Rai, Harleen Kaur
(2021)
Adapting individual Cognitive Stimulation Therapy (iCST) for delivery by a touch-screen application for people with dementia.
PhD thesis, University of Nottingham.
Abstract
Introduction: people with dementia may benefit from technology to enhance their quality of life (QoL), reduce social isolation and potentially improve cognition. Adapting existing interventions to digital platforms is a promising approach with prospective benefits. Group Cognitive Stimulation Therapy (CST) for people with dementia can benefit cognition and QoL. Individual CST (iCST) is delivered by a carer at home and can improve the relationship quality between the person with dementia and carer, and the QoL of carers. Given the lack of technological resources for the mental stimulation and engagement of people with dementia, there are potential benefits of combining iCST with touch-screen technology, which include improving global accessibility to iCST.
Aims: to develop and evaluate a touch-screen version of iCST, and examine its potential for implementation internationally.
Methods: this study employed a mixed methods approach to the development and evaluation of a novel iCST app. Development included a narrative synthesis systematic review supported by the Medical Research Council (MRC) Framework and the Centre for eHealth Research (CeHRes) roadmap, and following principles of action research and the agile approach to software development. Forty-one people with dementia and carers were involved in patient and public involvement (PPI) consultation meetings, focus groups, individual interviews, and usability questionnaires. Evaluation included a two-arm, feasibility randomised controlled trial (RCT) (n = 43) to investigate the usability of the iCST app, and feasibility of conducting a large-scale RCT. Three dyads participated in semi-structured, post- trial interviews. Feasibility of cultural adaptation and implementation internationally was investigated in Indonesia where 39 people with dementia, carers, and healthcare professionals participated in focus groups and a stakeholder meeting.
Results: the systematic review led to best practice guidelines on how to optimise involvement of people with dementia in technology development. These guidelines informed the development of the iCST app through three iterative prototypes. The idea of an iCST app was well received in PPI consultation meetings, and feedback indicated that the design and navigation of the prototypes were appropriate. A need for a wider range of more relevant activities was identified in the focus groups and interviews. The third prototype of the iCST app was used for the feasibility RCT. Carers using the iCST app rated their QoL better at follow-up 2 (FU2) compared to the treatment as usual (TAU) control group (EQ-5D, MD = 6.34, 95% CI = .92 – 11.76, p = .02). No other significant differences were found. The exploratory work in Indonesia indicated that it is feasible to implement the iCST app given appropriate cultural adaptation and provided that logistical barriers to accessibility have been overcome.
Conclusions: this is the first study to develop and evaluate an interactive, touch- screen version of iCST. Findings indicate certain modifications to the trial components including increased recruitment capacity and sample size, and an augmented version of the iCST app. Expansion of the iCST app is needed as most participants completed the activities more quickly than anticipated and therefore, did not receive the recommended dose. Given these adaptations to the study design, it is recommended to conduct a large-scale RCT to investigate formal effectiveness.
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