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Svedin F, Blomberg O, Brantnell A, Farrand P, Åberg AC, Woodford J. Healthcare and community stakeholders' perceptions of barriers and facilitators to implementing a behavioral activation intervention for people with dementia and depression: a qualitative study using Normalization Process Theory. BMC Geriatr 2023; 23:814. [PMID: 38062362 PMCID: PMC10702110 DOI: 10.1186/s12877-023-04522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Depression is commonly experienced by people with dementia, and associated with lower quality of life and functional decline. However, access to evidence-based psychological interventions for people with dementia and depression is limited. One potential solution is guided low-intensity behavioral activation. Following the new Medical Research Council Framework, considering factors such as potential barriers and facilitators to implementation is recommended during the development of new interventions. Aims of this study were to: (1) develop an understanding of existing healthcare and community support in the Swedish context for people with dementia and their informal caregivers; and (2) identify barriers and facilitators to intervention uptake informed by Normalization Process Theory. METHODS Semi-structured interviews and focus groups were held with healthcare (n = 18) and community (n = 7) stakeholders working with people with dementia and/or informal caregivers. Interview questions were informed by Normalization Process Theory. Data was analysed utilizing a two-step deductive analysis approach using the Normalization Process Theory coding manual, with inductive categories applied to data related to the main mechanisms of the theory, but not captured by its sub-constructs. RESULTS Twelve deductive and three inductive categories related to three Normalization Process Theory primary mechanisms (Coherence, Cognitive Participation, and Collective Action) were identified. Identified barriers to intervention uptake included: (1) additional burden for informal caregivers; (2) lack of appropriate workforce to provide guidance; (3) lack of time and financial resources; (4) people with dementia not recognising their diagnosis of dementia and/or a need for support; and (5) stigma. Identified facilitators to intervention uptake included: (1) intervention has potential to fill a large psychological treatment gap in Sweden; (2) objectives and potential benefits understood and agreed by most stakeholders; and (3) some healthcare professionals recognized their potential role in providing intervention guidance. CONCLUSIONS Several barriers and facilitators for future implementation, specific to the intervention, individuals and families, as well as professionals, were identified during intervention development. Barriers were mapped into evidence-based implementation strategies, which will be adopted to overcome identified barriers. A feasibility study further examining implementation potential, acceptability and feasibility, alongside clinical, methodological, and procedural uncertainties associated with the intervention will be conducted. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Frida Svedin
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
| | - Oscar Blomberg
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
| | - Anders Brantnell
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
- Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, 751 21, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Perry Road, Devon, EX4 4QG, UK
| | - Anna Cristina Åberg
- Clinical Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Medical Sciences, School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
| | - Joanne Woodford
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden.
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Bergeron CD, Robinson MT, Willis FB, Albertie ML, Wainwright JD, Fudge MR, Parfitt FC, Lucas JA. Creating a Dementia Friendly Community in an African American Neighborhood: Perspectives of People Living with Dementia, Care Partners, Stakeholders, and Community Residents. J Appl Gerontol 2023; 42:280-289. [PMID: 36184924 PMCID: PMC9906431 DOI: 10.1177/07334648221130055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A dementia friendly community allows people with dementia and their care partners to remain engaged in their community well into the disease. This study presents the results of primary research aimed at exploring perceptions regarding building a dementia friendly community in an African American neighborhood in northeast Florida. Twelve focus groups and five interviews were conducted with people living with dementia, informal and formal care partners, community stakeholders and neighborhood residents, and analyzed using a grounded theory approach. Three main themes emerged from the analyses, including (1) perceived needs, (2) facilitators and barriers to being dementia friendly, and (3) opportunities for the community to become more dementia friendly. Study findings highlight the unique needs of a single African American neighborhood and the importance of culturally tailoring the dementia friendly model to diverse communities.
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Affiliation(s)
- Caroline D. Bergeron
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Maisha T. Robinson
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Floyd B. Willis
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Monica L. Albertie
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Jolita D. Wainwright
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Michelle R. Fudge
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - Francine C. Parfitt
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
| | - John A. Lucas
- Outreach, Recruitment and Engagement Core, Alzheimer’s Disease Research Center, Mayo Clinic, Jacksonville, FL, USA
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Ramji R, Carlson E, Kottorp A, Rämgård M. Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden. Front Public Health 2022; 10:997329. [PMID: 36478727 PMCID: PMC9719947 DOI: 10.3389/fpubh.2022.997329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood. Methods A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach. Results In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge". Conclusion The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.
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Daly L, Byrne G, Keogh B. Health promotion for older people with dementia living in the community. Nurs Stand 2022; 37:55-60. [PMID: 36254555 DOI: 10.7748/ns.2022.e11973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Dementia has physical, psychological, social and economic effects, not only on people with dementia but also on their families, carers and society as a whole. Health promotion interventions for older people with dementia living in the community can support their health and well-being, particularly early in the course of the condition. Nurses have an important role in working collaboratively with patients, family carers and the multidisciplinary team to develop health promotion activities that are tailored to the person and take into account the progressive nature of the condition. This article gives an overview of health promotion as an aspect of post-diagnosis dementia care and considers how nurses can work with older people with dementia living in the community to promote their health.
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Affiliation(s)
- Louise Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Gobnait Byrne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Sm-Rahman A, Hydén LC, Kelfve S. People Living with a Dementia Diagnosis with No Eldercare at all: Who Are They? J Aging Soc Policy 2022; 34:876-893. [PMID: 35957610 DOI: 10.1080/08959420.2022.2111165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Dementia is a non-curable disease that progressively affects people's ability to handle their everyday life. Still, previous Swedish research found that many people living with dementia (PlwD) do not use any eldercare. In this study, we investigated the association between not using eldercare services and key social background factors: years with dementia, hospital care, and country of birth for PlwD. We identified all people aged 65+ diagnosed with dementia between January 2006 and March 2015 (n = 43,372) using secondary data analysis of information taken from multiple Swedish nationwide registers. Results showed that not using eldercare was more common among younger age groups and men. The likelihood of having no eldercare was three times higher for those cohabiting; notably, almost a fifth of the PlwD who had the diagnosis for four years or more did not have eldercare at all. Finally, people born outside Europe used eldercare less than persons born in Sweden. Since the public dementia policy in Sweden is basically geared toward PlwD in a later stage and primarily in residential care, there has been almost no policy development around the needs and rights of PlwD in their homes. This study provides a ground for reconsidering dementia policy regardless of the ethnic and cultural backgrounds of PlwD.
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Affiliation(s)
- Atiqur Sm-Rahman
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Norrköping, Sweden
| | - Lars-Christer Hydén
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Norrköping, Sweden.,Center for Dementia Research (CEDER), Linkoping University, Norrköping, Sweden
| | - Susanne Kelfve
- Department of Culture and Society (IKOS), Division Social Work (SOCARB), Linkoping University, Norrköping, Sweden.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden
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