一项针对痴呆症患者及其照料者睡眠障碍的DREAMS-START（痴呆症相关睡眠手册；亲属策略）随机对照试验的过程评估。
Process evaluation in a randomised controlled trial of DREAMS-START (dementia related manual for sleep; strategies for relatives) for sleep disturbance in people with dementia and their carers.
作者信息
Amador Sarah, Livingston Gill, Adeleke Mariam, Barber Julie, Webster Lucy, Yuan Hang, Banerjee Sube, Bhojwani Ankita, Charlesworth Georgina, Clarke Christopher, Connell Caroline, Espie Colin A, Gan Ruochen, Gonzalez Lina, Horsley Rossana, Hunter Rachael M, Kyle Simon D, Muralidhar Malvika, Pikett Liam, Raczek Malgorzata, Taneska Marija, Walker Zuzana, Wang Zuyu, Rapaport Penny
机构信息
University College London, Mental Health of Older People Department, Division of Psychiatry, London W1T 7NF, England, UK.
Camden and Islington NHS Foundation Trust, London, NW1 0PE, England, UK.
出版信息
Age Ageing. 2025 Mar 3;54(3). doi: 10.1093/ageing/afaf053.
INTRODUCTION
DREAMS-START is a multicomponent intervention targeting sleep disturbance in people with dementia. To enhance understanding of the DREAMS-START randomised controlled trial, which showed improved sleep in the intervention compared to the control arm, we conducted a process evaluation exploring (i) DREAMS-START delivery, (ii) behaviour change mechanisms and (iii) contextual factors impacting outcomes.
METHODS
Mixed-methods design. We measured intervention adherence, fidelity and additional therapeutic process measures. We interviewed a sub-sample of intervention arm family carers and facilitators delivering DREAMS-START. We analysed data thematically guided by a prespecified theory of change logic model informed by the Theoretical Domains Framework. We measured movement using an actigraph worn by the person with dementia at baseline and at four- and eight-month follow-ups to explore potential mechanisms of action.
RESULTS
Attendance was good (82.8% attended ≥4/6 sessions). Mean fidelity score (95.4%; SD 0.08) and median score for all four process measures assessed (5/5; IQR 5-5) were high. We interviewed 43/188 family carers and 9/49 DREAMS-START facilitators. We identified three overarching themes aligned with our model: (i) knowledge and facilitation enable behaviour change, (ii) increasing sleep pressure and developing skills to manage sleep disturbances and (iii) Establishing a routine and sense of control. We were unable to collect sufficient data for pre-specified actigraphy analyses.
CONCLUSION
Despite competing demands, carers attended DREAMS-START. It promoted behaviour change through supportive in-session reflection, increasing carer knowledge and skills. This was embedded between sessions and actions were positively reinforced as carers experienced changes. Results will inform future implementation in clinical services.
引言
“DREAMS-START”是一项针对痴呆症患者睡眠障碍的多成分干预措施。为了更好地理解“DREAMS-START”随机对照试验（该试验表明干预组的睡眠状况优于对照组），我们进行了一项过程评估，探讨了以下方面：（i）“DREAMS-START”的实施情况；（ii）行为改变机制；（iii）影响结果的背景因素。
方法
采用混合方法设计。我们测量了干预的依从性、保真度和其他治疗过程指标。我们采访了干预组家庭护理人员和实施“DREAMS-START”的协调员的一个子样本。我们在预先指定的由理论领域框架提供信息的变革逻辑模型理论的指导下，对数据进行了主题分析。我们使用痴呆症患者在基线、四个月和八个月随访时佩戴的活动记录仪来测量活动情况，以探索潜在的作用机制。
结果
参与率良好（82.8%的人参加了≥4/6次会议）。平均保真度得分（95.4%；标准差0.08）和所评估的所有四个过程指标的中位数得分（5/5；四分位间距5-5）都很高。我们采访了43/188名家庭护理人员和9/49名“DREAMS-START”协调员。我们确定了与我们的模型一致的三个总体主题：（i）知识和促进措施能促成行为改变；（ii）增加睡眠压力并培养管理睡眠障碍的技能；（iii）建立日常规律和控制感。我们无法收集到足够的数据用于预先指定的活动记录仪分析。
结论
尽管有其他事务的干扰，护理人员仍参加了“DREAMS-START”。它通过支持性的会议反思、增加护理人员的知识和技能来促进行为改变。这在各次会议之间得以体现，并且随着护理人员经历变化，行动得到了积极强化。研究结果将为未来在临床服务中的实施提供参考。
Zotero 插件