Faculty of Science and Engineering, School of Psychology and Sport Science at Anglia Ruskin University, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK.
University of Exeter, The Medical School, Exeter, UK.
Age Ageing. 2024 Aug 6;53(8). doi: 10.1093/ageing/afae181.
We report a mixed-methods process evaluation embedded within a randomised controlled trial. We aimed to test and refine a theory of change model hypothesising key causal assumptions to understand how the New Interventions for Independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over 1 year.
In 2021-2022, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions. We conducted qualitative interviews with dyads and intervention facilitators, purposively selected for diverse follow-up GAS scores. We collected observational data from intervention session recordings. We thematically analysed data, then integrated qualitative and quantitative data.
174/204 (85.3%) dyads allocated to NIDUS-Family, fully completed it, 18 partially completed, while 12 received no intervention. We interviewed 27/192 (14%) of dyads receiving any sessions, and 9/10 facilitators; and observed 12 sessions. 47/192 (24.5%) of carers completed the acceptability questionnaire. We identified four themes: (A) 'Someone to talk to helps dyads feel supported'; (B) 'NIDUS-Family helps carers change their perspective'; (C) 'Personalisation helps people living with dementia maintain their identity' and (D) 'Small steps help dyads move forward'.
Key causal pathway mechanisms were: a respectful, trusting and impartial relationship with the facilitator: supporting the development of meaningful goals and support to find manageable solutions. Core implementation factors were delivery of the modules from a consistent facilitator across regular sessions. Core contextual factors influencing these mechanisms were dyadic participation and understanding of abilities.
我们报告了一项混合方法的过程评估，嵌入在一项随机对照试验中。我们旨在测试和完善一个变化理论模型，假设关键的因果假设，以了解新的独立于痴呆症的干预措施研究（NIDUS-家庭）（一种规范化的、多模式的心理社会干预）如何相对于常规护理，在主要结局目标实现量表（GAS）上在 1 年内更有效。
在 2021-2022 年，干预组的对接受了为测试因果假设而开发的可接受性问卷。我们对不同随访 GAS 评分的对和干预促进者进行了定性访谈。我们从干预会议记录中收集了观察数据。我们对数据进行了主题分析，然后整合了定性和定量数据。
174/204（85.3%）对被分配到 NIDUS-家庭的对完成了整个干预，18 对部分完成，而 12 对没有接受干预。我们采访了 27/192（14%）接受任何会议的对，以及 9/10 名促进者；并观察了 12 次会议。192 名照顾者中的 47 人（24.5%）完成了可接受性问卷。我们确定了四个主题：（A）“有人交谈可以帮助对感到支持”；（B）“NIDUS-家庭帮助照顾者改变他们的观点”；（C）“个性化帮助痴呆症患者保持他们的身份”和（D）“小步骤帮助对向前迈进”。
关键的因果途径机制是：与促进者建立尊重、信任和公正的关系：支持发展有意义的目标和支持找到可管理的解决方案。核心实施因素是在定期会议中由一致的促进者提供模块。影响这些机制的核心环境因素是对的参与和对能力的理解。
