Association for Dementia Studies, University of Worcester, Worcester, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2019 Jul 26;9(7):e032109. doi: 10.1136/bmjopen-2019-032109.
With numbers set to increase globally, finding ways to better support people with dementia and their families is a matter of growing concern. Community-based interventions can play a key role in supporting people with early to moderate stage dementia postdiagnosis, helping delay decline and hospitalisation. However, provision of such interventions is fragmented, with significant gaps and no reliable funding model, hence innovative groups and schemes catering for a genuine need can struggle long term and frequently fold.
This realist review aims to expand our understanding of how best to implement and facilitate community-based interventions to run sustainably, focusing on contextually relevant explanations. We will gather and synthesise literature using a realist approach designed to accommodate and account for the complexity of 'real life' programmes, as implemented under different conditions in different settings, aiming to draw transferable conclusions about their sustainability that explain how and why context can influence outcomes. Our review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence (using Academic Search, AMED, CINAHL, EMBASE, MEDLINE, ProQuest, PsycINFO, PubMed, Scopus and Social Care Online, between May and September 2019); (3) article selection; (4) extracting and organising data; (5) synthesising the evidence and drawing conclusions. Data analysis will use a realist logic to explain what works, for whom, in what circumstances, in what respects, how and why. A stakeholder group will provide guidance and feedback throughout.
Ethical approval was not required. Recommendations drawn from results are likely to be of interest to a range of stakeholders including those commissioning, planning, running, supporting or attending such interventions, as well as policymakers, healthcare professionals and researchers. We will draw on the expertise of our stakeholder group regarding tailoring dissemination to each audience using a variety of materials, formats and channels.
随着全球数量的增加，找到更好的方法来支持痴呆症患者及其家属是一个日益令人关注的问题。基于社区的干预措施可以在支持早期至中度痴呆症患者的诊断后发挥关键作用，有助于延缓病情恶化和住院。然而，这种干预措施的提供是分散的，存在很大差距，没有可靠的资金模式，因此满足真正需求的创新团体和计划可能难以长期维持，并经常倒闭。
本真实主义审查旨在扩大我们对如何最好地实施和促进社区为基础的干预措施以实现可持续性的理解，重点是对背景相关的解释。我们将使用真实主义方法收集和综合文献，该方法旨在适应和解释“现实生活”计划的复杂性，因为这些计划在不同的环境下根据不同的条件实施，旨在得出关于其可持续性的可转移结论，解释背景如何以及为什么会影响结果。我们的审查将通过五个步骤逐步进行：（1）确定现有的理论；（2）搜索证据（使用 Academic Search、AMED、CINAHL、EMBASE、MEDLINE、ProQuest、PsycINFO、PubMed、Scopus 和 Social Care Online，在 2019 年 5 月至 9 月期间）；（3）文章选择；（4）提取和组织数据；（5）综合证据并得出结论。数据分析将使用真实主义逻辑来解释什么有效、为谁、在什么情况下、在哪些方面、如何以及为什么。一个利益相关者小组将在整个过程中提供指导和反馈。
不需要伦理批准。从结果中得出的建议可能会引起一系列利益相关者的兴趣，包括委托、规划、运行、支持或参加此类干预的人，以及政策制定者、医疗保健专业人员和研究人员。我们将利用我们的利益相关者小组的专业知识，针对每个受众，使用各种材料、格式和渠道来调整传播。
