Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK.
Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
BMJ Open. 2019 Aug 20;9(8):e030933. doi: 10.1136/bmjopen-2019-030933.
In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income).
Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation.
Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer's Disease International, and via ongoing engagement with key policymakers.
在中低收入国家（LMICs），被诊断患有痴呆症的人数预计会大幅增加，而治疗选择有限，乙酰胆碱酯酶抑制剂的使用频率不如高收入国家（HICs）高。认知刺激疗法（CST）是一种针对痴呆症患者的群体、短暂、非药物干预措施，在临床试验中显著改善认知和生活质量，在 HIC 中具有成本效益。然而，在其他国家，其实施情况研究较少。本方案描述了 CST-International；这是一项在三个 LMIC 中实施 CST 的研究：巴西（中上收入）、印度（中下收入）和坦桑尼亚（低收入）。
四个重叠阶段：（1）通过与利益相关者（包括临床医生、政策制定者、痴呆症患者及其家属）举行会议，探索每个国家实施 CST 的障碍；（2）为每个国家制定实施计划；（3）使用在每个国家进行的 CST 研究评估实施计划（n=50，总计 n=150）。结果将包括依从性、出勤率、可接受性和流失率、成功的约定参数、结果（认知、生活质量、日常生活活动）和成本/负担能力；（4）完善和传播实施策略，为持续的实践途径提供便利，解决实施的障碍和促进因素。
每个国家都已获得伦理批准。CST 没有记录到不良影响，数据将符合相关法规。培训师培训模式将在每个国家制定，以增加 CST 的提供，并不断与政策制定者/政府机构合作，以帮助成功实施。研究结果将在会议上、同行评审文章和通讯中、与阿尔茨海默病国际合作以及通过与主要政策制定者的持续参与进行传播。
