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- Blomberg, Oscar, et al.
(författare)
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Adaptation of a guided low-intensity behavioral activation intervention for people with dementia in Sweden : a qualitative study exploring the needs and preferences of key stakeholders
- 2024
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Ingår i: BMC Geriatrics. - : Springer. - 1471-2318. ; 24:113
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDespite depression being prevalent in people with dementia, contributing to negative health outcomes and placing increased burden on individuals and family members, access to psychological interventions is limited. A potential solution is guided low-intensity behavioral activation, supported by informal caregivers and guided by healthcare professionals. However, it is necessary to adapt interventions to meet the needs and preferences of key stakeholders to enhance acceptability and relevance. Study objectives were to: (1) explore needs and preferences concerning the content and delivery model of the guided low-intensity behavioral activation intervention; and (2) adapt the intervention to ensure cultural appropriateness, relevancy, and acceptability to people with dementia and their caregivers in Sweden.MethodsSemi-structured interviews and focus group discussions were conducted with key stakeholders, including healthcare professionals (n = 18), community stakeholders (n = 7), people with dementia (n = 8), and informal caregivers (n = 19). A draft of the written low-intensity behavioral activation intervention and a description of the proposed intervention delivery model were provided to participants. Open-ended questions explored the perceived relevance of the intervention, alongside needs and preferences concerning content and delivery. A manifest content analysis approach was adopted.ResultsContent analysis resulted in three categories: Content, Delivery procedures, and Illness trajectory. Results highlighted a need to consider the intervention Content via increased cultural adaptation to the Swedish context, and increasing the inclusiveness of intervention content. Delivery procedures were identified as needing to be flexible given the unpredictable nature of caring for people with dementia, with the provision of additional guidance to informal caregivers supporting the intervention. Illness trajectory was viewed as essential to consider, with the intervention regarded as suitable for those early in the dementia trajectory, alongside a need to reduce workbook text to minimize burden given dementia symptomology.ConclusionsThe intervention and proposed delivery model were generally well received by all stakeholders. We were able to identify key adaptations to enhance cultural appropriateness, relevancy, and acceptability for a currently neglected population. Results will inform a feasibility study to explore the feasibility and acceptability of the intervention and study procedures to inform the design of a future superiority randomized controlled trial.
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| 4. |
- Svedin, Frida, Doktorand, 1995-, et al.
(författare)
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Developing and adapting a guided low-intensity behavioral activation intervention targeting depression in people with dementia for the Swedish context (The INVOLVERA Study)
- 2022
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Konferensbidrag (refereegranskat)abstract
- Introduction: Dementia continues to increase worldwide, with numbers set to rise from 50 million in 2021 to 150 million by 2050. Global health and social care policies highlight a need to support people with dementia to ‘live well’. This is of particular importance given the high burden caused by dementia on individuals, informal caregivers, and society. Depression is highly prevalent in people with dementia. Whilst evidence-based psychological interventions (e.g. Cognitive Behavioral Therapy (CBT)) have been shown effective, access remains limited. To overcome this psychological ‘treatment gap’, global efforts have been made to increase access via provision of low-intensity CBT. Behavioral activation (BA), an example of an evidence-based low-intensity CBT approach, may represent a solution for people with dementia and depression in Sweden. Given the promise of BA, research was conducted in the United Kingdom to develop and examine feasibility of a low-intensity BA intervention tailored to people with dementia. Findings indicated the intervention feasible and acceptable to people with dementia and their informal caregivers. Given the promise of the intervention, development work has taken place in Sweden to maximise acceptability, relevancy, and feasibility in the Swedish context.Method: A mixed-methods study involving people with dementia, informal caregivers, healthcare professionals, and non-governmental organisations (NGOs) to co-design and adapt the intervention for the Swedish context. Through iterative phases, interviews and focus groups were conducted with all stakeholders to gain feedback on the intervention. Results informed adaptations to improve intervention acceptability, relevancy, and feasibility. Interviews and focus groups were analysed using framework content analysis according to Normalization Process Theory (NPT) constructs (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring). Alongside, a Public Involvement group was established to further inform the intervention design.Results: Preliminary results indicate facilitators include: (1) intervention has the potential to fill a large psychological treatment gap given lack of current support (Coherence); (2) objectives and potential benefits of intervention were understood and agreed by stakeholders (Coherence). Barriers include: (1) lack of involvement and engagement from politicians, decision-makers, and managers (Collective Action); (2) lack of appropriate workforce providing guidance to the intervention in Sweden (Collective Action); (3) NGOs not recognising their potential role in the intervention (Cognitive Participation); (4) lack of time and financial resources (Collective Action); (5) healthcare professionals and NGOs acting gatekeepers for informal caregivers accessing support (Cognitive Participation).Discussion: Psychological needs of people with dementia and depression are currently unmet by Swedish healthcare. The proposed intervention has potential to meet unmet psychological needs and global priorities to support people with dementia to ‘live well’. Given barriers to intervention implementation are common, NPT provides a useful framework for understanding potential barriers and facilitators to implementation from the intervention development phase. Understanding barriers and facilitators to implementation at the intervention development phase may enhance future implementation potential if intervention is shown effective.Conclusion: Results inform the development of a tailored intervention, optimised to improve maximise acceptability, relevancy, and feasibility for people with dementia and depression. A subsequent feasibility study will further examine the feasibility and acceptability of the intervention.
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| 5. |
- Svedin, Frida, Doktorand, 1995-, et al.
(författare)
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Development and co-design of a behavioral activation intervention targeting depression among people with dementia for the Swedish context
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background: Approximately 40% of people with dementia experience depression. Whilst psychological interventions are effective for the treatment of depression in dementia, access remains low. A behavioural activation self-help intervention, with support to the person with dementia to use the intervention provided by an informal caregiver, who themselves receives guidance from an occupational therapist (or other trained healthcare professional), may represent a solution.Objective: To develop a behavioral activation intervention targeting depression among people with dementia for the Swedish context together with key stakeholders.Methods: Semi-structured interviews and focus groups were held with people with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and non-governmental organisations (n=7) and analysed using manifest content analysis. A Public Advisory Group, consisting of informal caregivers of people with dementia (n=4), worked alongside the research team to support the interpretation and sense-making of research findings and co-design of the intervention.Results: An overarching theme ‘Tailoring and flexibility’ resulted from interviews and focus groups. Stakeholders expressed a need to adapt intervention material to increase relevancy and representativeness by: (1) adding multiple case stories to illustrate different life situations, age groups, ethnic backgrounds, and to increase relevance to Swedish society and culture; (2) designing new illustrations, as proposed illustrations were perceived old-fashioned and reinforced ageing and dementia stereotypes; and (3) reducing text to minimize treatment burden. Stakeholders also expressed a need for flexibility concerning intervention delivery and expressed a need for choice concerning: (1) location of guidance sessions to enable face-to-face sessions to be delivered in a familiar, safe, and convenient environment (e.g., home or familiar community setting); (2) mode of guidance (e.g., face-to-face, telephone, online); and (3) amount of guidance (e.g., frequency and number of guidance sessions).Conclusions: Results informed the development of a tailored intervention, optimised to improve acceptability, feasibility, and relevancy for people with dementia and depression. A planned feasibility study will further examine feasibility and acceptability of the intervention.Public involvement: Our Public Advisory Group has worked closely together with the research team to support the interpretation and sense-making of research findings and co-design the intervention to increase acceptability and relevancy of the intervention.
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- Svedin, Frida, Doktorand, 1995-, et al.
(författare)
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Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment : protocol for a mixed-methods systematic review
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting.Methods and analysis: Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide.Ethics and dissemination: No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries.PROSPERO registration number: CRD42023400514.
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| 7. |
- Svedin, Frida, Doktorand, 1995-, et al.
(författare)
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Healthcare and community stakeholders' perceptions of barriers and facilitators to implementing a behavioral activation intervention for people with dementia and depression : a qualitative study using Normalization Process Theory
- 2023
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDepression is commonly experienced by people with dementia, and associated with lower quality of life and functional decline. However, access to evidence-based psychological interventions for people with dementia and depression is limited. One potential solution is guided low-intensity behavioral activation. Following the new Medical Research Council Framework, considering factors such as potential barriers and facilitators to implementation is recommended during the development of new interventions. Aims of this study were to: (1) develop an understanding of existing healthcare and community support in the Swedish context for people with dementia and their informal caregivers; and (2) identify barriers and facilitators to intervention uptake informed by Normalization Process Theory.MethodsSemi-structured interviews and focus groups were held with healthcare (n = 18) and community (n = 7) stakeholders working with people with dementia and/or informal caregivers. Interview questions were informed by Normalization Process Theory. Data was analysed utilizing a two-step deductive analysis approach using the Normalization Process Theory coding manual, with inductive categories applied to data related to the main mechanisms of the theory, but not captured by its sub-constructs.ResultsTwelve deductive and three inductive categories related to three Normalization Process Theory primary mechanisms (Coherence, Cognitive Participation, and Collective Action) were identified. Identified barriers to intervention uptake included: (1) additional burden for informal caregivers; (2) lack of appropriate workforce to provide guidance; (3) lack of time and financial resources; (4) people with dementia not recognising their diagnosis of dementia and/or a need for support; and (5) stigma. Identified facilitators to intervention uptake included: (1) intervention has potential to fill a large psychological treatment gap in Sweden; (2) objectives and potential benefits understood and agreed by most stakeholders; and (3) some healthcare professionals recognized their potential role in providing intervention guidance.ConclusionsSeveral barriers and facilitators for future implementation, specific to the intervention, individuals and families, as well as professionals, were identified during intervention development. Barriers were mapped into evidence-based implementation strategies, which will be adopted to overcome identified barriers. A feasibility study further examining implementation potential, acceptability and feasibility, alongside clinical, methodological, and procedural uncertainties associated with the intervention will be conducted.
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| 8. |
- Svedin, Frida, Doktorand, 1995-, et al.
(författare)
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Professional stakeholders’ perceptions of barriers and facilitators to implementing a behavioural activation intervention for people with dementia
- 2024
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Konferensbidrag (refereegranskat)abstract
- Introduction: Depression is commonly experienced by people with dementia. Whilst evidence-based psychologicalinterventions are effective, a large psychological care gap remains. Behavioral activation may representa potential solution to close this gap. Following the MRC Framework for developing complexinterventions, considering potential barriers and facilitators to implementation is recommended duringintervention development. This study aimed to identify professional stakeholders’ perceptions of barriersand facilitators to future implementation.Methods: Following a topic guide informed by Normalization Process Theory (NPT), focus groups and semistructuredinterviews were held with healthcare professionals (n=18) and community stakeholders (n=7).Data was analyzed using the NPT coding manual, with inductive categories generated for data related tomain NPT mechanisms, but not captured by its sub-constructs.Results: A number of barriers and facilitators were identified. Facilitators include the proposed intervention: (1)has potential to fill a large psychological care gap; (2) has understandable and agreed upon objectivesand potential benefits; and (3) could easily be integrated into the lives of people with dementia and theirinformal caregivers. Barriers include lack of: (1) engagement from politicians and decision-makers; (2)appropriate workforce to provide intervention guidance; (3) time and financial resources.Conclusions: Results have informed the adaptation of a tailored intervention, optimized to improve futureimplementation potential. A subsequent feasibility study will further examine intervention feasibility andacceptability.
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