Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations

Abstract

Objectives

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs).

Methods

Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context.

Results

Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually.

Conclusion

Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

Keywords:

• Process evaluation
• e-Health
• dementia
• physical activity
• quality of life

Acknowledgements

We would like to thank the participating DCC, their staff, all research participants with dementia, and their informal caregivers. Additionally, we would like to thank Sjef van Bommel (Sjef van Bommel Management & Support), Judith Bosmans (VU University), Esther Hakvoort (Evean), Marije Holstege (GRZ Plus), Carla Scholten (Embedded Fitness), Joris Wiersinga and Marjolein Smit (SilverFit) for their contributions as project group members (together with co-authors), and everyone else involved in our process evaluation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, JvS, upon reasonable request.

Additional information

Funding

This research project was funded by ZonMw/Alzheimer Nederland (number 733050609) for personnel, material, and dissemination costs. Additional funding was obtained from Stichting Dioraphte (project number 16 02 04 03) and Foundation for Support VCVGZ. This research was carried out as part of the Marie Curie Innovative Training Network (ITN) [Interdisciplinary Network for Dementia Using Current Technology (INDUCT)] action, H2020-MSCA-ITN-2015, under grant agreement number 676265, which funded three years of the PhD trajectory of the first author. The exergaming equipment was paid for by the day-care centers themselves. However, they could purchase it at a discount from Embedded Fitness B.V. or SilverFit B.V.