Building effective digital post-hospital discharge and reablement services for older adults in social care: a mixed methods process evaluation using the NASSS framework

Background. Delayed hospital discharge remains a persistent challenge for UK health and social care systems, particularly for older people. Delays are often due to a lack of timely and appropriate post-discharge support in social care. In response, local authorities (LAs) are deploying digital Post-Hospital Discharge and Reablement Services (PHDRSs), which integrate assistive and household smart technologies (e.g. sensors, alarms, smart speakers) to support transition from hospital to home. However, there is limited evidence regarding the design, implementation, and effectiveness of PHDRS across diverse social care contexts. Aims. This project will identify what helps or hinders implementation of PHDRS in social care for older people (aged 65+) with assisted living needs. The project will evaluate the development, implementation, adoption, and scalability of digital PHDRSs to support older people. It will identify outcomes of these services, explore feasibility of integrating routine service and technology data, and identify key factors influencing PHDRS adoption and abandonment. The study will develop a Participatory Theory of Change (ToC), informed by empirical data and co-produced with stakeholders, to support the scaling and sustainability of PHDRSs across social care. Methods. A mixed-methods design will be used, structured through six interconnected work packages. The NASSS (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) framework and its associated complexity assessment tool (NASSS-CAT) guide the process evaluation. The study will be conducted in three sites (Middlesbrough, Oxfordshire, and Bristol and its surrounding region) reflecting diverse service models, technological configurations, and population needs. A scoping review will identify existing evidence (WP1), followed by mapping and feasibility analysis of routine sensor and outcomes collected data from PHDRS (WP2). WP3 involves an ethnographic process evaluation, including ethnographic observation of routine PHDRS service delivery over a 24-month period and qualitative interviews with service providers, clients, and informal carers. WP4 synthesizes findings to co-develop a Participatory Theory of Change with stakeholders across LAs, clients, carers and partners. WP5 embeds co-production with older social care users and carers throughout the research process. WP6 focuses on knowledge mobilisation and impact, co-designed with study partners to benefit them and the wider social care ecosystem. Timelines for delivery. The project will be delivered over a 48-month timeline. Initial project set up, scoping reviews and secondary analysis of service and outcomes data will take place in M1-36. Ethnographic case studies and stakeholder interviews in M12-M36. Project outcomes in WP4 & WP6 in months 36-48. Co-production activities are central to the project and will take place over the project duration. Anticipated impact and knowledge exchange This project will deliver new knowledge and critical insights on how digital PHDRSs function in social care, types of data collected, technology/service configurations and implementation factors facilitating or constraining PHDRS delivery locally and at scale. The Participatory ToC will offer a scalable framework applicable across varied social care settings. Data visualisations will use routine service data to monitor and improve outcomes. Impacts include greater PHDRS deployment and integration across LAs, more rapid hospital discharges, delayed re-entry to hospital or into care, and improved client and carer outcomes.