1
|
O'Connor CMC, Poulos RG, Preti C, Heldon M, Barclay L, Beattie E, Poulos CJ. Steps to implementation: Understanding barriers and enablers for implementing Arts on Prescription at Home for people impacted by dementia. Health Promot J Austr 2024; 35:110-121. [PMID: 36964997 DOI: 10.1002/hpja.720] [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] [Received: 09/13/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
ISSUE ADDRESSED Arts on Prescription at Home (AoP@Home) involves a professional artist visiting a person with dementia and their informal carer(s) in their own home to engage them in participatory art making. While there is evidence for the use of these programs, more work is needed to facilitate effective implementation. This study explored contextual barriers and enablers to implementation of AoP@Home within a real-world community aged care service. METHODS Two remote focus groups were conducted at a community aged care provider in Sydney, Australia. Key stakeholders (n = 14) were recruited, representing: people with dementia, informal (family) carers, AoP artists, service referrers and community service managers. Focus group transcripts were analysed using qualitative content analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). Outcomes were reviewed against the Expert Recommendations for Implementing Change (ERIC) strategy compilation to inform development of a tailored implementation strategy. RESULTS Four overarching themes described the range of barriers and enablers to AoP@Home implementation: (1) "I don't know enough about it" (awareness and engagement within the sector), (2) artists delivering programs, (3) awareness and engagement of people impacted by dementia, (4) practicalities of implementation. All five domains of the CFIR were represented across the four themes. The ERIC compilation provided a list of practical strategies for implementation of AoP@Home. CONCLUSIONS The implementation of psychosocial interventions for people living with dementia within a community aged care service is complex and multifactorial. So what?: Organisations planning implementation should consider conducting their own pre-implementation analysis to identify context-specific strategies.
Collapse
Affiliation(s)
- Claire M C O'Connor
- Schoolof Population Health, University of New South Wales, Sydney, New South Wales, Australia
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Roslyn G Poulos
- Schoolof Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Costanza Preti
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
| | - Michelle Heldon
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
| | - Linda Barclay
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher J Poulos
- Schoolof Population Health, University of New South Wales, Sydney, New South Wales, Australia
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Low LF, Gresham M, Phillipson L, Jeon YH, Hall D, Tan A, Wong N, Brodaty H. Forward with Dementia: process evaluation of an Australian campaign to improve post-diagnostic support. BMC Health Serv Res 2023; 23:1369. [PMID: 38062410 PMCID: PMC10701926 DOI: 10.1186/s12913-023-10347-4] [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: 05/03/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Forward with Dementia is a co-designed campaign to improve communication of dementia diagnosis and post-diagnostic support. METHODS Webinars, a website, social and traditional media, and promotions through project partners were used to disseminate campaign messages to health and social care professionals (primary audience) and people with dementia and carers (secondary audience). The campaign ran between October 2021 and June 2022, with 3-months follow-up. The RE-AIM framework was used for process evaluation. Measurements included surveys and interviews, a log of activities (e.g. webinars, social media posts) and engagements (e.g. attendees, reactions to posts), and Google Analytics. RESULTS There were 29,053 interactions with campaign activities. More than three-quarters of professionals (n = 63/81) thought webinars were very or extremely helpful. Professionals and people with dementia and carers reported that the website provided appropriate content, an approachable tone, and was easy to use. Following campaign engagement, professionals planned to (n = 77/80) or had modified (n = 29/44) how they communicated the diagnosis and/or provided post-diagnostic information and referrals. Qualitative data suggested that the campaign may have led to benefits for some people with dementia and carers. CONCLUSIONS Forward with Dementia was successful in terms of reach, appropriateness, adoption and maintenance for professionals, however flow-through impacts on people with dementia are not clear. Targeted campaigns can potentially change health professionals' communication and support around chronic diseases such as dementia.
Collapse
Affiliation(s)
- Lee-Fay Low
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Danika Hall
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Amy Tan
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nora Wong
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
3
|
Alty J, Lawler K, Salmon K, McDonald S, Stuart K, Cleary A, Ma J, Rudd K, Wang X, Chiranakorn-Costa S, Collins J, Merl H, Lin X, Vickers JC. A new one-stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry. Int J Geriatr Psychiatry 2023; 38:e5988. [PMID: 37592719 DOI: 10.1002/gps.5988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. 'One-stop' cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one-stop State-wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. METHODS A novel single-visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross-sectional evaluation was undertaken using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. RESULTS Over the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. EFFECTIVENESS 98.5% (128/130) received a same-day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients. IMPLEMENTATION Nearly all 'ideal' diagnostic clinical practices were met and >90% of surveyed patients reported 'good/very good' clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). CONCLUSIONS This 'one-stop' model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.
Collapse
Affiliation(s)
- Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Scott McDonald
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Kimberley Stuart
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Alison Cleary
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Jak Ma
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- I-Med Radiology Network Hobart, Hobart, Australia
| | - Kaylee Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xinyi Wang
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | | | - Jessica Collins
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Helga Merl
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xiaoping Lin
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| |
Collapse
|
4
|
O'Connor CMC, Fisher A, Cheung SC, Caga J, Piguet O. Supporting behaviour change in younger-onset dementia: mapping the needs of family carers in the community. Aging Ment Health 2022; 26:2252-2261. [PMID: 34424808 DOI: 10.1080/13607863.2021.1966744] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Almost 10% of people with dementia experience a younger-onset of disease (before 65 years). Changes in behaviour are common, as are delays in diagnosis and limited access to appropriate support and services. This study aimed to explore the specific behaviour support needs of families living with younger-onset dementia. METHODS Seventy-one families of people with younger-onset dementia were surveyed to understand the experience of family carers regarding difficult-to-manage behaviour changes, confidence in identifying and implementing behaviour support strategies, use of specific behaviour support strategies, and use of formal and informal support services regarding behaviour changes. RESULTS Survey responses were received from family members of people living with behavioural variant frontotemporal dementia (n = 28), semantic dementia (n = 17), and Alzheimer's disease (n = 23). Over 90% of family carers reported difficult-to-manage behaviours which fell into four main domains: (1) aggression, (2) compulsive behaviour, (3) disinhibition and inappropriate social behaviour, and (4) apathy. A range of preventative and responsive strategies, with an emphasis on de-escalation strategies were identified and carers reported variable confidence in managing behaviour changes or in accessing formal support strategies. CONCLUSIONS Difficult-to-manage behaviour changes in community-dwelling people with younger-onset dementia are common. The existing agency of families should be recognised and built upon with better access to specific behaviour support services to increase competence and confidence in providing behaviour support and ultimately improve quality of life for them and their family member with dementia.
Collapse
Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences Adelaide, Flinders University, Adelaide, Australia
| | - Sau Chi Cheung
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Jashelle Caga
- Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
5
|
Lion KM, Moyle W, Cations M, Day S, Pu L, Murfield J, Gabbay M, Giebel C. How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study. JOURNAL OF FAMILY NURSING 2022; 28:205-218. [PMID: 35674356 DOI: 10.1177/10748407221101638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore how formal social support changed after implementation of the COVID-19 public health measures and how these restrictions affected people living with dementia and their informal carers in Australia. Sixteen informal carers and two people living with dementia were interviewed between August and November 2020. Participants were asked about their experiences of the pandemic and the impact that the restrictions had on their lives and care. Thematic analysis identified four overarching themes describing (a) prepandemic limitations of the aged care system, (b) the aged care system's response to the COVID-19 restrictions, (c) changes affecting informal carers, and (d) the challenges faced by people living with dementia. The findings highlighted the challenges faced by the Australian aged care system before the pandemic and the additional burden placed on informal carers who supported people living with dementia across residential and home settings during the pandemic.
Collapse
Affiliation(s)
| | - Wendy Moyle
- Griffith University, Brisbane, Queensland, Australia
| | - Monica Cations
- Flinders University, Adelaide, South Australia, Australia
| | - Sally Day
- Flinders University, Adelaide, South Australia, Australia
| | - Lihui Pu
- Griffith University, Brisbane, Queensland, Australia
| | - Jenny Murfield
- Griffith University, Brisbane, Queensland, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Mark Gabbay
- University of Liverpool, Liverpool, UK
- National Institute of Health Research Applied Research Collaboration North West Coast, Liverpool, UK
| | - Clarissa Giebel
- University of Liverpool, Liverpool, UK
- National Institute of Health Research Applied Research Collaboration North West Coast, Liverpool, UK
| |
Collapse
|
6
|
Rayner JA, Fetherstonhaugh D, Ibrahim JE. We need a model of health and aged care services that adequately supports Australians with dementia. Med J Aust 2021; 215:286-287. [PMID: 34414569 DOI: 10.5694/mja2.51228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Joseph E Ibrahim
- Victorian Institute of Forensic Medicine, Melbourne, VIC.,Monash University, Melbourne, VIC
| |
Collapse
|