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Cognitive stimulation therapy in dementia care: exploring the views and experiences of service providers on the barriers and facilitators to implementation in practice using Normalization Process Theory

Published online by Cambridge University Press:  13 July 2017

Claire Dickinson ,
Grant Gibson ,
Zoe Gotts ,
Lynne Stobbart  and
Louise Robinson
Claire Dickinson
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Grant Gibson
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Zoe Gotts
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Lynne Stobbart
Affiliation:
Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
Louise Robinson*
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
*
Correspondence should be addressed to: Professor Louise Robinson, Institute of Health and Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK. Phone: +0191 2087013; Fax: +0191 2081101. Email: [email protected].
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Abstract

Background:

Cognitive stimulation therapy (CST) is an evidence-based, cost-effective psychosocial intervention for people with dementia but is currently not a standard part of post-diagnostic care. This qualitative study explored the views and experiences of dementia care providers on the barriers and facilitators to its implementation in usual care.

Method:

Thirty four semi-structured interviews (24 participants) were conducted across four dementia care sites in the North of England; ten were follow-up interviews. Data were analyzed using thematic analysis and then mapped to the Normalization Process Theory framework.

Results:

Participants considered CST a “good fit” with their “preferred” ways of working and goals of dementia care namely the provision of person-centered services. For facilitators delivering the intervention, compared to other behavioral interventions, CST was seen to offer benefits to their work and was easy to understand as an intervention. Training in CST and seeing benefits for clients were important motivators. Time and resources were crucial for the successful implementation of CST. Participants were keen to objectively measure benefits to participants but unsure how to do this.

Conclusions:

CST is a cost-effective psychosocial intervention for people with dementia, recommended by national guidance. Despite our findings which show that, using the NPT framework, there are more facilitators than barriers to the implementation of CST, it is still not a standard part of post-diagnostic dementia care. Further research is needed to explore the reasons for this implementation gap in ensuring evidence-based care in translated into practice.

Keywords

dementiacognitive stimulation therapypsychosocial interventioncommunity carepost-diagnostic care
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 11 , November 2017 , pp. 1869 - 1878
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Aguirre, E. et al. (2013). Cognitive stimulation therapy (CST) for people with dementia—who benefits most?. International Journal of Geriatric Psychiatry, 28, 284–290 . CrossRefGoogle Scholar
Bamford, C. et al. (2014). Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory. BMC Health Services Research, 14, 549. 10.1186/s12913-014-0549-6.CrossRefGoogle Scholar
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.CrossRefGoogle Scholar
D'Amico, F. et al. (2015). Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. Journal of the American Medical Directors Association, 16, 63–70.CrossRefGoogle ScholarPubMed
Department of Health (2009). Living well With Dementia: A National Dementia Strategy. London: Department of Health.Google Scholar
Department of Health (2015). Prime Minister's Challenge on Dementia 2020. London: Department of Health.Google Scholar
Finch, T. L., Bamford, C., Deary, V., Sabin, N. and Parry, S. W. (2014). Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development. BMC Health Services Research, 14, 436.CrossRefGoogle ScholarPubMed
Hodge, S., Hailey, E., Colwill, A., Walker, L. and Orrell, M. (2016). Memory Services National Accreditation Programme (MSNAP) (Pub. No. CCQ1221). London. Psychiatrists, R.C.o [Online]. Available at: http://www.rcpsych.ac.uk/PDF/MSNAP%20standards%205th%20edition.pdf.Google Scholar
House of Commons All Party Parliamentary Group on Dementia (2011). The £20 billion question; enquiry into cost effective dementia services. London.Google Scholar
Kitwood, T. (1997). The Person Comes First. Buckingham: Open University Press.Google Scholar
Knapp, M., Iemmi, V. and Romeo, R. (2013). Dementia care costs and outcomes: a systematic review. International Journal of Geriatric Psychiatry, 28, 551–561.CrossRefGoogle ScholarPubMed
Knapp, M. et al. (2006). Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. The British Journal of Psychiatry, 188, 574–580.CrossRefGoogle ScholarPubMed
May, C. and Finch, T. (2009). Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology, 43, 535–554.CrossRefGoogle Scholar
Murray, E. et al. (2010). Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Medicine, 8, 63. doi: 10.1186/1741-7015-8-63.CrossRefGoogle ScholarPubMed
National Audit Office (2007). Improving services and support for people with dementia. London. The Stationery Office [Online]. Available at: https://www.nao.org.uk/wp-content/uploads/2007/07/0607604.pdf.Google Scholar
National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence (NICE-SCIE) (2006). Dementia: supporting people with dementia and their carers in health and social care NICE guidelines [CG42] London: NICE/SCIE [Online]. Available at: www.nice.org.uk/guidance/cg42.Google Scholar
NICE-SCIE (2011). Dementia: supporting people with dementia and their carers in health and social care. Care guideline (amended March 2011). London: NICE-SCIE.Google Scholar
Orrell, M. et al. (2014). Maintenance cognitive stimulation therapy for dementia: single-blind, multicentre, pragmatic randomised controlled trial. The British Journal of Psychiatry, 204, 454–461.CrossRefGoogle ScholarPubMed
Orrell, M., Woods, B. and Spector, A. (2012)a. Should we use individual cognitive stimulation therapy to improve cognitive function in people with dementia?. BMJ, 344, e633.CrossRefGoogle ScholarPubMed
Orrell, M. et al. (2012b). Individual cognitive stimulation therapy for dementia (iCST): study protocol for a randomized controlled trial. Trials, 13, 1.CrossRefGoogle ScholarPubMed
Prince, M., Bryce, R. and Ferri, C. (2011) World Alzheimer Report 2011: The Benefits of Early Diagnosis and Intervention. London: Alzheimer's Disease International.Google Scholar
Spector, A., Davies, S., Woods, B. and Orrell, M. (2000). Reality orientation for dementia: a systematic review of the evidence of effectiveness from randomized controlled trials. The Gerontologist, 40, 206–212.CrossRefGoogle ScholarPubMed
Spector, A., Gardner, C. and Orrell, M. (2011). The impact of cognitive stimulation therapy groups on people with dementia: views from participants, their carers and group facilitators. Aging & Mental Health, 15, 945–949.CrossRefGoogle ScholarPubMed
Spector, A., Orrell, M., Davies, S. and Woods, B. (2001). Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia. Neuropsychological Rehabilitation, 11, 377–397.CrossRefGoogle Scholar
Spector, A. et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. The British Journal of Psychiatry, 183, 248–254.CrossRefGoogle ScholarPubMed
Streater, A., Aguirre, E., Spector, A. and Orrell, M. (2016). Cognitive stimulation therapy for people with dementia in practice: a service evaluation. British Journal of Occupational Therapy, doi: 10.11770308022616659886.Google Scholar
Tang, E. Y. H., Birdi, R. and Robinson, L. (2016). Attitudes to diagnosis and management in dementia care: views of future general practitioners. International Psychogeriatrics. Epub ahead of print. doi:10.1017/S1041610216001204.CrossRefGoogle Scholar
Turner, S. et al. (2004). ‘General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461–467.CrossRefGoogle ScholarPubMed
Woods, B., Aguirre, E., Spector, A. E. and Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database System Review, CD005562 Google ScholarPubMed