Association for Dementia Studies, University of Worcester, Worcester, UK.
Association for Dementia Studies, University of Worcester, Worcester, UK
BMJ Open. 2022 May 2;12(5):e062697. doi: 10.1136/bmjopen-2022-062697.
Improving support for people with early to moderate dementia to live at home in their communities is a global public health goal. Community adult social care is not robust in many parts of the UK, however, with the pandemic increasing pressure on services for this population. Community-led interventions can play a key role in supporting people postdiagnosis, helping delay decline, but many interventions struggle to sustain beyond 1-2 years. Meeting Centres (MCs) are one such intervention, which many UK community groups find attractive and achievable. However, it is not understood how these communities can ensure they are putting in place strategies that will help them sustain in the longer term, beyond start-up phase.
This realist evaluation aims to understand the factors affecting sustainability of MCs in rural areas and learn lessons from MCs that have sustained beyond 3 years. Data will be collected using mixed methods: interviews and group discussions with stakeholders involved at every level in three case study locations in England and Wales, analysed with Soft Systems modelling; a Discrete Choice Experiment exploring what people across the UK value and are willing to pay for MCs, analysed with regression modelling. All data will be synthesised using a Realist logic of analysis to build a theoretical model of how, why, for whom, in what contexts and to what extent MCs can be successfully implemented for the long term.
As participants may lack capacity for informed consent, favourable ethical opinion was received from a Health Research Authority research ethics committee. Resulting recommendations will be of interest to stakeholders including those commissioning, planning, running, supporting or attending MCs, as well as policy-makers and healthcare professionals. Knowledge will be shared with emerging MCs to help accelerate scale up of this intervention.
提高对早期至中度痴呆症患者的支持，使其能在社区中居家生活，这是全球公共卫生目标。然而，在英国许多地区，社区成人社会关怀服务并不完善，且大流行增加了为这部分人群提供服务的压力。社区主导的干预措施在支持人们确诊后发挥着关键作用，可以帮助延缓衰退，但许多干预措施难以持续超过 1-2 年。“会面中心”（MC）就是这样一种干预措施，许多英国社区团体认为这种干预措施具有吸引力且可行。然而，目前尚不清楚这些社区如何确保采取的策略能够帮助它们长期维持下去，而不仅仅是在启动阶段。
本真实主义评价旨在了解影响农村地区 MC 可持续性的因素，并从持续 3 年以上的 MC 中吸取经验教训。数据将通过混合方法收集：在英格兰和威尔士的三个案例研究地点，对各级利益相关者进行访谈和小组讨论，使用软系统建模进行分析；使用离散选择实验探索全英各地的人们对 MC 的重视程度和愿意支付的费用，使用回归建模进行分析。所有数据将使用真实主义分析逻辑进行综合，以构建一个关于 MC 如何、为何、为谁、在何种情况下以及在何种程度上能够长期成功实施的理论模型。
由于参与者可能缺乏知情同意的能力，因此获得了健康研究管理局研究伦理委员会的有利伦理意见。产生的建议将引起利益相关者的关注，包括那些负责委托、规划、运行、支持或参加 MC 的人，以及政策制定者和医疗保健专业人员。研究结果将与新兴的 MC 共享，以帮助加速该干预措施的推广。
