Implementation of the PrAISED (Promoting Activity, Independence and Stability in Early Dementia) intervention in practice: a mixed methods study

BackgroundThere is a paucity of evidence relating to the implementation of interventions for dementia care. The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a 12-month, home-based, individually tailored rehabilitation programme, delivered by therapists and rehabilitation support workers, with a focus on strength, balance, physical activity and activities of daily living which has been tested in a randomised controlled trial (RCT). The aim of this study was to identify what is required to implement PrAISED, or similar interventions, in a real-world setting in routine practice. MethodsA 6-month version of PrAISED was delivered as a pilot service in one National Health Service organisation in England. Adaptations were made to intervention processes to facilitate the delivery of PrAISED as a service instead of as part of a research study. The number and duration of visits for each patient were recorded by intervention delivery staff and were summarised using descriptive statistics. Semi-structured interviews were conducted with seven members of staff delivering the PrAISED pilot service (two managers, five delivery staff) and eight members of staff from other sites involved in the PrAISED RCT (four managers, four delivery staff). The Consolidated Framework for Implementation Research was used to inform interview guides and conduct a codebook thematic analysis. ResultsBetween April and November 2022, 11 patients were referred to, and participated in, the service. Patients received on average 20.9 visits (mean duration 82.1 mins). Five themes were identified from interviews relating to the pilot service: operational processes; workforce capacity; referral; intervention delivery and patient impact. A further six themes were identified regarding the wider implementation of dementia therapy programmes: the need for support post-dementia diagnosis; acceptability; effective delivery; reach/referral; intervention design and adaptability; and intervention materials and training. ConclusionsInterventions like PrAISED are needed to fill a gap in support immediately post-dementia diagnosis. Future implementation in practice will require attention to the identification of intervention funding; leadership and management; time to establish operational processes; therapists with appropriate skills and experience; providing training and resources to support intervention delivery; defining patient eligibility, refining referral processes; and maintaining fidelity of the intervention.