Most people living with dementia in the early-to-middle stages live in the community or in their own homes and engagement in enjoyable activities is fundamental to maintaining quality of life and autonomy. Horticulture-based activities are beneficial for the health and well-being for people living with dementia (“PLWD”) in residential care settings, yet evidence within community settings, where the majority live, has not been comprehensively synthesized. A mixed studies systematic review protocol was registered and a systematic search conducted to June 2022 across MEDLINE, COCHRANE, Web of Science, Embase, Psycnet, CINAHL, PsycINFO databases, using terms relating to dementia and horticulture. Original studies examining group or individual horticulture-based programs for community-dwelling PLWD were included. Forty-five articles were selected for full review, eight met inclusion criteria and were retained for data extraction. Evidence from three mixed methods, two quantitative, two qualitative, and one case study design, involving a total of 178 community dwelling PLWD, was narratively summarized. Findings revealed that involvement in horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical well-being in PLWD. No conclusive evidence was found from included studies for improvement in cognitive function. As most studies to date have concentrated on PLWD in long-term care settings, future research should evaluate the effect of these types of activities in a more rigorous intervention design in community settings.

Background Two important factors that prolong and exacerbate chronic noncancer pain (CNCP) and disability are low pain self-efficacy and loneliness. Yet, few interventions have shown long-term sustained improvements in pain self-efficacy, and there are no evidence-based treatments that target social connectedness in people living with CNCP. More effective and accessible interventions designed to target self-efficacy and social connectedness could ease the burden of CNCP. Objective To co-design accessible interventions to increase pain self-efficacy, social connection, pain-related outcomes, and quality of life, this study explored patients’ interest and preferences for digital peer-delivered interventions for CNCP as well as implementation barriers and enablers. Methods This cross-sectional mixed methods study was part of a larger longitudinal cohort study. Adult Australian residents (N=186) with CNCP diagnosed by a medical professional or pain specialist were included. Participants were initially recruited through advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions and their preferences for specific features (eg, Newsfeed). Pain self-efficacy and loneliness were assessed using validated questionnaires, and the association between these factors and interest in digital peer-delivered support was explored. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. Results There was interest in accessing digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated an interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education, links to health services and resources, and delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: shared experience, social connection, and shared pain management solutions. Five potential barriers were identified: negative focus on pain, judgment, lack of engagement, negative impact on mental health, privacy and security concerns, and unmet personal preferences. Finally, there were 8 suggestions from participants: moderation of the group, interest subgroups, professional-led activities, psychological strategies, links to professional pain resources, newsletter, motivational content, live streaming, and online meetups. Conclusions Digital peer-delivered interventions were of particular interest to those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study could guide further co-design and the development of such interventions.

BACKGROUND Two important factors that prolong and exacerbate chronic non-cancer pain (CNCP) and disability are pain self-efficacy and social connectedness. Yet the availability of pain treatments that target social connectedness and loneliness are limited and often overlooked, and few interventions have shown long-term sustained improvements in pain self-efficacy. More effective and accessible treatments designed to target these modifiable factors could ease the burden of CNCP. OBJECTIVE To inform co-design of new and innovative digital peer support interventions to increase pain self-efficacy, pain-related outcomes, and quality of life, this study examined patient interest in digital peer-delivered interventions for CNCP and potential factors associated with interest (pain self-efficacy; loneliness). It also explored preferences for peer-delivered support as well as implementation barriers and enablers. METHODS This cross-sectional mixed-methods study was part of a larger longitudinal cohort study. Individuals (N = 186) with CNCP for 3-months or longer diagnosed by a medical professional or pain specialist, who resided in Australia, and were 18 years or over were included in this study if they also completed a subsequent survey in wave 3 (Nov 2021-Jan-2022) examining interest and preferences for digital peer-delivered interventions. Participants were initially recruited through online advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions (yes, no) and their preferences for specific features (e.g., Newsfeed). Possible factors associated with level of interest including pain self-efficacy and loneliness were assessed using validated questionnaires. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. RESULTS There was interest in a digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education and links to health services and resources as well as delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: Shared experience; Social Connection; and Shared pain management solutions. Five potential barriers were identified: Negative focus on pain; Judgement; Lack of engagement; Negative impact on mental health; Privacy and security concerns; and Unmet personal preferences. Finally, there were eight suggestions from participants: Moderation of the group; Interest sub-groups; Professional-led activities; Psychological strategies; Links to professional pain resources; Newsletter; Motivational Content; Live streaming and online meet-ups. CONCLUSIONS Digital peer-delivered interventions particularly interested those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study that could guide further co-design and development such interventions.