knowledge, explore uncertainties and develop and refine practice [1]. Communities of Practice were first described as a social learning concept by Lave and Wenger [2]. Through the late 1990s and 2000s, CoPs were applied with an expanded focus on knowledge management, particularly in business settings [3]. In early healthcare reviews, CoPs were described somewhat cautiously as having the potential to support the implementation of evidence in practice [3, 4]. As the CoP field has developed, CoPs have been adopted as a complementary approach to standard didactic or skill‐based training, by fostering mutual support and cross‐discipline, cross‐organisation or cross‐sector collaboration [1, 5]. Community of Practice participation can build confidence and develop professional identity, is practice‐oriented, collaborative and collegial, and provide a forum for debriefing and problem‐solving [1, 3, 4, 6, 7, 8, 9]. Communities of Practice also have potential as a cost‐effective way of offering professional development and advancing practice [10].

The current, widely accepted definition is: ‘Communities of Practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.’ [1, p. 11] Communities of Practice have three key components: (1) Domain—a shared interest and member identity; (2) Community—the group of people who interact; and (3) Practice—what they do together and their shared repertoire of resources, tools and techniques that evolve over time [1].

In health care, CoPs are now commonly described as a tool to facilitate practice change and the implementation of evidence‐based practice [5, 8, 11, 12]. A recent systematic review by Noar et al. [5] was the first to conclude that CoPs aiming to improve clinical outcomes were effective at doing so. This review of 50 studies included only two CoP programs offered in long‐term aged care [5, 13, 14].

Long‐term care (LTC), when offered in the aged care sector, is also known as residential aged care or nursing homes. It provides facility‐based 24 h care to residents, typically older people with complex health and support needs [15]. As a workplace, LTC typically has a large and diverse care workforce, few qualified nurses, limited opportunities for professional development, mentoring or staff support and high workforce turnover [16, 17, 18, 19]. This is a challenging environment in which to effectively implement evidence‐based practice [20]. As a practice‐focussed, collegial and collaborative social learning approach, CoPs could offer a viable solution for the learning, support and implementation challenges encountered in LTC [6, 21, 22, 23, 24]. When considering a CoP as a potential learning and implementation approach, it is important to better understand the barriers and enablers to developing, operationalising and sustaining or scaling CoPs in the LTC sector.

This review builds on previous systematic and scoping reviews of CoPs in health care [3, 4, 5, 12] and a rapid review in LTC [24, 25] to explore the application of CoPs in LTC by asking:

1. What frameworks, tools and/or definitions have been used to support development and operation of CoPs in LTC?

2. What frameworks, tools and methods have been used to evaluate these CoPs?

3. What is known about barriers and enablers at different time points in the life cycle of these CoPs (e.g., pre‐implementation/development, implementation, maintenance/sustainment and scaling)?

2. Methods

The systematic review protocol was registered with PROSPERO (Registration: CRD42023450158).

2.1. Search Strategy and Selection Criteria

The search strategy included a range of synonyms for CoPs and LTC as the primary context or setting. We included published, English language, peer reviewed, original research on CoPs that primarily support LTC staff to implement evidence‐based practice, ‘best practice’ or quality improvement (Search Strategy and Inclusion/Exclusion Criteria—Appendix: Table A1). We excluded CoPs that were predominantly for students or trainee health and aged care workers. Four bibliographic databases were searched: MEDLINE (EBSCO Host), CINAHL (EBSCO Host), PsycInfo and Embase. Searches, with no historical date restriction, were completed in January 2024 and updated in August 2025. Search results were deduplicated in Zotero, titles and abstracts were uploaded into Covidence systematic review software (Veritas Health Innovation; www.covidence.org) and further duplicates removed. Two reviewers (RS and JT) independently screened all titles and abstracts against inclusion and exclusion criteria. All relevant full text papers were retrieved and independently assessed to determine eligibility. We hand searched reference lists of included studies and completed forward citation searches using the Spidercite software (Evidence Review Accelerator https://tera‐tools.com/), cross‐checked with Web of Science (https://webofscience.zendesk.com/hc/en‐us). At each stage, two reviewers discussed and resolved discrepancies, with a third reviewer (SP) if needed.

2.2. Data Collection and Items

One reviewer (RS) extracted data about study type, LTC type, CoP context and characteristics (e.g., auspice, mode of operation), CoP purpose, CoP membership and facilitation, and any CoP definitions, tools or frameworks used. These data were checked for accuracy by the second reviewer (JT). The two reviewers independently extracted data on reported study outcomes, barriers and enablers, author conclusions, study limitations and strengths, and these data were developed into summary tables. The reported processes, findings, barriers and enablers were mapped to the Values Creation Framework (VCF) [1, 26, 27, 28, 29] to summarise the diverse study contexts, processes, experiences and outcomes. The VCF is a model first described in 2011 by Wenger et al. [26] for exploring and evaluating how CoPs and social learning activities create value (Box 1). The current VCF iteration focuses on eight areas of value including individuals' CoP experiences through to transformative change [1, 29]. Findings were reviewed and refined with co‐authors.

BOX 1. Values Creation Framework summary [1, 29].

Value	Description
Immediate	Your experience of the CoP/interactions within the community
Potential	What a CoP member gets out of it/what do you learn or take away?
Applied	What you do with it/what if anything do you do differently in practice?
Realised	The result/what difference, if any, does the practice change make?
Enabling	What makes it all possible? (can also include what presents a barrier)
Orienting	Interactions with the broader landscape: what others are doing, exploring relevant trends and research
Strategic	Conversations with stakeholders; engaging support for the CoP/learning
Transformative	Broader or deeper impacts; beyond improving the practice of CoP members; transforming people, systems or culture

Quality appraisal using the Quality Assessment with Diverse Studies tool (QuADS) [30] was completed independently by the two reviewers and any discrepancies discussed and resolved.

This work was supported by the Australian Medical Research Future Fund (MRFF) Dementia, Ageing and Aged Care Mission 2020 Grant Opportunity—Grant number: 2021/MRF207632. The funder played no role in the study.

3. Results

The search generated 784 references for title and abstract review. Thirty‐nine studies were selected for full text review, and 15 studies were eligible for inclusion in the final analysis (Figure 1).

FIGURE 1.

Communities of practice in long term aged care—PRISMA diagram.

3.1. Frameworks, Tools and Definitions—Establishing LTC CoPs

3.1.1. CoP Context and Setting

The 15 included papers reported on eight CoP programs: two each in England and Australia, one each in Scotland, Netherlands and Canada, and a Canada/USA partnership (Table 1). Three papers reported on the Caledonian Development model [13, 31, 32], a Scotland‐wide program established to strengthen gerontological nursing and care of older people. Three papers reported on the Seniors Health Research Transfer Network (SHRTN) Collaborative [7, 33, 34], a Canadian program using CoPs to support practice change in long term aged care. Four papers reported on a single CoP focused on fall prevention that operated across multiple facilities within one LTC organisation in Australia [14, 35, 36, 37]. All other reviewed programs operated across multiple facilities and multiple organisations.

TABLE 1.

Context of included long term aged care Community of Practice (CoP) studies.

Project or CoP	Author and year	Country	Setting	Type of LTC	CoP purpose (Practice)	CoP domain	Co‐design of CoP	Development frameworks and CoP definition (as referenced in each paper)
Caledonian Model	Tolson [31] 2005	Scotland	Across orgs	Independent sector care homes	To define gerontological nursing and to connect across Scotland in order to advance evidence based gerontic practice	Gerontological nursing and best practice care of older people	No	Wenger et al. (2002) Brown and Duguid (1991)
	Booth [32] 2007	Scotland	Across orgs	Independent sector care homes	To prepare credible, evidence‐based care guidance (best practice statements) to inform nursing care of older people	Gerontological nursing and best practice care of older people	No	Wenger (2003) – referred to; not discussed
	Tolson [13] 2008	Scotland	Across orgs	Independent sector care homes	To support implementation of evidence‐based practice care by nurses working care homes (and also in acute care and in day hospitals)	Care for older people. Care Homes and nutrition in frail older people	No	Leeman's taxonomy: Implementing change in nursing practice (2007) Modified group supervision model (Proctor 2000) Transformational learning strategies (Hui and Pudelko 2003)
Seniors Health Research Transfer Network (SHRTN)–later Seniors Health Knowledge Network (SHKN)	Conklin [33] 2008	Canada	Across orgs	NFP and Private	Improve Senior's health and long‐term care by improving knowledge flow	Alzheimer Knowledge Exchange CoP‐focus on smoking cessation with LTC residents with dementia	No	Promoting Action on Research Implementation in Health Services (PARiHS) Framework
	Kothari [7] 2015	Canada	Across orgs	Not stated	People from across the province to work together to help improve oral care in residents in long‐term care in Ontario Provide a case example of a CoP trying to effect systems change	Oral health care for older people	No	PARiHS Framework Lave and Wenger (1991) Wenger et al. (2002), Bertone, (2013)
	Elliott [34] 2023	Canada	Across orgs	Not stated	Develop a toolkit for Wayfinding design for assisting individuals with dementia to find their way around LTC facilities	Dementia care	No	Wenger et al. (2002), Wenger (2016)
Fall prevention program–Australia	Francis‐Coad [14] 2017	Australia	Within one org (multi facility)	Private‐NFP	To improve evidence‐based fall prevention	Fall prevention in LTC	Yes – Stake holder steering committee to develop the CoP	Wenger (1998) three phases of CoP development (potential, coalescing, active) Structural elements of a CoP from Ranmuthugala (2011)
	Francis‐Coad [35] 2017	Australia	Within one org (multi facility)	Not stated	To improve evidence‐based fall prevention	Fall prevention in LTC
	Francis‐Coad [36] 2018	Australia	Within one org (multi facility)	Private‐NFP	To improve evidence‐based fall prevention	Fall prevention in LTC
	Francis‐Coad [37] 2018	Australia	Within one org (multi facility)	Not stated	To develop and deliver evidence‐based interventions that could change the rate of falls and injurious falls in a LTC setting	Fall prevention in LTC
Single paper	Hirdes [38] 2020	Canada and USA	Across orgs	Private and NFP	Enable peer‐to‐peer engagement that supports using evidence based on risk‐adjusted indicators to guide collaborative initiatives to improve the quality of care in nursing homes. Fostering research and educational partnerships, quality assurance and improvement and showcasing national and international experts in health policy, research and patient care	Quality of care in nursing homes/LTC	No	Wenger et al. (2002) definition and Tolson et al. (2011) indicators of CoP maturity
Single paper	Hullick [39] 2021	Australia	Across orgs	Not stated	…enable service providers to develop shared expertise, and collaborate across services and across a region/geographic area	Best practice care for older LTC residents‐avoiding acute hospital/ED admission	No—but informed by previous focus group with LTC staff and GPs	Not stated
Single paper	Jack [40] 2021	England/UK	Across orgs	Not stated	Not stated	PAL and staff development in LTC	No	Wenger (2000) and Wenger et al. (2001) mentioned in background. Peer‐assisted learning approach adopted
Single paper	Vrerink [41] 2022	Netherlands	Across orgs	Not stated	To develop/strengthen the hermeneutic competence of care practitioners in residential care for older people with dementia	Hermeneutic competence and person‐centred approaches to dementia car	No	Wenger (1998)—definition mentioned
Single paper	Manson [42] 2024	UK	Across orgs	Not stated	To build knowledge, confidence of Nursing Home staff and improve palliative care in Nursing Homes	Palliative Care in Nursing Homes	No	Adopted Project ECHO methodology

Abbreviations: ED, emergency department; GPs, general practitioners; LTC, long term care; NFP, not for profit; Orgs, organisations; PAL, peer assisted learning.

Hirdes et al. [38] described the USA/Canadian Seniors Quality Leap Initiative (SQLI) that fostered improved LTC quality. Hullick et al. [39] reported on a collaborative CoP in Australia between LTC, emergency departments (ED) and key stakeholders that aimed to reduce ED presentations. Jack et al. [40] described a UK educational initiative to support LTC staff establishing CoPs within their own facilities and Vrerink et al. [41] reported on a CoP focussed on strengthening practitioners' competence in working with people living with dementia in the Netherlands. Manson et al. [42] described a UK palliative care program based on the Project ECHO (Extension for Community Healthcare Outcomes) model.

3.1.2. Development and Operation of CoPs

Seven of the eight programs mentioned a definition or theory to support development of the CoP, referencing CoP specific definitions [7, 14, 32, 34, 36, 37, 38, 40, 41]; change or implementation frameworks [7, 33], and peer learning or supervision theory (Table 1) [13, 40, 42]. Only Francis‐Coad et al. [35] formally assessed CoP acceptability or feasibility, predominantly focussed on technology use by CoP members. This program also involved a stakeholder steering committee to support CoP establishment [14, 35, 36, 37]. Hullick et al. [39] drew on findings from a stakeholder focus group to inform program design. None of the studies referred to a formal CoP co‐design process.

3.1.3. Characteristics of CoPs

3.1.3.1. Participants and Recruitment

All papers described the disciplines involved in the CoP, yet provided limited detail on recruitment methods (Table 2). The Caledonian Model CoPs were for nurses only [13, 31, 32]. The remaining programs described multi‐professional participation. Most programs also included researchers in the CoP, often as facilitators or leaders.

TABLE 2.

Characteristics of communities of practice (CoP) and CoP evaluation approach.

Author and year	Number of CoP participants	Participants	Facilitator	Facilitator support or training	CoP format	Number/frequency/length of sessions	Evaluation method	Evaluation frameworks
Tolson [31] 2005	36 people from a pool of 62 applicants	Nurses who care for older people in Scotland (n = 36), e.g., staff nurses, charge nurses, clinical nurse specialists, practice development roles, senior clinical managers	Not stated	Not stated	Online facilitated discussion AND Virtual college	Not stated	PAR—qualitative	None stated
Booth [32] 2007	CoP1–30 nurses CoP2–28 care home nurses and 16 nurses from CoP1 (NHS and independent sector care homes)	Link nurses with expertise in aged care, care home staff and academics	Not stated	Not stated	Virtual college and real time meetings	Not stated	PAR—qualitative	None stated
Tolson [13] 2008	10 nurses from six LTC sites	Nurses	Practice development facilitator	Not stated	Virtual college and full‐day in person study days	3× full‐day study days over 6 months	Pre–post mixed methods	None stated
Conklin [33] 2008	Not stated	A knowledge broker, supported by a SHRTN librarian, panel of experts and CoP members (disciplines not specified)	Knowledge brokers	Not stated	Limited detail: Webinar; email dialogue	Not stated	Case study—qualitative	Own SHRTN evaluation model (drawing on PARiHS framework)
Kothari [7] 2015	Approx. 60 members	Nurses, dentists, related paraprofessionals, knowledge broker, librarian	Experienced health professional Co‐leads and knowledge broker	Not stated	Limited detail: CoP planning group met and emailed; webinars offered	CoP met to develop webinars; number, length or frequency not stated	Case study—qualitative	PARiHS
Elliot [34] 2023	Drawn from a pool of approximately 2000 members, 4–11 participants per meeting	Knowledge broker, ‘frontline providers’ Occupational Therapy, Social Work, physiotherapy, psychogeriatric resource consultant; researcher, home adaptation/maintenance person, info specialist, LTC director, education director architect	Two CoP co‐leads and a knowledge broker	Not stated	Structured meetings – likely online	Nine meetings over 12 months; 60–90 min meetings	Case study—qualitative	From Protocol paper (Conklin et al. [43] references PARiHS framework)
Francis‐Coad [14] 2017	20 participants	MD staff: four nurses, four care managers, 12 allied health. 18 females	Allied Health Consultant	Yes—researcher trained the facilitator	Face‐to‐face Online discussion	Eight over two years Length not stated	Cross sectional clinical audit mixed methods	From Protocol paper (Francis‐Coad [23]): Wenger's three phases of CoP development; COM‐B model; CoP structural elements from Ranmuthugala (2011) Realist approach—Context/Mechanism/Outcome
Francis‐Coad [35] 2017	20 participants	Four nurses, 4 care managers (nursing background), 12 allied health. 18 females					Cross‐sectional mixed methods
Francis‐Coad [36] 2018	20 participants	Four nurses, four care managers (nursing background), 12 allied health					Prospective pre–post mixed methods
Francis‐Coad [37] 2018	20 participants	Nursing/care manager (five) and allied health (14) and one researcher					Prospective pre–post quantitative methods
Hirdes [38] 2020	14 Seniors Care/LTC orgs and 10 Academic/stakeholder partners Unclear number of CoP participants	Leaders in Senior Care Member organisations and strategic partners, including researchers, managerial and clinical professionals in LTC, no further detail provided	Not stated	Not stated	Face‐to‐face meetings	Two workshops per year; length not stated	Quantitative methods—Time Series	Tolson's indicators of CoP maturity (2011)
Hullick [39] 2021	Nine hospitals and 81 LTC sites in the evaluation. Unclear number of CoP participants	LTC staff, GPs, ambulance, local hospital and ED staff	Advanced Practice Registered Nurses	Not stated	Face to face meetings (pre‐COVID19) Virtual during COVID19 [44]	Four per year; length not stated Fortnightly: length not stated	Stepped wedge non‐random cluster trial Quantitative methods	None stated
Jack [40] 2021	Session 1: five care managers, plus additional staff – facility number not stated. Session 2: three care managers—facility number not stated	Care home managers (professions not stated) Session 1: five care managers, plus other staff (unknown number); Session 2: three care home representatives Personal Care Workers working with the care home managers (unknown number)	Peer Assisted Learning lead from the University	Not stated	Full‐day workshops for LTC managers face‐to‐face In person meetings	Two during project One hour sessions in LTC	Qualitative study Elements of Framework analysis	None stated
Vrerink [41] 2022	6–8 participants/CoP. Eight CoPs across five nursing homes	Mix of nurses, geriatric nurses, activity therapists, psychologists, spiritual counsellors, staff members and case managers, with researchers	Action researchers	Not stated	In person sessions	Six over one year per CoP Length not stated	Qualitative study Participatory Action Research	None stated
Manson [42] 2024	121 participants across 20 sessions 12–43 people/session	Home manager (17); Deputy manager (five); Clinical lead nurse (14); Registered Nurse (18); Senior Carer (eight); Carer (49); other (10)	Local hospice ECHO hub; knowledge experts‐primary and secondary care	Not stated	Online sessions	Fortnightly for 90 min from Oct 2018—July 2019	Qualitative study phenomenology, inductive line by line coding	None stated

Abbreviations: ECHO, Extension for Community Healthcare Outcomes; ED, emergency department; GPs, general practitioners; LTC, long term care; MD, multidisciplinary; NHS, national health service; PAR, participatory action research; PARiHS, promoting action on research in health services; SHRTN, Seniors Health Research Transfer Network.

3.1.3.2. Number of Participants

If numbers were reported, CoP size ranged from 3 to 5 participants per session [40] to 60 members (Table 2) [7]. Some papers described the pool of potential participants, ranging from 100 nurses across Scotland [32] to 8000 people cross Canada [7]. Two papers described the number and type of participating stakeholder organisations; however, neither gave any indication of how many people engaged directly in CoP activities [38, 39].

3.1.3.3. Session Details and Facilitation

Format and frequency of sessions ranged from face‐to‐face twice per year [38] to fortnightly 90 min sessions online (Table 2) [42]. Most programs named the profession or role of the CoP lead or facilitator, yet provided little additional detail about facilitator experience, resources or training. Two programs provided an outline of session topics [41, 42]; all others were silent on session details.

3.1.3.4. Timeline and Evolution of the CoP

Individual CoPs operated from six months [13] to over 10 years and still ongoing (Table 2) [38]. Manson et al. [42] offered three rounds of the Project ECHO 20 week program. The SHRTN (later called the Seniors Health Knowledge Network—SHKN) operated for over 10 years, reporting on shorter term individual CoPs within that timeframe [7, 33, 34], such as a CoP that offered nine sessions over a 12 month period [34]. The Caledonian Model also operated time limited individual CoPs within a longer‐term project [13, 31, 32], and the other programs reviewed were time limited, single projects over 1–2 years [14, 35, 36, 37, 40, 41]. Longevity appeared to be influenced by available funding and infrastructure support (e.g., funded facilitators, access to knowledge brokers) [38]. However, there was an overall paucity of detailed information on CoP governance models, specific funding or sustainability strategies.

3.2. Evaluating CoPs

3.2.1. Evaluation Approach and Frameworks

Eight papers adopted qualitative methods, describing participatory action research [31, 32, 40, 41], case study [7, 33, 34], or other qualitative approaches (Table 2) [42]. Data collection methods included semi‐structured interviews, focus groups or open question survey. Qualitative data collection techniques across both the qualitative and four mixed methods studies also included observation, facilitator or researcher notes and reflections, CoP‐related documents and CoP meeting transcripts or notes [13, 14, 35, 36]. Qualitative analysis was mostly through inductive thematic analysis.

Three papers were quantitative (Table 2); Francis‐Coad et al. [37] analysed data on falls rates and injurious falls, Hirdes et al. [38] conducted time‐series analysis of pain management, and Hullick et al. [39] analysed data on emergency department presentations and hospital admissions in a non‐randomised stepped wedge cluster design project.

The fall prevention CoP program used a mix of learning evaluation, implementation and CoP frameworks to explore outcomes [14, 35, 36, 37]. The SHRTN program [7, 33, 34] referred to the Promoting Action on Research Implementation in Health Services (PARiHS) framework and Hirdes et al. [38] mentioned a CoP specific framework. None of the other programs described using any specific implementation evaluation frameworks and none of the post 2011 programs applied the Values Creation Framework (VCF) [1, 26, 27, 28, 29].

3.2.2. Barriers and Enablers: Enabling, Orienting and Strategic Value

Table 3 summarises the three VCF components that relate directly to CoP barriers and enablers: Enabling, Orienting and Strategic Value. Time constraints, competing priorities, staff turnover, management or organisational support and LTC culture were the most frequently reported barriers or enablers across studies. Additional factors included technology competence and confidence, available resources, participant mix and characteristics, and skilled CoP facilitation.

TABLE 3.

Values Creation Framework (VCF) summary of evaluation findings (n = 15).

Author and date	Enabling value	Orienting value	Strategic value
Tolson [31] 2005	Enablers: Computer access essential for virtual Community of Practice (VCoP) approach Support of management and colleagues Best Practice Statement (BPS) methods, library and research access e‐practice development, particularly if geographically and professionally isolated Barriers: Absence of a learning at‐work culture Practice development a low priority Lack of time Doubts about legitimacy of internet‐based learning	Gerontological nursing not seen as a specialty in the nursing field. Importance of practice change/EBP acknowledged as difficult to achieve in isolation	National project—engaging multiple facilities and multiple stakeholders, including older people and their families
Booth [32] 2007	Enablers: Funded project Academic/practitioner collaboration Methods developed in CoP1 applied by CoP2 Part of larger program—role of action researcher shared by the academic team Purpose built, internet‐based practice development college Barriers: Technical issues with virtual college	Theory to practice gaps have been long identified and more work is needed to close these gaps	Development of the BPS involved diverse stakeholder input Considered by authors as a low cost approach
Tolson [13] 2008	Enablers: CoP members felt structured, but flexible support for EBP processes and mechanisms was essential Organisational and management support Safe, supportive environment Regular use by participants of the virtual college‐average 1/week Barriers: Time and resource constraints, lack of manager/senior nurse recognition and support LTC culture—work‐based learning requirements not legitimised	Company mergers and increased regulation—described as powerful external influencers resulting in sector ‘change fatigue’. Organisational changes in the NHS and independent sector had an overwhelmingly negative influence on practice development	Not evident
Conklin [33] 2008	Enablers: Multiple stakeholders: Librarians, caregivers, policy‐makers and researchers The SHRTN and CoP provide a supportive context—infrastructure and resources, e.g., fund ‘knowledge brokers’ to foster change Barriers: Technology issues with online collaboration Limited active facilitation at point of care to foster change	Policy context of a growing interest in networks to facilitate knowledge exchange in health care	The project engaged a Network across a province of Ontario with multiple organisations involved
Kothari [7] 2015	Enablers: Passionate and knowledgeable participants/champions: collective drive, dedication, hard work—CoP dynamics identified as an enabler Positive collaboration—mutual comfort and mutual exchange Effective CoP core planning team—content expertise, connections with wider community and diversity vital to the group's success Turnover/evolving membership seen positively as refreshing ideas and expertise Common identity and clear vison for change Tailoring content to audiences Infrastructure supports and multiple modalities, e.g., live webinar technology; workshops; members only web area for interaction Barriers: Competing priority areas—e.g., other mandatory training prioritised. Oral health area not mandated—therefore a lower priority for organisations/leaders Strategic and orienting/contextual challenges	SHRTN/SHKN—large knowledge network operating since 2005 linking caregivers, policymakers, and researchers across Ontario—focus on improving care and health for Seniors CoP drive for practice change was challenged by organisational and LTC cultural norms and structural priorities	Part of the larger SHKN/SHRTN project—connections with the wider community Experts were called on from the health and dental fields to aid in resource development Difficulty reaching management to garner support practice change
Elliot [34] 2023	Enablers: Clear expectations of members fostered group functioning (e.g., attendance and participation in the CoP/work of the CoP) Positive team dynamics, structured process, use of technology, variety of knowledge sources, clear goal—members cared about the issue Members took on key roles (e.g., facilitation, organising) and a core group coordinated the process Fluid membership of CoP—enabling and also a barrier—with high staff turnover Barriers: Difficulty engaging stakeholders in CoP program or in supporting the CoP. Knowledge to Action uptake Competing priorities for those participating in CoP implementation activities	Managers made decisions based on resources, policy, time constraints—these contextual factors might influence practice change Managers/administrators may have constraints or different priorities	Part of a broader SHRTN/SHKN program Held webinar for broader engagement with stakeholders and to disseminate work undertaken (guidelines, toolkit) Links to a broad range of stakeholders, however, greater engagement needed with administrators, managers and policy makers to enable change
Francis‐Coad [35] 2017	Enablers: Stakeholder engagement to support CoP set‐up/establishment Endorsement from organisational management CoP voluntary membership from across all 13 LTC sites Computer access to enable participation Training document on access/use of web‐based group for posting and sharing Barriers: Web‐based interaction challenging—some unfamiliar with technology application Building rapport and trust challenging online as participants didn't know each other well Competing demands from other clinical tasks away from the computer	LTC culture with a preference for face‐to‐face communication: concern that web‐based discussion could be beyond ‘comfort zone’ in LTC	Stakeholder steering committee formed to commence the logistical development of the CoP Endorsement from organisational management important
Francis‐Coad [14] 2017	Enablers: Allied health consultant as facilitator CoP connected staff across sites and enabled a coordinated approach to work CoP meetings and web‐based options were helpful to communicate and brainstorm solutions to the audit process challenges Access to external experts (researchers) supported the CoP member's activities Barriers None described that were CoP specific	Falls in LTC a significant issue and a priority for action	Collection of audit tool items required input from multiple staff Access to external experts to support the process was important
Francis‐Coad [36] 2018	Enablers: Support from LTC facility management and operating within a single organisation Regular CoP activities and outcomes reporting created a strong feedback loop from frontline staff to organisational Managers Face‐to‐face and online interaction—important to have both Barriers: Lack of dedicated time for CoP participation and activities Competing interests and priorities for CoP members	One of the 13 LTC sites did not participate in this intervention evaluation as it converted to a short‐term transition care facility	New falls policy and risk assessment discussed with stakeholder groups Engaged management to foster support for change Organisation wide resources developed Care staff and residents were surveyed to inform education development
Francis‐Coad [37] 2018	Not described—mentioned in previous paper on this study	No industry wide fall definition and injury classification therefore hard to compare rates across the sector. All sites involved in some fall prevention activities prior to the study	Not evident
Hirdes [38] 2020	Enablers: Funding contributed by each organisation to be part of the SQLI Active participation expected and preparedness to share data that could be exposing for organisations—evidence of commitment to the collaboration Knowledge exchange between LTC sites and researchers; support to use more sophisticated approaches to quality improvement and decision‐making Barriers: Shifting priorities specific to each organisation may limit time and staff commitment Change in membership (e.g., costs, staffing/resource constraints/‘mission drift’)	Public and sector focus on Quality Improvement and care improvement in LTC Industry expectation that LTC orgs focus on improving the quality of care Public reporting of core quality indicators through SQLI	Engaged government support, university collaboration and multiple organisations across two countries Member organisations and strategic partners, researchers, managerial and clinical LTC professionals involved Funding contributed by each organisation
Hullick [39] 2021	Enablers: Willingness to participate in the CoP Engagement of multiple organisations across a region Advance Practice Registered Nurses coordinated the CoP with quarterly meetings linking each of the EDs with their LTC partners Multidisciplinary group of interested providers sustain the ACE program Barriers: None described	Other studies have taken different approaches to fostering improved LTC/hospital interface and minimising ED visits and hospital admissions for LTC residents	Links and connections made between key service providers within the region Intervention based on findings from a focus group study with LTC staff and GPs
Jack [40] 2021	Enablers: Perceived learning benefits of Peer Assisted Learning sessions/CoP need to outweigh the cost of additional staffing needed to enable participation Introduced facilitative prompt cards to support the growth of CoPs Viewed as a low cost approach Culture of trust and respect needed Barriers: Time to participate/reflect and challenging to get staff together, e.g., no shift overlap Physical space to meet difficult in some facilities Competing demands – work demands and personal demands (e.g., child care if planning to participate in peer learning on a day off) LTC culture—people initially feeling uncomfortable to ask for help	Workforce shortages, high workforce turnover, need for ongoing training and support of staff working in care homes Strong need for training/support in the face of ageing population globally	Viewed as a low cost approach to professional development/staff education
Vrerink [41] 2022	Enablers: Offering practitioners a place to experiment and make mistakes Research team for program support/to facilitate sessions Rewarding process for staff to engage in the CoP and the project Barriers: Staff turnover, participant shift work and shifting work schedules Management and org support needed to enable CoP members to sustainably implement what they're learning/developing in the CoP	Personhood, and person‐centred care (PCC) approaches with people living with dementia are expected and considered good practice Some organisations have rules, structural and organisational obstacles that can make PCC challenging to implement	The life story approach required CoP care practitioners to work with/engage with families and residents Policy and organisational change needed to create an environment for PCC
Manson [42] 2024	Enablers: Peer support—people feeling comfortable to share Effective approach to education and supporting isolated practitioners Relevant topics and case‐studies reflecting ‘real life’ Barriers: Time the major barrier—including time of day and session length Computer access limited for some participants—in admin offices Some staff uncomfortable being on camera Clinical and work demands, and low staffing	LTC a common place of death—therefore a sector‐wide need for palliative care training International evidence that palliative care in LTC may be lacking	Program addressing known gaps in LTC palliative care education Video conferencing approach known to support hard to reach populations

Abbreviations: ACE, aged care emergency; BP, evidence based practice; ED, emergency department; GP, general practitioners; LTC, long term care; NHS, National Health Service; SHRTN/SHKN, Seniors Health Research Transfer Network/Seniors Health Knowledge Network; SQLI, Seniors Quality Leap Initiative.

3.3. Quality Appraisal

The papers in this review were of variable quality when appraised with the 13 item QuADS tool (Figure 2) [30]. The strongest elements of the reported studies (rated 2/3 or 3/3) were clear study aims (93%) and setting and population description (93%). The weakest elements (rated 0/3 or 1/3) were the lack of stakeholder inclusion in design (73%) and description of sampling procedures (73%).

FIGURE 2.

QuADS quality assessment summary.

4. Discussion

This is a heterogeneous literature, where the CoP development and operational descriptions are often insufficiently detailed, making it difficult to clearly identify key characteristics of the implemented CoPs. Although specific frameworks or CoP definitions were mentioned by most, little detail was provided for planning or evaluation, which made comparison and synthesis challenging. Most studies applied qualitative or mixed methods, and all included purposive samples. A wide range of barriers and enablers was documented. Key elements that contributed towards positive enabling value were management and organisational support; adequate or dedicated time and permission to participate, and the building of relationships and trust among CoP participants. Community of Practice participation was hampered by practical issues such as technology access or confidence, time or competing priorities, and by LTC culture and lack of management or organisational support. Lack of management support, time and resourcing were also barriers to translating CoP learning to practice.

4.1. Definitions and Framework Application

Despite repeated calls in past reviews [3, 4, 12, 24, 45, 46] for the application of frameworks to support CoP development, implementation and evaluation, few were applied or reported in depth. All but three of the papers referred to CoP literature, particularly for context [13, 33, 39], but most offered limited depth or discussion of CoP or social learning theory or application in evaluation. McGrath et al. [47] found similar issues in the medical education literature, identifying that use of the term CoP was often ‘cosmetic’ with little more than surface level reference to a CoP definition or fundamental CoP characteristics.

Only one study in our review formally tested the feasibility or acceptability of a CoP in LTC, related mostly to technology use [35]. There was no mention of formal co‐design for any of the CoPs, with only the fall prevention CoP program establishing a steering committee to support development [14, 35, 36, 37] and the emergency department project drawing on a previous stakeholder focus group [39]. This is a significant gap in the literature and in practice, with potentially negative impacts on CoP development, engagement, participation, effectiveness and sustainability. Using tools such as a Program Logic Model [48] and actively engaging stakeholders to support CoP development could foster greater CoP participation and translational outcomes [8, 9, 24]. Co‐design may build ownership and is important for ensuring that a program meets participants' and stakeholders' needs and can also enhance participation [49, 50].

4.2. Implementation Detail and Process Reporting

Implementation detail was consistently inadequate across studies. We could establish that most CoPs were small (3–20 participants/session) and multi‐professional, with diverse membership drawn from multiple LTC facilities and organisations. However, beyond this, critical details about session structure, session length or frequency, participant engagement approaches, specific activities or session outlines, and facilitator background, skills or training were poorly described. Only Vrerink et al. [41] and Manson et al. [42] provided brief session‐level detail. This paucity of operational information represents a significant limitation in the LTC CoP literature, undermining comparison of CoP process and outcomes and the potential for translation of successful approaches. This lack of detail remains an issue, despite having been raised in other CoP reviews [3, 4, 5, 12, 24, 45]. The field would benefit greatly from applying a structured framework for CoP development and sharing enhanced detail, with greater transparency and consistency in CoP reporting.

4.3. Barriers and Enablers

We mapped barriers and enablers to CoPs using the Values Creation Framework; [1, 26, 27, 29] however, there was insufficient detail to consider these at specific timepoints in the CoP lifecycle. The range of reported barriers suggests CoP implementation in LTC faces multifaceted challenges.

4.3.1. Orienting Value

The LTC landscape is complex, characterised by a diverse and time‐poor workforce facing significant challenges to deliver high‐quality, evidence‐based care for vulnerable residents [19, 20, 51]. Communities of Practice have been proposed as a mechanism for change, yet many structural factors challenge their capacity to achieve this goal [6, 7, 9, 52]. As Kothari et al. [7] highlight, it is worth questioning whether CoPs—usually with a ‘bottom up’ approach driven by frontline staff—can realistically achieve both individual learning and direct practice benefits, as well as broader systemic transformation. Barriers included negative perceptions about ageing and the LTC workforce [31, 38, 40]; mergers, policy and regulatory changes and ‘change fatigue’ [7, 13, 36, 41]; and competing priorities for learning activities and practice improvement [13, 37, 38, 39, 41, 44]. The LTC landscape is further complicated by unique structural constraints including high levels of staff turnover, staff mix and limited staff training [6, 34, 40].

4.3.2. Strategic Value

Management or organisational level support was identified as critical to enabling consistent CoP participation and also sustained implementation of CoP generated practice initiatives [7, 34, 36]. This raises important considerations about the level of agency and autonomy over role, time and decision‐making that LTC staff have—both to be involved in CoPs and to take initiative to apply CoP facilitated learning. Jack et al. [40] and Hullick et al. [39] specifically engaged organisational leaders in their CoPs with the intention of increasing facility level participation and action. It is clear that CoP initiatives need greater strategic engagement of stakeholders, particularly facility and organisational managers, to enable consistent staff participation and to foster sustained practice improvement actions to flow from CoPs [7, 34, 36, 39, 40, 44].

4.3.3. Enabling Value

Key CoP elements contributing towards positive enabling value were management and organisational support, permission and adequate or dedicated time to participate, and the building of relationships and trust among CoP participants. Six programs (75%) raised time as a barrier to CoP engagement in the LTC setting. This contrasts with Noar et al.'s systematic review looking more broadly at CoPs in health care where approximately 20% of studies (9 of 50) reported time as a barrier [5]. Time as a barrier manifested in different ways in LTC: (1) practical issues such as time of day and length of CoP sessions; (2) low staffing levels, limited overlap at shift change and persistent staffing gaps; and (3) competing demands where clinical/resident care or other activities are prioritised over professional development, or quality improvement. These challenges are commonly reported in LTC [20, 42, 53, 54, 55, 56].

The CoPs mostly delivered a blended program incorporating online and some face‐to‐face interaction. Technological barriers to CoP engagement evolved over the review period. While Tolson et al. [31] identified IT access as problematic and Conklin and Stolee [33] identified technology issues, later studies found technical competence had improved, though cultural acceptance remained challenging such as computer‐based engagement not being considered ‘real work’ [35]. In their 2019 program, Manson et al. [42] found some staff were uncomfortable appearing on camera. However, COVID‐19 accelerated virtual CoP adoption [44], aligning with broader healthcare trends showing that access to, familiarity with and confidence in using technology for online interaction may no longer be a significant barrier to CoP engagement [12]. This evolution presents opportunities for CoPs engaging geographically dispersed, often time‐poor LTC staff [9, 12, 24, 44, 52].

4.4. Evaluation Approaches

A range of evaluation approaches was applied to the CoPs, and there were limitations with the methodological quality of some papers. The majority of studies used qualitative methods, and all studies included purposive samples. Communities of Practice are a complex intervention and robustly capturing their value is challenging. In the reviewed LTC studies, there were many tangible examples described to demonstrate positive experiences, collaboration, knowledge development, skill building and practice translation, mostly identified through participant self‐report, with some audit evidence. Yet, we need to give greater attention to strengthening evaluation approaches that explore the value of CoPs from different LTC stakeholders' perspectives, enabling us to better understand any positive and negative value, and the scale and scope of any CoP outcomes [5, 24, 46]. Future studies would be strengthened by greater focus and more detailed descriptions on: (1) CoP theory and conceptual framing; (2) research methods (e.g., evaluation frameworks, sampling, data collection and analyses); and (3) explicitly discussing CoP details, study strengths and limitations. Consistent application of CoP‐specific evaluation approaches, such as the Values Creation Framework [1, 29] could address the current heterogeneity of evaluation and reporting and create opportunities for comparing CoP processes and outcomes [1, 29, 46, 57].

4.5. CoP Appropriateness and Sustainability

Notwithstanding the encountered challenges, all studies suggested that a CoP approach is valuable in LTC. Some raised the idea that CoPs could help address workforce retention challenges, predominantly through peer support, though none measured this outcome. Only two papers offered commentary on CoP costs, both claiming that CoPs are a low‐cost approach relative to the benefits [32, 40]. However, neither offered detailed costing information or formal economic evaluation. The economics and sustainability of CoPs in LTC are a major gap requiring future research.

5. Limitations

The CoP literature is diffuse with ubiquitous and sometimes inappropriate use of the term [5, 47] and a specific Medical Subject Heading (MeSH) term for CoPs was only recently introduced to health and medical literature databases. As a result, we may have missed some ‘CoP‐like’ programs in this review. To counter this and strengthen the review, we adopted rigorous review methods, designed a comprehensive search strategy, hand‐searched reference lists and had strict inclusion and exclusion criteria to ensure that included papers met our CoP definitions and were LTC‐focussed. This heterogeneous literature often poorly describes CoP operational details, limiting our ability to derive definitive guidance to inform the development or evaluation of CoPs in LTC settings. Use of the VCF as a CoP specific tool for data extraction and analysis is a novel approach and a strength of this review.

Communities of Practice were first described in 1991, yet the first study we found in the peer‐reviewed literature evaluating CoPs in LTC was Tolson and colleagues' work [31] with few primary studies [24]. It appears that the literature on the application and outcomes of CoPs in the LTC sector is limited [57], which may partly reflect the complexities of implementing this learning approach in LTC settings [7, 9] and also the broader challenges of researching implementation initiatives in LTC [20, 53, 54, 55]. This review adds important information on the strengths and gaps in the current LTC CoP literature, with clear findings to inform future research and CoP development, implementation, evaluation and reporting.

6. Conclusions

Despite 20 years of CoP implementation in LTC, and CoPs being considered as a valuable adjunct to other learning and practice change approaches, there are few comprehensive or robust evaluations to guide our future practice. Communities of Practice in LTC do demonstrate individual learning and peer support benefits from CoP participation; however, systemic and organisational barriers can limit sustained staff participation and the effective translation of learning to practice. To better understand CoP value, we need to address the heterogeneity of evaluation and methodological quality of existing research. The field would benefit from routinely applying existing frameworks to foster greater rigour in CoP planning, co‐design, implementation and evaluation. Enhanced detail and consistency in reporting on CoPs will better support the future development and implementation of CoPs in LTC settings.

Funding

This work was supported by the Australian Medical Research Future Fund (MRFF) Dementia, Ageing and Aged Care Mission 2020 Grant Opportunity. Grant number: 2021/MRF2007632.

Ethics Statement

This is a systematic review of the published peer‐reviewed literature. No ethics approval was required.

Conflicts of Interest

The authors declare no conflicts of interest.

TABLE A1.

Example search strategy—Medline search strategy and inclusion/exclusion criteria.

#	Query—Medline
1	communit* of practice.mp.
2	communit* of interest.mp.
3	communit* of learn*.mp.
4	communit* of knowledge.mp.
5	learning communit*.mp
6	knowledge network*.mp.
7	learning network*.mp.
8	knowledge communit*.mp
9	situated learning.mp.
10	1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9
11	exp Residential Facilities/
12	exp Geriatric Nursing/
13	exp Assisted Living Facilities/
14	exp Housing for the Elderly/
15	residential aged care.mp.
16	aged residential care.mp.
17	long term care.mp.
18	nursing home$.mp.
19	aged care home$.mp.
20	old age home$.mp.
21	aged care facilit$.mp.
22	11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21
23	10 AND 22

	Inclusion criteria	Exclusion criteria
Focus area	Evidence‐based practice/best practice implementation in long‐term care/residential aged care Paper includes evaluation of CoP implementation or processes	Other areas of staff development or learning Paper is descriptive only and includes no evaluation of CoP implementation or processes
Target population	CoP is primarily for health/aged care workers in long‐term care/residential aged care	CoP is for pre‐professional students or health‐care workers in training CoP is primarily for staff not working in long‐term care/residential aged care settings
Intervention (s)	Communities of Practice established primarily for the purpose of supporting health professionals/aged care workers to implement evidence‐based practice or ‘best practice’ or to support quality improvement in long‐term care/residential aged care settings Community of Practice could be in‐person, virtual or a combination and must meet more than once during the study period Community of Practice that meets Wenger‐Trayner et al. definition: ‘Communities of Practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly’	Other forms of support or professional development not linked with, or reflecting a Community of Practice Not a CoP or CoP‐like program and doesn't meet the CoP definition. Can be excluded if named by the study authors as a CoP, but not operating as a CoP
Context	Studies set in long‐term care/residential aged care facilities, or in a setting that interacts directly with long‐term care/residential aged care (e.g., hospitals) where the main study purpose is to improve the care in the long‐term care/residential aged care setting	Studies conducted only in community health, mental health, hospitals, universities/academic settings, paediatric and any residential facilities that support other groups (e.g., disability services/independent living units), policy‐related environments, community‐based services/programs, general adult health care or universities

Abbreviation: CoP, Community of Practice.

Data Availability Statement

Research data are not shared.