School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
BMC Geriatr. 2023 Jun 9;23(1):361. doi: 10.1186/s12877-023-04090-y.
The aim of this study is to 1) explore the experiences of people living with dementia interacting with DFCs and 2) identify factors that influence empower and support people living with dementia to live successfully in DFCs. The main elements of a DFC are related to people; communities; organisations and partnerships. There are over 200 organisations recognised as dementia-friendly in Northern Ireland (NI). This realist evaluation is to understand how DFCs work for people living with dementia, how positive outcomes are achieved, for whom and in what contexts do DFCs work best.
A realist evaluation using case study methodology. The process evaluation includes a realist review of the literature, non-participant observation of people living with dementia in their local communities, semi-structured interviews to explore the facilitators and barriers to living well in DFCs and focus groups comprised of people living with dementia, family caregivers and people working in DFCs to support Context- Mechanisms and Outcomes (CMOs). This four-stage realist assessment cycle is used, including iterative rounds of theory development, data gathering, and theory testing. In the end, analysis will reveal context mechanisms that influence how dementia-friendly communities operate and present an initial theory of how people think, which, if adopted, may be able to alter current contexts so that "key" mechanisms are activated to generate desired outcomes.
To give confidence in moving from hypothetical constructions about how DFCs could function to explanations of possible or observable causal mechanisms, the realist evaluation of a complex intervention incorporates a variety of evidence and perspectives. Despite playing a significant role in a person with dementia's everyday life, it appears that little is known about how communities function to achieve intended results. Even though there has been a lot of work to pinpoint the fundamentals and crucial phases of building DFCs, it is still unclear how people living with dementia benefit the most from these communities. This study intends to advance our understanding of how outcomes are produced for people living with dementia by contributing to the underlying theory of DFCs as well as addressing the primary research objectives.
本研究旨在：1）探索与 DFC 互动的痴呆症患者的体验；2）确定影响赋予和支持痴呆症患者在 DFC 中成功生活的因素。DFC 的主要元素与人、社区、组织和伙伴关系有关。北爱尔兰（NI）有超过 200 个组织被认可为痴呆症友好组织。这项真实评估旨在了解 DFC 如何为痴呆症患者服务，如何实现积极的结果，以及 DFC 在哪些情况下对哪些人最有效。
采用案例研究方法进行真实评估。过程评估包括对文献进行真实评估、对当地社区中的痴呆症患者进行非参与式观察、对在 DFC 中生活良好的促进因素和障碍进行半结构化访谈、以及由痴呆症患者、家庭照顾者和在 DFC 中工作的人员组成的焦点小组，以支持情境-机制和结果（CMO）。使用四阶段真实评估循环，包括理论发展、数据收集和理论测试的迭代循环。最终，分析将揭示影响 DFC 运作的情境机制，并提出一个关于人们如何思考的初始理论，如果被采纳，可能会改变当前的情境，从而激活“关键”机制，产生预期的结果。
为了从关于 DFC 如何运作的假设结构转变为对可能或可观察的因果机制的解释，对复杂干预措施的真实评估纳入了各种证据和观点。尽管痴呆症患者的日常生活社区发挥了重要作用，但似乎对社区如何运作以实现预期结果知之甚少。尽管已经做了很多工作来确定 DFC 的基础和关键阶段，但仍然不清楚痴呆症患者如何从中受益最多。这项研究旨在通过为 DFC 的基础理论做出贡献并解决主要研究目标，来增进我们对痴呆症患者产生结果的理解。
