Evaluation as an opportunity to co-create a favourable context for professional empowerment: AUDACE, a realist mixed methods evaluation of an occupational therapy programme for older people ageing in place with assistive devices

Background The BCM2.0 programme provides occupational therapy sessions and assistive devices to support older people who want to age in place. We designed the AUDACE evaluation to improve understanding of the programme and its effectiveness, and to promote a favourable context for the professional empowerment of occupational therapists as primary care providers. Methods We involved home care occupational therapists at every stage of the protocol design to ensure that the tools, training, and organisational structures put in place for the evaluation could also form the basis of their routine practice, harmonising their practices, ethos and processes. We designed a realist mixed methods evaluation to answer the following question: "How, for whom and why do assistive devices, integrated with occupational therapy support, enable older people to remain at home, and under what conditions?" Interrelated components addressed different research sub-questions: (1a) To describe the evaluation population, interventions, and contexts: a descriptive quantitative study using baseline data from all BCM2.0 beneficiaries. (1b) To describe the frailty process in older people receiving the programme: a qualitative study using semi-structured individual interviews with a biographical dimension. (2) To explore the enrolment process: focus groups with occupational therapists, following a realist approach. (3) To assess effectiveness: a prospective cohort study with up to 12 months follow-up of all BCM2.0 beneficiaries. (4) To identify barriers and facilitators to implementation: multiple nested case study in five areas, using a realist approach. (5) To build a learning community to clarify ethical considerations: communities of practice meetings. Discussion The inclusion of occupational therapists in the design and implementation process ensured that the evaluation met their needs. This led to the development of a participatory action research protocol that improved the quality of the evaluation and supported the professional development of occupational therapists. Trial registration Primary Registry and Trial Identifying Number: https://clinicaltrials.gov/study/NCT06819982 Date of Registration in Primary Registry: February 11, 2025.