USING HYBRID EFFECTIVENESS DESIGNS TO FACILITATE IMPLEMENTATION: THREE CASE STUDIES IN DEMENTIA CARE RESEARCH

BackgroundResearch has yielded advancements in understanding dementia and developing promising interventions. However, translating research findings into routine practice and policy remains a significant challenge. Additionally, there are few studies of implementation; that is, examination of the processes, outcomes, and factors influencing implementation of interventions. Implementation science provides a critical framework for addressing this gap by investigating factors that influence the adoption and sustainment of evidence‐based dementia care interventions in real‐world settings.MethodThis presentation provides an up‐to‐date overview of the evolving field of dementia implementation science, highlighting its role in improving care outcomes. The presenter outlines key theoretical frameworks and the core principles of implementation science, including identifying and addressing barriers to implementation, developing and testing implementation strategies, and evaluating the effectiveness of these strategies. This presentation uses as an example an applied research example from Australia – the Promoting Independence Through quality dementia Care in The Home (PITCH) study, aimed to improve sense of competency in dementia home care and outcomes for people with dementia via a co‐designed evidence‐based dementia training program.ResultA national cluster stepped‐wedge randomized controlled trial tested PITCH, alongside a health economic and process evaluation. Overall, the interactive, adult‐learning‐based, face‐to‐face PITCH program was effective in improving sense of competence in dementia care as well as knowledge and attitudes. For carers and people with dementia, no differences in health and quality of life outcomes were found. The process evaluation explored barriers and facilitators to implementation of PITCH, explored its acceptability, feasibility, suitability, and sustainability, and whether participation led to changes in practice. Themes from the process evaluation (from qualitative interviews and surveys) investigating the experiences and opinions of the intervention receivers and intervention deliverers included their motivations to participate, perceived benefits of PITCH, challenges of involvement, and suggestions for improvement, analyzed using the Theoretical Domains Framework. Results inform how the PITCH intervention could be modified to improve future wider implementation.ConclusionBy applying rigorous methodologies, the field of implementation science offers a promising avenue for maximizing the impact of dementia research and enhancing the quality of life for individuals living with dementia and their caregivers.

Objectives A post-hoc, mixed methods analysis of a randomized controlled trial of a 12-month psychosocial and psychoeducational telehealth intervention to support dementia caregivers of cognitively impaired relatives living in residential long-term care settings (the Residential Care Transition Module/RCTM) was conducted to identify and test potentially new mechanisms and outcomes of the RCTM. Method Two hundred and forty caregivers were randomly assigned to the RCTM treatment condition or to usual care as the control group and were administered quarterly surveys. Participants in the treatment condition provided qualitative data on perceptions of intervention benefits on follow-up surveys and semi-structured interviews conducted after the 12-month intervention (n = 30). New mechanisms and outcomes identified in the qualitative analysis were mapped onto existing items and scales (e.g. single items from the Short Sense of Competence Questionnaire) and re-analyzed quantitatively using general linear models. Results The mixed methods analysis suggested that dementia caregivers in the RCTM group were more confident in their ability to obtain information about and arrange services (e.g. legal and financial planning, long-term care ombudsman) than controls and were less likely to report annoyance with care recipients’ behaviors. Conclusion The mixed methods results advance our understanding of the RCTM’s potential efficacy, and the adoption of similar methodologies may yield greater insights into how and why dementia care interventions are beneficial, even in the face of initial null findings.

To present evidence-based factors for the recruitment and retention of licensed nurses caring for older people and persons with dementia. The international nurse shortage crisis is intensified in the aged and dementia care sector. Strategies to address this crisis rely on qualitative, quasi-experimental, anecdotal and unsubstantiated literature. Systematic literature review. Search terms 'nurse''nurses''nursing''clinical supervision''staff''staffing''staff mix''staff levels''recruitment''retention''aged care''gerontology''gerontological''dementia care''residential''nursing home,' were used in all possible combinations and applied in a wide range of relevant academic databases, with secondary hand searches of selected bibliographies. Two hundred and twenty-six papers were retrieved and scanned, with 105 chosen for closer examination that were relevant to recruitment and retention strategies for dementia and aged care nursing. Twenty-five of the papers chosen for review were rated at level 2++ to 3, according to the guidelines of the National Institute for Health and Clinical Excellence (The NICE Guidelines Manual, National Institute for Health and Clinical Excellence, London). The 25 critically reviewed papers are organised as promising strategies for (1) nurse recruitment and (2) nurse retention. The intrinsic rewards of the caring role attract nurses to dementia and aged care. Essential strategies linking recruitment with retention are: careful selection of student nurse clinical placements and their ongoing supervision and education, training for skills, leadership and teamwork for new and existing nurses, increased staffing levels, pay parity across different health settings and family friendly policies. A family-friendly, learning environment that values and nurtures its nursing staff, in the same way as nurses are expected to value and care for their patients and residents, is critical in ensuring their retention in dementia and aged care.

BackgroundAboriginal and Torres Strait Islander peoples experience greater dementia prevalence at a younger age than non‐Indigenous Australians. Place influences health outcomes, yet urban‐rural effects on brain ageing remain unclear. Whilst rural regions may lack adequate health resourcing, existing local strengths such as connection to Country, proximity to Community and culturally appropriate care can support healthy brain ageing and dementia care among Aboriginal and Torres Strait Islander peoples living in these areas. This study employed research yarning, an Indigenous methodology, to examine the influence of Place on dementia prevention and care for Aboriginal and Torres Strait Islander peoples.MethodsResearch methodology was designed to ensure cultural safety, integrating Indigenous and Western approaches. Research yarns on dementia prevention and care were held with Aboriginal and Torres Strait Islander and non‐Indigenous community members (n = 42) and healthcare professionals (n = 24) across one metropolitan, three regional/rural, and two remote sites in New South Wales, Australia. Thematic analysis was conducted by Aboriginal and non‐Indigenous researchers using inductive and deductive coding.ResultsKey themes included Community understanding of brain ageing, relationships between Place and brain ageing, service accessibility, and availability of training relating to dementia care for Aboriginal and Torres Strait Islander peoples. Maintaining cognitive health to share intergenerational experiences is a key foundation of ageing well for Aboriginal and Torres Strait Islander peoples across rural strata. Strengths relating to dementia prevention include the embedding of cardiovascular health in primary care, regular contact with family and Indigenous health providers, and, especially in more rural areas, connection to traditional knowledges. Barriers include limited awareness of brain health strategies among Community and healthcare providers and differing perceptions of declining cognition. Gaps in culturally appropriate approaches impair adequate dementia care with a lack of service availability and coordination more evident in rural areas.ConclusionsHealth for Aboriginal and Torres Strait Islander peoples is holistic and collectivist, reflecting the conditions of Place and Community. With almost half of dementia risk modifiable over the life course, leveraging existing cultural strengths, including the regenerative capacity of Community, especially in rural settings, offers an innovative approach to dementia prevention and care for Aboriginal and Torres Strait Islander peoples.

With the passage of the National Alzheimer's Project Act (NAPA) in 2011 and the National Plan to Address Alzheimer's Disease in the U.S., federal funding support for dementia care science increased exponentially. The National Institute on Aging (NIA), in keeping with National Plan's goal of effectively treating and preventing Alzheimer's disease and Alzheimer's Disease Related Dementias (AD/ADRD) by 2025, created a series of research milestones to track success. One of these is research milestone 13.H: Create research programs to evaluate novel and innovative dissemination and implementation methods to scale up promising practices in dementia care across settings and across the disease severity spectrum. The objective of this presentation is to summarize scientific advancements in the dissemination and implementation of dementia care innovations. This presentation uses narrative review and case study methods to assess the state-of-the-science of dementia care implementation and dissemination and to identify recommendations to continue to propel the field forward so that the ultimate goal of ensuring people living with dementia and their carers can benefit from evidence-based programs, services, and innovations are more readily achieved. Although a range of efforts exist documenting dissemination and implementation efforts of dementia care interventions, a range of barriers have been identified in the literature, including staff training requirements, length, complexity, little alignment with operations and daily workflow, and lack of incentivization/reimbursement. Within the framework of the NIH Stage Model of Behavioral Intervention Development, several methodological strategies could be applied to dementia care intervention design, testing, and dissemination/implementation to expedite the translation of evidence into real-world contexts. Designing dementia care interventions with the intent of implementation at the earliest stages of development is critical. Key methodological strategies to expedite the translational "pipeline" of dementia care science include the identification, measurement, and testing of mechanisms of action; use of process evaluations; application of advanced intervention design methodologies such as the Multiphase Optimization Strategy, Sequential Multiple Assignment Randomized Trials, and hybrid-effectiveness studies; and incorporation of person-centered outcome measures.

The place of music therapy in the spectrum of musical interventions in dementia care needs to be better understood in light of the ‘supply’ and ‘demand’ of this provision. A semi-structured, online survey of British Association for Music Therapy members and affiliates was undertaken in summer 2017. It asked respondents to report on employment practice and settings, and experience in dementia-related music therapy. It asked about training received and given, and what barriers prevent wider availability of music therapy for people with dementia in the United Kingdom. Replies came from 188 people, 142 of whom were working with people with dementia. Most respondents reported working in the public or voluntary sector, but one in five was self-employed. Most (61%) were employed in residential care or hospital settings, for an average of 20 hours per week. The main factor that would increase music therapy provision in dementia care was seen as ‘greater awareness’ of music therapy amongst the general public and within the National Health Service. Nearly one-quarter (23%) thought that training and development could help increase provision. This was the largest survey undertaken to date of dementia practice by Music Therapists in the United Kingdom. It has implications for recruitment, professional development, promotion of the specialism and research.

BackgroundCurrent evidence favours a shift away from pharmacological to non‐pharmacological approaches for the prevention and management of non‐cognitive symptoms of dementia. With the limited effectiveness of pharmacological treatments and their risk of adverse effects, it is imperative to understand the effectiveness of non‐pharmacological approaches to dementia care and lived experience. However, there has been little work to date to adapt non‐pharmacological approaches in partnership with Indigenous people. The current model of dementia care is unsafe and inadequate and continued inaction will only lead to continued harm. The primary aim of this research was to develop an implementation‐ready approach to Indigenous‐centered dementia care that has been co‐designed with partnering Indigenous communities.MethodThis study prioritized ethical engagement with Indigenous community members. Participants were recruited through community social media and newsletters. Data were co‐analysed using Indigenous approaches to thematic qualitative analysis to draft a preliminary structure for the Indigenous‐centred dementia care approach. A modified Nominal Group Technique was held with a group of health care providers and decision makers that led to agreement on content and design, as well as the development of training materials for facilitators.ResultFour focus groups (five Indigenous participants with experience of dementia/group) were completed between October and December 2024 for participants to discuss potential content and modes of delivery of an Indigenous‐centred dementia care intervention. Participants identified the need for: 1) culturally‐specific brain health education that includes information on what dementia is; 2) Indigenous‐specific risk identification and dementia prevention; 3) dementia‐friendly Indigenous cultural and spiritual ceremonies; 4) programs for community and facility‐living seniors that involved the traditions of local Indigenous Nations (e.g. jigging, beading, etc); and 5) in‐depth training for staff to deliver the programming.ConclusionThis work will impact numerous populations that need culturally specific approaches to dementia care policy and planning by informing an ethical process to engaging with diverse populations. This work can help health and continuing care services provide community‐specific approaches to non‐pharmacological dementia care.

ContextThe development of new effective and sustainable dementia care interventions requires active engagement of all service users in research studies. This ensures that interventions are tailored to meet individual needs and preferences. Here, we describe modelling and development of a multi‐faceted sensory health support intervention for residents with dementia in long‐term care, co‐designed with dementia care users and their supporters. There is a high rate of unrecognised hearing and vision loss in people with dementia, particularly in long term care (LTC) settings, which can hasten cognitive and functional decline, contribute to neuropsychiatric challenges, and increase the impact on health resource utilization.MethodsWe undertook a multistage process with key user stakeholders, interdisciplinary health experts, LTC professionals, and Patient and Public Involvement (PPI) representatives, following the UK’s Medical Research Council’s framework for the development of complex interventions.In the first stage, we crafted an outline of the intervention by extending a previously evaluated home‐based sensory support intervention and incorporating evidence from a systematic survey of hearing rehabilitation interventions. The ‘Sensory‐Cognitive Model of Place’ served as the theoretical framework.In the second stage, qualitative feedback from professional and PPI stakeholders, along with insights into existing care sensory health training approaches, were integrated to form a multi‐component sensory support intervention ready for field testing.The third stage involved pilot‐feasibility trialing in a single LTC facility, with subsequent design modifications based on feedback.The resulting Sensory Support Intervention for Residents with Dementia in Care (SSI‐RC) comprises four tiered components addressing (1) resident, (2) staff, (3) environmental, and (4) organizational levels. These include personalized sensory health status checks, staff awareness training, sensory environment audits, and organizational pathway assessments.ConclusionWith the guidance of service users, we successfully developed and field tested the SSI‐RC, highlighting its potential for implementation in a cluster‐randomized pilot trial in LTC facilities. The collaborative approach with dementia care users and supporters ensures the intervention’s relevance and effectiveness in enhancing sensory‐cognitive health for residents with dementia. The research contributes to the broader goal of tailoring dementia care interventions to individual needs and preferences.

PurposeIn dementia care, the complexity of psychosocial needs and contextual variables often demands nonpharmacological interventions of a complex nature. The purpose of this scoping review was to investigate (1) how manuals published in refereed journals explaining procedures of complex interventions in dementia care are structured and their content disseminated and (2) to provide recommendations for future manuals.MethodsA systematic search was conducted using four databases (Embase, PsychInfo, CINAHL and Scopus) following PRISMA-ScR and PICo method. The results were analysed using template analysis aiming to describe the possibility of tailoring the intervention, degree of flexibility of the manual and dissemination elements used in the manual.ResultsA total of 882 records were identified, and 86 full-text articles were assessed. Nine articles containing manuals met the inclusion criteria. All of the included manuals allowed the user to tailor actions in the intervention to specific situations. Two-thirds of the manuals showed a medium degree of flexibility. The types of dissemination elements varied. All used written text, and some used various graphical organisers such as headlines and lists. None used illustrations or audio/video material.ConclusionCurrently, only few manuals for complex interventions in the field of dementia are published in refereed journals, all disseminated as written text. For future manuals, we suggest considering the inclusion of illustrations and/or audio/video material to describe actions, to allow for tailoring of the intervention, and to maintain a medium or low degree of flexibility by structuring the content hierarchically in phases while providing the user with detailed description of what to do, and how to decide what to.

Purpose: The purpose of this study was to report the clinical outcomes of delayed speech-language pathology intervention in an individual with Alzheimer's disease and highlight implementation barriers in dementia care. Method: A 63-year-old man diagnosed with Alzheimer's disease went 4.5 years without a speech-language consultation, despite declining cognitive-linguistic abilities noted by his neurologist. Neither he nor his care partner received guidance on interventions, leading the care partner to independently seek services, self-referring to a speech-language pathology clinic where a comprehensive cognitive-communication evaluation was completed. Following the evaluation, a person-centered intervention was implemented incorporating cognitive-communication strategies and care partner training, providing specific methods to enhance communication with the goal of improving quality of care (QoL). Results: The evaluation revealed that, despite severe cognitive impairment and notable word-finding difficulties, he had relatively intact syntactic and grammatical language skills. However, the patient lacked compensatory communication strategies, which hindered his ability to convey overall message effectively, resulting in frequent communication breakdowns. Following speech-language pathology intervention, the patient demonstrated improved functional communication abilities, and both he and his care partner reported enhanced QoL, as documented through standardized outcome measures. Conclusions: This case presentation demonstrates that despite delayed speech-language pathology intervention, individuals with severe dementia and their care partners could benefit from person-centered intervention approaches targeted at communication, safety, and social connection. This case presentation is also a call to action for health care systems to develop standardized clinical pathways where speech-language pathology referrals are initiated early in the progression of the condition.

This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory-social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design.

The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system

BackgroundPancreatic cancer has one of the highest mortality rates of any malignancy, placing a substantial burden on patients and families with high unmet informational and supportive care needs. Nevertheless, access to psychosocial and palliative care services for the individuals affected is limited. There is a need for standardized approaches to facilitate adjustment and to improve knowledge about the disease and its anticipated impact. In this intervention-development paper guided by implementation science principles, we report the rationale, methods, and processes employed in developing an interdisciplinary group psychoeducational intervention for people affected by pancreatic cancer. The acceptability and feasibility of implementation will be evaluated as a part of a subsequent feasibility study.MethodsThe Schofield and Chambers framework for designing sustainable self-management interventions in cancer care informed the development of the intervention content and format. The Consolidated Framework for Implementation Research served as an overarching guide of the implementation process, including the development phase and the formative evaluation plan of implementation.ResultsA representative team of stakeholders collaboratively developed and tailored the intervention content and format with attention to the principles of implementation science, including available resourcing. The final intervention prototype was designed as a single group-session led by an interdisciplinary clinical team with expertise in caring for patients with pancreatic cancer and their families and in addressing nutrition guidelines, disease and symptom management, communication with family and health care providers, family impact of cancer, preparing for the future, and palliative and supportive care services.ConclusionsThe present paper describes the development of a group psychoeducational intervention to address the informational and supportive care needs of people affected by pancreatic cancer. Consideration of implementation science during intervention development efforts can optimize uptake and sustainability in the clinical setting. Our approach may be utilized as a framework for the design and implementation of similar initiatives to support people affected by diseases with limited prognoses.

Although evidence for dementia care programs continues to grow, families and health providers do not have ready access to programs, nor have they been widely disseminated and routinized in healthcare. Understanding implementation considerations when embedding evidence-based programs in healthcare systems can inform ways to effectively transform dementia care. This symposium will examine similarities and differences in implementation challenges encountered and strategies used when implementing four evidence-based programs being tested in different healthcare environments using distinct study designs. Dr. Gaugler et al., will discuss implementation challenges encountered with a staff-delivered intervention (ADS Plus) to support caregivers in adult day services that is being tested using a mixed methods hybrid trial design in >50 sites nationally. Dr. Hodgson et al., will discuss adaptions and their measurement to COPE, a home-based dyadic support program being embedded in 10 PACEs of a large healthcare system using a noninferiority trial testing staff training strategies. Dr. Forester et al., will examine implementation of the Care Ecosystem for dementia patients in a high-risk, integrated care management program using a pilot embedded pragmatic trial. Dr. Hepburn et al., will explore tactical challenges of implementing Tele-Savvy, an online caregiver psychoeducation program, within the context of a pilot pragmatic clinical trial. Drawing upon implementation science, themes discussed include balancing adaptations and fidelity, measurement of implementation outcomes and organizational readiness, and staff training implications. Also highlighted are research design considerations. Dr. Czaja, an expert in the design and implementation of dementia care interventions from in-person to technology-based will be the discussant.

BackgroundThere is a growing interest in using olfactory (smell) stimulation in dementia care. The sense of smell plays an important role in everyday life. It enables humans to detect and differentiate between various scents, mediates the flavours of foods and drinks, and serves as a first warning signal, detecting smoke from a fire, leaking natural gas or spoiled food. There is also evidence demonstrating the power of smells in triggering autobiographical memories and emotions, given the close relationship between olfaction, memory, and emotional processes at the neuroanatomical level. Despite its increasing in popularity in clinical practice, limited studies evaluate the effectiveness of olfactory interventions.AimsThis work aims to i) synthesis the current state of research on dementia and olfaction interventions; ii) and identify current evidence on odour‐evoked memory by people living with dementia.MethodsTwo rapid reviews are used, including an update published rapid review on the efficacy of interventions using olfactory stimulation in dementia care; and an ongoing mixed‐method rapid review on odour‐evoked memories for people living with dementia. The search is conducted across five databases (Medline, Academic Search Elite, PsycARTICLES, CINAHL, PsycINFO). Eligible studies are assessed for methodological quality and synthesised using a narrative approach.ResultsFindings suggest mixed results on the benefits of olfactory stimulation on responsive behaviours and cognitive function. Although the evidence available is limited, encouraging results were found regarding olfactory stimulation and increased autobiographic memories, sleep duration, food intake and improved balance.ConclusionOlfactory intervention in dementia care is an emergent area of research warranting attention. This work discussed the important role of smell and the current state‐of‐the‐art in dementia and olfaction research, and its contribute to overall well‐being of people with dementia.