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Title: Evaluating the implementation of interventions to improve independence in dementia
Author: Walton, Holly Jane
ISNI:       0000 0004 7660 0096
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2018
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To understand effects of psychological and social interventions for people with dementia, it is necessary to understand whether interventions are delivered as planned ('fidelity of delivery') and engaged with. This thesis aimed to evaluate the implementation of two interventions for people with dementia: the 'Promoting Independence in Dementia' intervention (PRIDE) and the 'Community Occupational Therapy in Dementia-UK' intervention (COTiD-UK). Three stages were followed: (i) systematically reviewing measures of fidelity and engagement in complex, face-to-face health behaviour change interventions, (ii) developing and using reliable measures to assess fidelity of PRIDE and COTiD-UK, and engagement with PRIDE, and (iii) identifying factors influencing fidelity and engagement and developing recommendations to improve these behaviours. Intervention sessions were audio-recorded and reliably rated for fidelity against fidelity checklists developed for PRIDE and COTiD-UK. Additionally, for PRIDE, dementia advice workers (DAWs) and participants completed checklists after each session. To identify factors influencing fidelity of, and engagement with PRIDE, interviews were conducted with DAWs, people with dementia and their supporters and analysed using thematic analysis and content analysis (informed by the COM-B model). The Behaviour Change Wheel was used to develop recommendations to improve fidelity and engagement. Reliable fidelity checklists were developed for PRIDE and COTiD-UK. Both interventions were delivered with at least moderate fidelity. Participants reported high levels of engagement with PRIDE. Knowledge, providers' attributes, ease of adaptation of PRIDE in relation to participants' needs and logistical considerations influenced fidelity. Participants' attributes, capability and opportunity influenced engagement. Recommendations to improve fidelity and engagement were developed to target barriers of opportunity and psychological capability. This thesis provides an applied example of how behavioural science can be used to evaluate and develop recommendations to improve the implementation of dementia interventions. If effective, recommendations may have the potential to improve implementation and help people to live well with dementia.
Supervisor: Michie, S. ; Spector, A. ; Tombor, I. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available