Fisher, Emily; (2025) Implementing Cognitive Stimulation Therapy for Dementia: Insights from Understudied Settings and Virtual Delivery Models. Doctoral thesis (Ph.D), UCL (University College London).

Text Fisher_10209612_Thesis_redacted_sig_removed.pdf Access restricted to UCL open access staff until 1 January 2026. Download (14MB)

Abstract

Background: Cognitive stimulation therapy (CST) is an evidence-based group intervention for people living with dementia that has been shown to improve cognitive function and quality of life. Despite its proven clinical and cost-effectiveness, CST implementation remains limited in specific settings, including care homes and low and middle-income countries (LMICs). Recent developments in the online delivery of CST have been driven by the COVID-19 pandemic, which has also been less widely studied. Main aims: This thesis explored CST implementation in underrepresented contexts, including care homes, LMIC healthcare facilities, and virtual platforms. Specific objectives included identifying barriers and facilitators of CST implementation, testing the feasibility and acceptability of virtual delivery, and developing scalable models for broader adoption. Methods: The research used a qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR), with some integration of quantitative methods. Studies included a systematic review of psychosocial interventions in care homes, a survey of UK NHS memory clinics on their use of virtual CST during COVID-19, feasibility studies of virtual CST in Brazil and India, and an implementation case study in a Tanzanian hospital. Results: The systematic review highlighted key barriers, including staffing challenges, training deficits, resource constraints, and facilitators, such as adaptability and external support. Virtual CST emerged as feasible and acceptable in UK memory clinics but faced digital literacy and equity issues. Feasibility studies of virtual CST in Brazil and India showed high acceptability among stakeholders, while the Tanzanian case study of CST implementation identified local adaptation needs and highlighted the importance of community engagement and capacity building. Conclusion: This thesis provides actionable insights into CST delivery and implementation across diverse settings and shares learnings about improving intervention and implementation research. The findings underscore the importance of adaptability, training, and stakeholder engagement for successful CST delivery.

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as XMLCSVJSON

Downloads by country - last 12 months

Export as CSVXMLJSON

Archive Staff Only

View Item