Implementing the WHO ICOPE framework for Singapore’s older adults: Interview with Dr Mimaika Ginting, Research Associate

To unlock not just longer but healthier lives, it is crucial to prevent or slow declines in older adults' physical and mental capacities, or their intrinsic capacity. This is at the heart of the World Health Organization (WHO)'s Integrated Care for Older People (ICOPE) framework, which guides practitioners and policymakers on intrinsic capacity screening, and providing personalised and coordinated care.

GERI is the implementation research partner for the INFINITY-ICOPE research project (Optimising INtrinsic Capacity for Functional INdependence and to Impede FrailTY in Older Adults: Adaptation of the WHO-ICOPE for Healthy Ageing in Singapore)*, which seeks to adapt and implement the WHO ICOPE framework in the community. INFINITY-ICOPE aims to help older adults maintain their functional independence. Programme components include screening and interventions that allow primary and community-care partners to manage frailty and intrinsic capacity in an integrated way.

In this two-part feature series, we speak to Dr Mimaika Ginting, Research Associate, GERI and member of the INFINITY-ICOPE study team, about implementation research and how it translates healthcare innovations into local practice in a way that is relevant and useful. Read part two with Dr Ginting below.

* Supported by the National Medical Research Council Singapore, under the National Innovation Challenge on Active and Confident Ageing.

GERI: As one of the core members of the GERI-based team working on the INFINITY-ICOPE project, could you outline for us GERI's role in supporting this project?

Dr Mimaika Ginting: The literature shows us that many healthcare innovations, despite being evidence-based, do not achieve anticipated health outcomes because they fail to account for contextual factors. As INFINITY-ICOPE's implementation research partner, GERI's contributions help to ensure that the WHO ICOPE framework is translated into local practice in a way that is contextualised, relevant and useful.

GERI is leading research to support the application and translation of the WHO ICOPE framework into practice in Singapore. We are doing this by systematically investigating and co-developing potential strategies that could facilitate the uptake of this care model in the local context, and boost the likelihood of smooth and successful programme execution. We are also providing our expertise in assessing the outcomes of the implementation. This will be done at a later stage after INFINITY-ICOPE's roll-out.

One way in which GERI contributed to this project is by carrying out a qualitative study to identify barriers and facilitators prior to implementation. Could you describe how the team identified these factors with relevant methods, and how these would be useful for implementers? 

In implementation research, we use theories and frameworks to provide explicit description of implementation-related phenomena to facilitate shared understanding across diverse settings. In our study, our team used the updated Consolidated Framework for Implementation Research (CFIR) with its Outcomes Addendum to inform all phases of our research. Learn more below.

In the pre-implementation phase, we focused on the likelihood of key stakeholders adopting INFINITY-ICOPE as the key anticipated implementation outcome. Using the CFIR, we mapped some of the potential barriers and enablers on the likelihood of adoption. This will allow us to address the factors prior to actual implementation. At the same time, it gave us an opportunity to engage potential implementers during the process.​

To mitigate these identified barriers, we went further and mapped them¹ to relevant implementation strategies. We are now working together with potential implementers to select, specify, and develop relevant solutions to facilitate a successful INFINITY-ICOPE run.

Findings are especially useful for implementers when they are provided in a timely manner during the project, as opposed to only disseminating the insights at a later stage of the study. To do this, we applied a rapid approach in our pre-implementation qualitative study, adapting our methods to produce analysis and generate timely and relevant insights within a short timeframe. This allows the implementation lead to make adaptations mid-way during the study, where necessary.

As part of your research for INFINITY-ICOPE, you have had the opportunity to engage with potential implementers such as healthcare workers and community nurses to understand their perspectives. What are your thoughts on this experience? 

It was a very insightful and fruitful experience for me. Rich perspectives were shared by stakeholders from the public, private and community sectors. I had the opportunity to understand, from implementers' perspectives, the potential challenges and considerations faced in doing the groundwork to get a healthcare innovation going. GERI was well-supported in this collaboration process by the study team from SingHealth and community partners.

Adapting and implementing an innovation into local practice is challenging. Factors such as constraints in resources, complexity, and the compatibility of the innovation (with local systems, processes and target users) can all play a part. It is important to leverage on known motivating factors and enablers for adoption, to minimise trade-offs and improve feasibility.

For example, we could look at the supporting evidence and experiences from other contexts to agree on the potential benefits that an evidence-based practice might have. This could intrinsically motivate healthcare professionals who strive to benefit the target population under their care.

Could you give us a peek into other ongoing research projects that you are involved in? What do you find meaningful about your current work at GERI and what keeps you motivated?

I am actively involved in two other projects on implementing a care model for frail older adults. One project is implemented in the hospital setting, and the other one is in the primary care setting across all three healthcare clusters in Singapore.  The latter is a national-level study that seeks to deliver and implement recommendations from the National Frailty Strategy Policy in our primary care landscape. 

As a researcher, I find my current work meaningful as we strive to not only generate knowledge, but to also translate and apply it in real-world practice, and to ultimately inform policy. Working in the field of implementation research has given me a different perspective: we do not stop at providing research findings, but are also an active partner in co-developing workable solutions, or to help answer the question: “So what, and what can we do next?" This active collaboration and partnership makes our research relevant and impactful for target users, including older adults at large.

I continue to grow and learn from my experiences at GERI over the years, be it the exposure to healthcare systems and practices, varied stakeholder groups, or to different research methods. Working within teams with individuals with diverse backgrounds and different kinds of expertise also challenges my thinking processes, broadens my horizons and helps me to appreciate differences in perspectives.​

Read part one of this story here with INFINITY-ICOPE's Principal Investigator, Associate Professor Laura Tay (Head and Senior Consultant, Geriatric Medicine at Sengkang General Hospital; Lead Scientist at GERI), as she shares her insights on integrated approaches to promoting intrinsic capacity and manage frailty.

¹ Based on the 73 Expert Recommendations for Implementing Change (ERIC) strategies. Read more here.