Understanding implementation breakdown: lessons from a type 2 hybrid effectiveness-implementation study in residential aged care

Introduction: Australia's aged care sector faces mounting pressures driven by an ageing population, increasing care complexity, and persistent workforce shortages. Burnout among residential aged care staff is a critical issue influencing retention, care quality, and staff wellbeing. Despite evidence supporting mindfulness-based interventions in healthcare, their uptake in Residential Aged Care Services (RACS) remains limited. This Type 2 hybrid effectiveness-implementation study examined the feasibility, acceptability, appropriateness, and effectiveness of Mindfulness in Motion (MIM) program within an Australian aged care organisation.

Methods: The study involved three stages: (1) capacity building through a Mindfulness Action Group (MAG); (2) co-design of an implementation strategy informed by the Consolidated Framework for Implementation Research and aligned with Expert Recommendations for Implementing Change; and (3) program implementation with a mixed-methods evaluation across five residential aged care sites. Quantitative measures of burnout, stress, resilience, and work engagement were collected at baseline (T1) and completion (T2). Qualitative data addressing implementation outcomes were derived from interviews with MIM participants and post-program meetings with MAG members.

Trial Registration: ACTRN12623000795695.

Results: Adoption of the MIM program was low: 22 staff registered and 11 commenced the Stage 3 program. Two of these participants, together with six MAG members who had completed the same pre- and post-program measures, provided complete paired T1-T2 data ( n = 8). Exploratory analyses indicated some favourable trends in staff wellbeing; however, the small, self-selected sample precluded definitive conclusions regarding program effectiveness. Interview data indicated that MIM was acceptable and perceived as beneficial by participants. However, intersecting inner- and outer-setting barriers, including chronic staffing shortages, heavy workloads, scepticism about implementation support, limited middle-management engagement, and communication silos, undermined adoption, feasibility and appropriateness.

Discussion: The MIM program was viewed as acceptable by aged care staff participants but could not be implemented as intended due largely to entrenched workforce and organisational barriers. Theoretically informed, co-designed strategies proved insufficient when contextual barriers were resistant to change or emerged only during implementation. Iterative, adaptive approaches that address structural pressures, staff perceptions, management engagement, and communication needs are required to support sustainable wellbeing interventions in aged care.