Implementing the Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: mixed-method process evaluation alongside a pragmatic randomised trial

Abstract

Objectives

The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package designed to improve the cognitive abilities, function and well-being of people with early-stage dementia and their carers, by providing a range of memory aids, together with appropriate training and support. This sub-study aimed to assess implementation and identify contextual factors potentially associated with participant outcomes.

Method

A mixed-methods approach was adopted alongside the pragmatic randomised trial. Data were obtained from intervention records and interviews with five dementia support practitioners across seven National Health Service Trusts in England and Wales. A reporting framework was constructed from available literature and data assessed by descriptive statistics and thematic analysis.

Results

Participation and engagement was high with 126 out of 128 participants completing the intervention with packages tailored to individual participants. Misplacing items and poor orientation to date and time were common areas of need. Memory aids frequently supplied included orientation clocks (91%), whiteboards (60%), calendars (43%) and notebooks (32%), plus bespoke items. Intervention duration and timing were broadly consistent with expectations. Variation reflected participants’ needs, circumstances and preferences. Qualitative findings suggested a potentially positive impact on the well-being of people with dementia and their carers. Issues associated with successful roll-out of the intervention are explored in the discussion.

Conclusion

Successful implementation increased confidence in future findings of the randomised trial. Depending on these, DESCANT may prove a scalable intervention with potential to improve the function and quality of life of people with dementia and their carers.

Keywords:

• Dementia
• pragmatic randomised trial
• intervention
• process evaluation
• mixed methods

Acknowledgements

The DESCANT research team acknowledges the support of the NIHR Clinical Research Network. Other members of the Programme Management Group were: Reagan Blyth (Pennine Care NHS Foundation Trust), Professor Linda Davies (University of Manchester), Dr David Jolley, Professor Narinder Kapur (University College London), Professor Fiona Poland (University of East Anglia), Professor Brenda Roe (Edge Hill University), Professor Chris Roberts and Jean Tottie (Together in Dementia Everyday). The team would also like to thank Professor Bob Woods for his assistance in developing the manual used for the DESCANT intervention and Professor Brenda Roe for her contribution to the training provided to the interviewers who collected the baseline data reported in this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (reference number: DTC-RP-PG-0311-12003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.