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

Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies providing evidence about effective interventions. There is a need to draw on a range of evidence to understand how, why and in what circumstances; particular programmes to reduce and manage FI are effective (or not) for people with dementia in care homes. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, how do they work, on what range of outcomes and when. The review will examine the barriers and facilitators to the acceptability, uptake, and implementation of interventions designed to address FI in people with dementia who are resident in care homes. A realist synthesis approach will be used. Evidence reviewed will include studies on continence, person centred care, implementation research in care homes, workforce and research on care home culture. An iterative four stage approach is planned. Phase 1 development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase Two: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase one. Phase three, validation of programme theory/ies with a purposive sample of participants from phase one. The final phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research. This protocol is registered on the PROSPERO database: CRD42014009902