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Evaluating the implementation of interventions to improve independence in dementia

Walton, Holly Jane; (2018) Evaluating the implementation of interventions to improve independence in dementia. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

To understand effects of psychological and social interventions for people with dementia, it is necessary to understand whether interventions are delivered as planned (‘fidelity of delivery’) and engaged with. This thesis aimed to evaluate the implementation of two interventions for people with dementia: the ‘Promoting Independence in Dementia’ intervention (PRIDE) and the ‘Community Occupational Therapy in Dementia-UK’ intervention (COTiD-UK). Three stages were followed: (i) systematically reviewing measures of fidelity and engagement in complex, face-to-face health behaviour change interventions, (ii) developing and using reliable measures to assess fidelity of PRIDE and COTiD-UK, and engagement with PRIDE, and (iii) identifying factors influencing fidelity and engagement and developing recommendations to improve these behaviours. Intervention sessions were audio-recorded and reliably rated for fidelity against fidelity checklists developed for PRIDE and COTiD-UK. Additionally, for PRIDE, dementia advice workers (DAWs) and participants completed checklists after each session. To identify factors influencing fidelity of, and engagement with PRIDE, interviews were conducted with DAWs, people with dementia and their supporters and analysed using thematic analysis and content analysis (informed by the COM-B model). The Behaviour Change Wheel was used to develop recommendations to improve fidelity and engagement. Reliable fidelity checklists were developed for PRIDE and COTiD-UK. Both interventions were delivered with at least moderate fidelity. Participants reported high levels of engagement with PRIDE. Knowledge, providers’ attributes, ease of adaptation of PRIDE in relation to participants’ needs and logistical considerations influenced fidelity. Participants’ attributes, capability and opportunity influenced engagement. Recommendations to improve fidelity and engagement were developed to target barriers of opportunity and psychological capability. This thesis provides an applied example of how behavioural science can be used to evaluate and develop recommendations to improve the implementation of dementia interventions. If effective, recommendations may have the potential to improve implementation and help people to live well with dementia.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Evaluating the implementation of interventions to improve independence in dementia
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2018. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
URI: https://discovery.ucl.ac.uk/id/eprint/10064480
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