scholarly journals Sustainability of community-based interventions for people affected by dementia: a protocol for the SCI-Dem realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e032109
Author(s):  
Thomas Morton ◽  
Teresa Atkinson ◽  
Dawn Brooker ◽  
Geoffrey Wong ◽  
Shirley Evans ◽  
...  
Keyword(s):  
Real Life ◽  
Realist Review ◽  
Stakeholder Group ◽  
Community Based Interventions ◽  
Community Based ◽  
Funding Model ◽  
People With Dementia ◽  
Ethical Approval ◽  
Academic Search

IntroductionWith numbers set to increase globally, finding ways to better support people with dementia and their families is a matter of growing concern. Community-based interventions can play a key role in supporting people with early to moderate stage dementia postdiagnosis, helping delay decline and hospitalisation. However, provision of such interventions is fragmented, with significant gaps and no reliable funding model, hence innovative groups and schemes catering for a genuine need can struggle long term and frequently fold.Methods and analysisThis realist review aims to expand our understanding of how best to implement and facilitate community-based interventions to run sustainably, focusing on contextually relevant explanations. We will gather and synthesise literature using a realist approach designed to accommodate and account for the complexity of ‘real life’ programmes, as implemented under different conditions in different settings, aiming to draw transferable conclusions about their sustainability that explain how and why context can influence outcomes. Our review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence (using Academic Search, AMED, CINAHL, EMBASE, MEDLINE, ProQuest, PsycINFO, PubMed, Scopus and Social Care Online, between May and September 2019); (3) article selection; (4) extracting and organising data; (5) synthesising the evidence and drawing conclusions. Data analysis will use a realist logic to explain what works, for whom, in what circumstances, in what respects, how and why. A stakeholder group will provide guidance and feedback throughout.Ethics and disseminationEthical approval was not required. Recommendations drawn from results are likely to be of interest to a range of stakeholders including those commissioning, planning, running, supporting or attending such interventions, as well as policymakers, healthcare professionals and researchers. We will draw on the expertise of our stakeholder group regarding tailoring dissemination to each audience using a variety of materials, formats and channels.

scholarly journals Sustaining community-based interventions for people affected by dementia long term: the SCI-Dem realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047789
Author(s):  
Thomas Morton ◽  
Geoff Wong ◽  
Teresa Atkinson ◽  
Dawn Brooker
Keyword(s):  
Financial Management ◽  
Local Community ◽  
Grey Literature ◽  
Realist Review ◽  
Social Needs ◽  
Support Network ◽  
Small Scale ◽  
Community Based Interventions ◽  
Community Based

ObjectivesCommunity-based support for people with earlier-stage dementia and their care partners, such as regularly meeting groups and activities, can play an important part in postdiagnostic care. Typically delivered piecemeal in the UK, by a variety of agencies with inconsistent funding, provision is fragmented and many such interventions struggle to continue after only a short start-up period. This realist review investigates what can promote or hinder such interventions in being able to sustain long term.MethodsKey sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking. No restrictions were made on article type or study design; only data pertaining to regularly meeting, ongoing, community-based interventions were included. Data were extracted, assessed, organised and synthesised and a realist logic of analysis applied to trace context–mechanism–outcome configurations as part an overall programme theory. Consultation with stakeholders, involved with a variety of such interventions, informed this process throughout.ResultsAbility to continually get and keep members; staff and volunteers; the support of other services and organisations; and funding/income were found to be critical, with multiple mechanisms feeding into these suboutcomes, sensitive to context. These included an emphasis on socialising and person-centredness; lowering stigma and logistical barriers; providing support and recognition for personnel; networking, raising awareness and sharing with other organisations, while avoiding conflict; and skilled financial planning and management.ConclusionsThis review presents a theoretical model of what is involved in the long-term sustainability of community-based interventions. Alongside the need for longer-term funding and skilled financial management, key factors include the need for stigma-free, person-centred provision, sensitive to members’ diversity and social needs, as well as the need for a robust support network including the local community, health and care services. Challenges were especially acute for small scale and rural groups.

A system dynamic perspective of stop–start prevention interventions in Australia

2019 ◽  
Vol 35 (5) ◽  
pp. 1015-1025
Author(s):  
Véronique Roussy ◽  
Therese Riley ◽  
Charles Livingstone ◽  
Grant Russell
Keyword(s):  
Life Course ◽  
Feedback Loops ◽  
System Dynamic ◽  
Community Based Interventions ◽  
Community Based ◽  
Design Elements ◽  
Design And Implementation ◽  
System Behaviour ◽  
Dynamic Perspective

Abstract Time-limited prevention initiatives are frequently used to address complex and persisting public health issues, such as non-communicable diseases. This often creates issues in terms of achieving sustainable change. In this study, we use a system dynamic perspective to explore the effects of stop–start funding over system behaviour in two community-based initiatives designed to prevent chronic diseases and obesity. We conducted a qualitative exploratory study using complexity theory as an analytical lens of two Healthy Together Communities (HTCs) initiatives in Victoria, Australia. Data were generated from 20 semi-structured interviews with health promotion practitioners and managers, from community health and local government organizations. Template analysis based on properties of complex systems informed the inductive identification of system behaviour narratives across the stop–start life-course of HTCs. A central narrative of system behaviour emerged around relationships. Within it, we identified pre-existing contextual conditions and intervention design elements that influenced non-linearity of system self-organization and adaptation, and emergence of outcomes. Examples include cynicism, personal relationships and trust, and history of collaboration. Feedback loops operated between HTCs and these conditions, in a way that could influence long-term system behaviour. Taking a dynamic life-course view of system behaviour helps understand the pre-existing contextual factors, design and implementation influences, and feedback loops which shape the long-term legacy of short-lived interventions aimed at solving complex issues. In turn, greater awareness of such interactions can inform better design and implementation of community-based interventions.

scholarly journals The role of public health in addressing child maltreatment in Canada

2010 ◽  
Vol 31 (1) ◽  
pp. 39-44 ◽  
Author(s):  
SM Jack
Keyword(s):  
Public Health ◽  
Child Maltreatment ◽  
Surveillance Systems ◽  
Long Term Outcomes ◽  
Community Based Interventions ◽  
Community Based ◽  
Complex Issue ◽  
Short And Long Term

Child maltreatment is a significant health and social issue given its prevalence across the general population and the significant short- and long-term outcomes associated with maltreatment in childhood. There is a need for a comprehensive, collaborative and multisectoral approach for identification, prevention and intervention of this complex issue. Within this multisectoral collaboration, it is essential for public health in Canada to define its role in addressing and preventing child maltreatment. This commentary summarizes how public health can address the issue of child maltreatment in Canada by specifically: 1) measuring the magnitude of maltreatment through public health surveillance systems such as the Canadian Incidence Study of Reported Child Abuse and Neglect; 2) identifying modifiable risk factors; 3) identifying and evaluating community-based interventions to prevent violence; and 4) implementing evidence-based primary prevention strategies.

scholarly journals A diversity of patterns: 10-year trajectories of men and women diagnosed with psychosis for the first time. A time-geographic approach

2020 ◽  
Vol 28 (4) ◽  
pp. 283-298
Author(s):  
Gunnel Andersson ◽  
Katerina Vrotsou ◽  
Anne Denhov ◽  
Alain Topor ◽  
Per Bülow ◽  
...  
Keyword(s):  
Mental Illness ◽  
Western World ◽  
Community Based Interventions ◽  
Community Based ◽  
Common Pattern ◽  
Men And Women ◽  
Institutional Experience ◽  
Third Sphere ◽  
First Time

AbstractPeople with severe mental illness face a different ‘interventional’ landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as “spheres”, were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10- year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year.

Efficacy of Postacute Neuropsychological Rehabilitation for Patients with Acquired Brain Injuries is Maintained in the Long-Term

2020 ◽  
Vol 26 (1) ◽  
pp. 130-141
Author(s):  
Tal Shany-Ur ◽  
Ayala Bloch ◽  
Tali Salomon-Shushan ◽  
Narkis Bar-Lev ◽  
Limor Sharoni ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Brain Injuries ◽  
Community Integration ◽  
Real Life ◽  
Program Completion ◽  
Community Based ◽  
Double Blind ◽  
Neuropsychological Rehabilitation ◽  
Term Maintenance

AbstractObjectives:We examined the long-term maintenance of treatment outcomes in patients with acquired brain injuries who participated in community-based neuropsychological rehabilitation (NR) programs, in a prospective, within-subject, longitudinal, partial double-blind cohort study.Methods:One hundred forty-three patients (39 females, mean age 33.5 years) who had experienced a brain injury (BI) (mean time since injury 3.95 years) were referred to a postacute community-based NR institute. Patients participated in one of the three programs aimed at improving their functional outcome: comprehensive–holistic neuropsychological rehabilitation, vocational-focused neuropsychological rehabilitation, and individual neuropsychological rehabilitation. Self-reported data regarding employment, community integration, perceived quality of life (PQoL), and mood were collected at program start and end, and annually for 3 years post program completion. Group placement was based on clinical considerations, such that the study did not aim to compare the programs, but rather to assess their long-term benefits.Results:Employment status and stability, community integration, and PQoL improved significantly after program completion and continued to improve for the following 3 years. The proportion of individuals with mood disturbances did not change during or after the programs.Conclusions:A clear consensus regarding BI rehabilitation is that long-term maintenance of treatment outcomes is imperative to its efficacy. Our findings suggest that postacute NR programs provide participants with various tools, skills, and psychological perspectives that they continue to gain from and generalize to real life after program completion, reflecting transformational processes with stable long-term benefits.

scholarly journals A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia

2021 ◽  
pp. 1-25
Author(s):  
Julie G. Kosteniuk ◽  
Debra G. Morgan ◽  
Valerie Elliot ◽  
Amanda Froehlich Chow ◽  
Melanie Bayly ◽  
...  
Keyword(s):  
Scoping Review ◽  
Systems Of Care ◽  
Adverse Outcomes ◽  
Community Based ◽  
Term Care ◽  
People With Dementia ◽  
Care Partners ◽  
The Individual ◽  
Discharge From Hospital

Abstract Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.

scholarly journals Managing diabetes in people with dementia: a realist review

2017 ◽  
Vol 21 (75) ◽  
pp. 1-140 ◽  
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Peter Reece Jones ◽  
Bridget Russell ◽  
Daksha Trivedi ◽  
...  
Keyword(s):  
Older People ◽  
Intervention Strategy ◽  
Realist Review ◽  
Cochrane Library ◽  
Future Research ◽  
Care Providers ◽  
Long Term Conditions ◽  
People With Dementia ◽  
Increased Risk

BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

scholarly journals Community-Based Interventions for the Treatment and Management of Conflict-Related Trauma in Low-Middle Income, Conflict-Affected Countries: a Realist Review

2021 ◽  
Author(s):  
Saleh Adel G. A. Al-Tamimi ◽  
Gerard Leavey
Keyword(s):  
Mental Health ◽  
Outcome Assessment ◽  
Realist Review ◽  
Assessment Tools ◽  
Community Based Interventions ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Manual Search ◽  
Low And Middle Income

AbstractWhere low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.

scholarly journals Architecture as third skin : spatial dimensions of stimuli for dementia care.

2021 ◽  
Author(s):  
Sebastian Lubczynski
Keyword(s):  
Dementia Care ◽  
Direct Care ◽  
Community Based ◽  
Term Care ◽  
Dementia Patients ◽  
People With Dementia ◽  
Spatial Dimensions ◽  
Short And Long Term ◽  
Mental And Physical Health

Our built environments have a direct correlation with our mental and physical health. This correlation is ever more evident with the process of ageing and the declining of neurological and physiological capacities of the human body. Architecture as Third Skin: Spatial Dimensions of Stimuli for Dementia Care thesis-project asserts that architecture, supported by evidence-based knowledge, can create an environment that triggers positive neurological changes in its users, negotiating the functional and social necessities of people with dementia in supporting their needs. The architectural model that informs this inquiry is explored through the design of a community-based Dementia Respite Care Centre, providing short and long term care as well as physical and mental therapy for those with early-to mid-stage dementia. Situated in Toronto, this thesis-project proposes a model that provides direct care for the specialized needs of dementia patients early in their illness condition to maintain independence and encourage living and ageing.

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