A systematic review of process evaluations for psychosocial interventions designed to improve the wellbeing and quality of life of community‐dwelling people with dementia and their carers

Abstract

Background: Psychosocial interventions improve the wellbeing and quality of life of People Living with Dementia (PLWD) and their family carers; but due to their complexity it can be challenging to identify mechanisms of action. We reviewed process evaluations that have sought to elucidate how these interventions work, to inform their implementation. Method:We systematically reviewed process evaluations of studies evaluating psychosocial interventions for PLWD in their own home and/or their family carers.We rated study quality using the Mixed Methods Appraisal Tool. We described, with reference to Medical Research Council (2015) process evaluation guidance, how implementation, mechanisms of impact and contextual factors were investigated; and describe commonalities in the mechanisms of action identified across studies. Results:Twenty four included studies evaluated the processes of 22 interventions.These studies collectively applied five frameworks; almost all frameworks' advised evaluations were theory-based and used mixed-methods analyses, but only 5/24 evaluation designs were informed by the intervention theory and 8/24 used mixed methods. 8/24 evaluations considered contextual factors in their design, though 20/ 24 cited contextual factors in findings. Interventions were more successful where PLWD were motivated and aware of potential benefits, and when carers could support engagement and were themselves supported by the intervention. How the intervention aligned with participants' current needs and stage of dementia were key influencing factors. Conclusion: Knowing how interventions can influence change for community-dwelling people with dementia and their family carer's will improve translation of trial findings into practice. Robust, theory-driven process evaluations can enable this.

Process evaluation of a New psychosocial goal-setting and manualised support intervention for Independence in Dementia (NIDUS-Family)

“…Methodological strengths of this process evaluation are its theory-based design, and triangulated data sources (8,15). The recruited sample of people with dementia was balanced for gender, and the proportions from non-White ethnic groups, and who owned their home were broadly comparable to the older general population (16).…”

A scoping review on the psychosocial interventions used in day care service for people living with dementia

“…There was strong evidence supporting the adaptation or modification of interventions as required based on individual client need in providing a person centred, flexible approach [ 31 , 32 , 34 , 36 , 37 , 42 , 46 , 52 , 55 , 56 , 58 , 60 – 62 , 69 , 72 ]. Wyman and colleagues in a recent review reported key implementation factors that influence the impact of interventions, including, interventions tailored to stage of dementia, flexibility of delivery, participants engagement and carer supported [ 77 ].…”