Embedding a co-designed digital intervention to reduce restrictive practices in care homes: an implementation science evaluation using the theoretical framework of acceptability

Background: Restrictive practices in care homes, such as physical and chemical restraint, remain widespread despite policies advocating minimal use. Implementation science provides tools to understand how evidence-based alternatives can be embedded into practice. This study applied the Theoretical Framework of Acceptability (TFA) to evaluate a co-designed digital educational intervention for care home staff.<br/>Aim: To assess the acceptability, feasibility, and early impact oSavef a co-designed digital intervention to reduce restrictive practices in care homes, guided by the TFA.<br/>Methods A sequential mixed-methods study was conducted in 15 care homes in Northern Ireland. Phase 1 measured pre/post changes in staff self-efficacy. Phase 2 audited restrictive practice use before and three months after implementation. Phase 3 involved semi-structured interviews structured around the seven TFA domains. The intervention was co-produced with staff, residents, families, and professional organizations.<br/>Results: 214 staff participated; 67% had no prior training. Self-efficacy scores increased significantly (mean difference = 16.5, p &lt; .001). Audits showed reductions in mechanical and environmental restraints, while chemical restraint use remained stable. Interviews confirmed high acceptability across TFA domains, with perceived effectiveness and ethical alignment as facilitators, and staff turnover and limited training time as barriers.<br/>Discussion: Using the TFA, this study demonstrates that co-designed digital education is an acceptable and feasible implementation strategy to support restraint reduction. Findings identify mechanisms that foster adoption (confidence, coherence, values alignment) and barriers requiring organisational support. This approach offers a scalable way to embed rights-based, person-centred practice in long-term care.