Table 4.

Fidelity to intervention

Factors	Type A facilitation	Type B facilitation
Variability in selection, preparation and drop out of IFs	• 7 of the 8 homes selected an IF to attend the 3-day residential programme. • 1 IF was selected later and completed a shorter development programme • 2 IFs withdrew shortly after the start of the intervention due to ill-health: 1 was replaced by a buddy (without training), and 1 was replaced by a nurse who did not meet all of the selection criteria, and who completed a shortened development programme.	• 6 of the 8 homes selected an IF to attend the 5-day residential programme (no IFs from one country attended). • 1 IF was recruited later and months later completed a condensed development programme. • Of the 6 IFs who participated in the full 5-day programme, 1 withdrew approximately 3 months after the start of the intervention due to ill-health and was replaced by a buddy who did not attend the initial programme or join the teleconferences; 1 other left for a new job and was replaced by someone who did not meet all the selection criteria. Whilst she attended a condensed development programme, she later withdrew from the project.
Variable engagement in the facilitation programme	• Following the residential programme 2 sites only engaged in a limited way. For example, one of the IFs had limited skills and access to IT making engaging in activities such as audit and feedback a challenge. • IFs from 2 sites participated in all 12 teleconference meetings; 2 sites in 3; attendance by IFs from the other 4 homes varied from 5 to 10 meetings.	• 1 site did not engage in the facilitation intervention and 1 other site in the same country disengaged soon after the start of the programme. • 18 monthly teleconference support meetings were held. 1 site participated in all 18 teleconferences. Attendance by the other sites varied between 10 and 15 meetings.
Progress according to plan	• None of the 8 homes were able to implement the plans devised at the residential programme, which included audit and feedback activity related to each of the guideline recommendations. • Partial implementation was achieved with 4 homes completing a baseline audit of the 4 recommendations and devised follow-up action plans • 4 homes addressed 2 or less of the recommendations	• 4 of the 8 homes created plans for developing more person-centred cultures. • 1 home made significant progress in advancing this plan and the others made variable progress. • Only 1 home was able to demonstrate progress in developing the quality of practice.