Overall, participants expressed satisfaction with the toolkit and its materials, though some also suggested some improvements. One participant indicated feeling uncomfortable with negative statements in the PET@home care plan discussion checklist. Positive or negative statements may lead to framing effects, potentially influencing clients’ responses [20]. Therefore, we considered it important for the care plan discussion checklist to contain neutral questions. The checklist’s statements were consequently reformulated. For instance, we changed the statement ‘The client has physical disabilities that can impact pet care, such as problems with walking, feeding, cleaning or caring for the pet’ to ‘Is the client sufficiently physically capable of independently caring for the pet?) where applicable. Additionally, the challenge of communicating with clients who have dementia suggests that, ideally, a family caregiver should be present during discussions about the pet’s care. The care plan discussion checklist and the information booklet can be used to record agreements between stakeholders.

Participants noted that the toolkit raised awareness about the benefits and challenges related to pets, which could be a starting point for improving the quality of the healthcare provided to clients with pets. An important aspect of this is the communication between stakeholders about pets, using a person-centered care approach while considering animal well-being [16]. This supports the relevance of the toolkit to long-term care at home. Since many people consider their pets as family members [21], most clients will likely appreciate having their pets considered in their care. Agreements and planning concerning pets can bring clarity to clients, their families, and professional caregivers, potentially fostering mutual understanding, improving healthcare quality, and reducing the burden on those involved. Therefore, healthcare organizations should consider documenting pet-related agreements in a digital care plan. This can enhance communication, decision-making, and accountability among stakeholders [22]. Moreover, using the toolkit for clients with pets aligns well with the person-centered care paradigm, which is considered a benchmark for healthcare quality [23]. Person-centered care tailors caregiving to clients’ needs and wishes, actively involving them in their care [16,24]. The results suggest that it is important for clients to receive guidance from a professional caregiver when using the information booklet. However, professional caregivers mentioned time constraints as a barrier to utilizing the toolkit materials. Time pressure is a common issue in home care [25,26,27], which may affect the amount of guidance a professional caregiver can provide when offering a client the information booklet. To address this, we added additional instructions in the booklet’s introduction and table of contents. These changes may offer clients and family caregivers extra support in using the materials independently. Additionally, some professional caregivers indicated that the toolkit included a lot of materials. However, some of the materials, such as the communication and animal welfare leaflets, are designed for professional caregivers rather than clients. Therefore, not all materials are required to be used with clients. We trust that caregivers can assess and select the materials that are necessary for each specific situation.

Time pressure may also hinder integrating the toolkit in home care settings. While using the toolkit does not necessarily require much time. Its use can start with providing clients with pets and their relatives with the information booklet and explaining its purpose. Nevertheless, professional caregivers, under time constraints, may be reluctant to adopt innovations. According to the ‘Diffusion of Innovations’ theory [28,29], successful implementation often relies on early adopters—those enthusiastic about the anticipated benefits [28,30]. To encourage wider use of an intervention or new materials, it is essential to showcase positive user experiences, such as the time required to use the toolkit [28,30]. Therefore, piloting the PET@home Toolkit with enthusiastic early adopters could promote its adoption across home care organizations before wider and more sustainable adoption in long-term care at home [31]. To support the integration of the toolkit in home care services, we developed an implementation guide to facilitate its use.