Top

BMC Geriatrics

Published in:

Open Access 01-12-2023 | Dementia | Research

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

Authors: Frida Svedin, Oscar Blomberg, Anders Brantnell, Paul Farrand, Anna Cristina Åberg, Joanne Woodford

Published in: BMC Geriatrics | Issue 1/2023

Abstract

Background

Depression 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.

Methods

Semi-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.

Results

Ten 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.

Conclusions

Several 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.

Trial registration

Not applicable.

Available only for authorised users

GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–25. https://doi.org/10.1016/S2468-2667(21)00249-8.CrossRef

Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginsonet IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7(7):e883–8e892. https://doi.org/10.1016/S2214-109X(19)30172-X.CrossRefPubMedPubMedCentral

Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734. https://doi.org/10.1016/S0140-6736(17)31363-6.CrossRefPubMed

Alzheimer’s disease facts and figures. Alzheimers Dement. 2022;18(4):700–89. https://doi.org/10.1002/alz.12638.CrossRef

Velandia PP, Miller-Petrie MK, Chen C, Chakrabarti S, Chapin A, Hay S, et al. Global and regional spending on dementia care from 2000–2019 and expectd future health spending scenarios from 2020–2050: an economic modelling exercise. EClinicalMedicine. 2022;45: 101337. https://doi.org/10.1016/j.eclinm.2022.101337.CrossRefPubMedPubMedCentral

Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021;36(9):1330–44. https://doi.org/10.1002/gps.5556.CrossRefPubMed

Orgeta V, Leung P, Del-Pino-Casado R, Qazi A, Orrell M, Spector AE, et al. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2022;4(4):CD009125. https://doi.org/10.1002/14651858.CD009125.pub3.CrossRefPubMed

Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemiet M, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. BMJ. 2021;372:n532. https://doi.org/10.1136/bmj.n532.CrossRefPubMedPubMedCentral

Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, et al. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: evidence from national healthcare records in England. EClinicalMedicine. 2022;52: 101692. https://doi.org/10.1016/j.eclinm.2022.101692.CrossRefPubMedPubMedCentral

10.

Black BS, Johnston D, Leoutsakos J, Reuland M, Kelly J, Amjad H, et al. Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics. Int Psychogeriatr. 2019;31(11):1643–54. https://doi.org/10.1017/S1041610218002296.CrossRefPubMedPubMedCentral

11.

Bergmann S, Peper J, Bieber A. The use of formal care for dementia from a professional perspective: a scoping review. BMC Health Serv Res. 2022;22(1):825. https://doi.org/10.1186/s12913-022-08229-2.CrossRefPubMedPubMedCentral

12.

Stephan A, Bieber A, Hopper L, Joyce R, Irving K, Zanetti O, et al. Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatr. 2018;18(1):131. https://doi.org/10.1186/s12877-018-0816-1.CrossRefPubMedPubMedCentral

13.

Farrand P. Low-Intensity CBT skills and interventions: a practitioners′ manual. London: SAGE Publications Ltd; 2020.

14.

Rebello TJ, Marques A, Gureje O, Pike KM. Innovative strategies for closing the mental health treatment gap globally. Curr Opin Psychiatry. 2014;27(4):308–14. https://doi.org/10.1097/YCO.0000000000000068.CrossRefPubMed

15.

Farrand P, Dawes A, Doughty M, Phull S, Saines S, Winter S, et al. Development and application of criteria to evaluate written CBT self-help interventions adopted by improving access to psychological therapies services. Cognitive Behav Ther. 2022;15:28. https://doi.org/10.1017/S1754470X22000241.CrossRef

16.

Cuijpers P, Noma H, Karyotaki E, Cipriani A, Furukawa TA. Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis. JAMA Psychiatry. 2019;17:700–7. https://doi.org/10.1001/jamapsychiatry.2019.0268. [published correction appears in JAMA Psychiatry. 2022 Feb 1;79(2):180]. JAMA Psychiatry. 2019;76(7):700-7.CrossRef

17.

Farrand P, Woodford J. Impact of support on the effectiveness of written cognitive behavioural self-help: a systematic review and meta-analysis of randomised controlled trials. Clin Psychol Rev. 2013;33(1):182–95. https://doi.org/10.1016/j.cpr.2012.11.001.CrossRefPubMed

18.

Farrand P, Pentecost C, Greaves C, et al. A written self-help intervention for depressed adults comparing behavioural activation combined with physical activity promotion with a self-help intervention based upon behavioural activation alone: study protocol for a parallel group pilot randomised controlled trial (BAcPAc). Trials. 2014;15:196. https://doi.org/10.1186/1745-6215-15-196.CrossRefPubMedPubMedCentral

19.

Wagener A, Baeyens C, Blairy S. Depressive symptomatology and the influence of the behavioral avoidance and activation: a gender-specific investigation. J Affect Disord. 2016;193:123–9. https://doi.org/10.1016/j.jad.2015.12.040.CrossRefPubMed

20.

Kerkhof Y, Pelgrum-Keurhorst M, Mangiaracina F, Bergsma A, Vrauwdeunt G, Graff M, et al. User-participatory development of FindMyApps; a tool to help people with mild dementia find supportive apps for self-management and meaningful activities. Digit Health. 2019;5:2055207618822942. https://doi.org/10.1177/2055207618822942.CrossRefPubMedPubMedCentral

21.

Quinn C, Pickett JA, Litherland R, Morris RG, Martyr A, Clare L, et al. Living well with dementia: what is possible and how to promote it. Int J Geriatr Psychiatry. 2022;37(1). https://doi.org/10.1002/gps.5627.

22.

Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374: n2061. https://doi.org/10.1136/bmj.n2061.CrossRefPubMedPubMedCentral

23.

Farrand P, Woodford J, Llewellyn D, Anderson M, Venkatasubramanian S, Ukoumunne OC, et al. Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE): a study protocol for a single-arm feasibility study. Pilot Feasibil Stud. 2016;2:42. https://doi.org/10.1186/s40814-016-0083-x.CrossRef

24.

Farrand P, Woodford J, Small F. Behavioural activation self-help to improve depression in people living with dementia: the promote treatment protocol. NZ J Psychol. 2017;46:51.

25.

Moore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, et al. Adapting interventions to new contexts - the ADAPT guidance. BMJ. 2021;374: n1679. https://doi.org/10.1136/bmj.n1679.CrossRefPubMedPubMedCentral

26.

O’Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8): e029954. https://doi.org/10.1136/bmjopen-2019-029954.CrossRefPubMedPubMedCentral

27.

Turner J, Martin G, Hudson N, Shaw L, Huddlestone L, Weis C, et al. Using Normalisation Process Theory (NPT) to develop an intervention to improve referral and uptake rates for self-management education for patients with type 2 diabetes in UK primary care. BMC Health Serv Res. 2022;22(1):1206. https://doi.org/10.1186/s12913-022-08553-7.CrossRefPubMedPubMedCentral

28.

Fernandez ME, Ten Hoor GA, van Lieshout S, Rodriguez SA, Beidas RS, Parcel G, et al. Implementation mapping: using intervention mapping to develop implementation strategies. Front Public Health. 2019;7:158. https://doi.org/10.3389/fpubh.2019.00158.CrossRefPubMedPubMedCentral

29.

Petkovic J, Riddle A, Akl EA, Khabsa J, Lytvyn L, Atwere P, et al. Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Syst Rev. 2020;9(1):21. https://doi.org/10.1186/s13643-020-1272-5.CrossRefPubMedPubMedCentral

30.

May CR, Cummings A, Girling M, Bracher M, Mair FS, May CM, et al. Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implement Sci. 2018;13(1):80. https://doi.org/10.1186/s13012-018-0758-1.CrossRefPubMedPubMedCentral

31.

May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43:535–54. https://doi.org/10.1177/0038038509103208.CrossRef

32.

Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010;8:63. https://doi.org/10.1186/1741-7015-8-63.CrossRefPubMedPubMedCentral

33.

Dack C, Ross J, Stevenson F, Pal K, Gubert E, Michie S, et al. A digital self-management intervention for adults with type 2 diabetes: combining theory, data and participatory design to develop HeLP-Diabetes. Internet Interv. 2019;17: 100241. https://doi.org/10.1016/j.invent.2019.100241.CrossRefPubMedPubMedCentral

34.

Mills K, Griffin SJ, Sutton S, Usher-Smith JA. Development and usability testing of a very brief intervention for personalised cancer risk assessment to promote behaviour change in primary care using normalisation process theory. Prim Health Care Res Dev. 2020;21: e1. https://doi.org/10.1017/S146342361900080X.CrossRefPubMedPubMedCentral

35.

Svedin F, Brantnell A, Farrand P, Blomberg O, Coumoundouros C, von Essen L, et al. Adapting a guided low-intensity behavioural activation intervention for people with dementia and depression in the Swedish healthcare context (INVOLVERA): a study protocol using codesign and participatory action research. BMJ Open. 2021;11(7): e048097. https://doi.org/10.1136/bmjopen-2020-048097.CrossRefPubMedPubMedCentral

36.

Morgan DL. Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods. J Mix Methods Res. 2007;1(1):48–76. https://doi.org/10.1177/2345678906292462.CrossRef

37.

Morgan DL. Pragmatism as a paradigm for social research. Qual Inq. 2014;20(8):1045–53. https://doi.org/10.1177/1077800413513733.CrossRef

38.

Elf M, Nordmark S, Lyhagen J, Lindberg I, Finch T, Åberg AC. The Swedish version of the Normalization Process theory measure S-NoMAD: translation, adaptation, and pilot testing. Implement Sci. 2018;13(1):146. https://doi.org/10.1186/s13012-018-0835-5.CrossRefPubMedPubMedCentral

39.

Goeman D, Michael J, King J, Luu H, Emmanuel C, Koch S. Partnering with consumers to develop and evaluate a Vietnamese Dementia Talking-Book to support low health literacy: a qualitative study incorporating. BMJ Open. 2016;6(9): e011451. https://doi.org/10.1136/bmjopen-2016-011451.CrossRefPubMedPubMedCentral

40.

Baum F, MacDougall C, Smith D. Participatory action research. J Epidemiol Community Health. 2006;60(10):854–7. https://doi.org/10.1136/jech.2004.028662.CrossRefPubMedPubMedCentral

41.

Masterson D, Areskoug Josefsson K, Robert G, Nylander E, Kjellström S. Mapping definitions of co-production and co-design in health and social care: a systematic scoping review providing lessons for the future. Health Expect. 2022;25(3):902–13. https://doi.org/10.1111/hex.13470.CrossRefPubMedPubMedCentral

42.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51. https://doi.org/10.1097/ACM.0000000000000388.CrossRefPubMed

43.

Meijer E, Casanova M, Kim H, Llena-Nozal A, Lee J. Economic costs of dementia in 11 countries in Europe: Estimates from nationally representative cohorts of a panel study. Lancet Reg Health Eur. 2022;20: 100445. https://doi.org/10.1016/j.lanepe.2022.100445.CrossRefPubMedPubMedCentral

44.

Nygren M, Roback K, Öhrn A, Rutberg H, Rahmqvist M, Nilsen P. Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils. BMC Health Serv Res. 2013;13:52. https://doi.org/10.1186/1472-6963-13-52.CrossRefPubMedPubMedCentral

45.

Socialtjänstlagen. 2001:453. Socialtjänstlagen, Stockholm: Riksdagen, 2001. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/socialtjanstlag-2001453_sfs-2001-453/. Accessed 01 Dec 2023.

46.

Robinson OC. Sampling in interview-based qualitative research: a theoretical and practical guide. Qual Res Psychol. 2014;11(1):25–41. https://doi.org/10.1080/14780887.2013.801543.CrossRef

47.

Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. Am J Theor Appl. 2016;5(1):1–4. https://doi.org/10.11648/j.ajtas.20160501.11.CrossRef

48.

Leighton K, Kardong-Edgren S, Schneidereith T, Foisy-Doll C. Using social media and snowball sampling as an alternative recruitment strategy for research. Clin Simul. 2021;55:37–42. https://doi.org/10.1016/j.ecns.2021.03.006.CrossRef

49.

Hagström J, Woodford J, von Essen A, Lähteenmäki P, von Essen L. Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey. BMJ Open. 2022;12(4): e056758. https://doi.org/10.1136/bmjopen-2021-056758.CrossRefPubMedPubMedCentral

50.

Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression: an update of meta-analysis of effectiveness and sub group analysis. PLos One. 2014;9(6): e100100. https://doi.org/10.1371/journal.pone.0100100.CrossRefPubMedPubMedCentral

51.

May C, Rapley T, Mair FS, Treweek S, Murray E, Ballini L, et al. Normalization process theory on-line users’ manual, toolkit and NoMAD instrument. 2015. https://normalization-process-theory.northumbria.ac.uk/. Accessed June 19 2023.

52.

May CR, Albers B, Bracher M, Finch TL, Gilberg A, Girling M, et al. Translational framework for implementation evaluation and research: a Normalisation Process Theory coding manual for qualitative research and instrument development. Implement Sci. 2022;17(1):19. https://doi.org/10.1186/s13012-022-01191-x.CrossRefPubMedPubMedCentral

53.

QSR International Ptd Ltd. QSR NVivo. 2023. https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home.

54.

Bonner C, Tuckerman J, Kaufman J, et al. Comparing inductive and deductive analysis techniques to understand health service implementation problems: a case study of childhood vaccination barriers. Implement Sci Commun. 2021;2(1):100. https://doi.org/10.1186/s43058-021-00202-0.CrossRefPubMedPubMedCentral

55.

Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45(3):214–22. https://doi.org/10.5014/ajot.45.3.214.CrossRefPubMed

56.

Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: a focus on trustworthiness. SAGE Open. 2014;4:1–10. https://doi.org/10.1177/2158244014522633.CrossRef

57.

IAPT2 International Federation. Spectrum of public participation. 2018. https://cdn.ymaws.com/www.iap2.org/resource/resmgr/pillars/Spectrum_8.5x11_Print.pdf. Accessed June 19 2023.

58.

Socialstyrelsen. Nationella riktlinjer – utvärdering 2018. Vård och omsorg vid demenssjukdom 2018. Indikatorer och underlag för bedömningar. Stockholm: Socialstyrelsen, 2018. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2018-3-2.pdf. Accessed 01 Dec 2023.

59.

Socialstyrelsen. Nationella riktlinjer för vård och omsorg vid demenssjukdom: stöd för styrning och ledning. Stockholm: Socialstyrelsen, 2017. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2017-12-2.pdf. Accessed 01 Dec 2023.

60.

Brantnell A, Woodford J, Baraldi E, van Achterberg T, von Essen L. Views of implementers and nonimplementers of internet-administered cognitive behavioral therapy for depression and anxiety: survey of primary care decision makers in Sweden. J Med Internet Res. 2020;22(8): e18033. https://doi.org/10.2196/18033.CrossRefPubMedPubMedCentral

61.

Sutton E, Herbert G, Burden S, Lewis S, Thomas S, Ness A, et al. Using the Normalization Process theory to qualitatively explore sense-making in implementation of the enhanced recovery after surgery programme: “It’s not rocket science.” PLoS One. 2018;13(4):e0195890. https://doi.org/10.1371/journal.pone.0195890. [published correction appears in PLoS One. 2018 May 17;13(5):e0197790].CrossRefPubMedPubMedCentral

62.

Coupe N, Anderson E, Gask L, Sykes P, Richards DA, Chew-Graham C. Facilitating professional liaison in collaborative care for depression in UK primary care: a qualitative study utilising normalisation process theory. BMC Fam Pract. 2014;15:78. https://doi.org/10.1186/1471-2296-15-78.CrossRefPubMedPubMedCentral

63.

Lloyd A, Joseph-Williams N, Edwards A, Rix A, Elwyn G. Patchy “coherence”: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC). Implement Sci. 2013;8:102. https://doi.org/10.1186/1748-5908-8-102.CrossRefPubMedPubMedCentral

64.

Kok G, Gottlieb NH, Peters GJ, Mullen PD, Parcel GS, Ruiter RAC, et al. A taxonomy of behaviour change methods: an Intervention Mapping approach. Health Psychol Rev. 2016;10(3):297–312. https://doi.org/10.1080/17437199.2015.1077155.CrossRefPubMed

65.

Kousgaard MB, Olesen JA, Arnold SH. Implementing an intervention to reduce use of antibiotics for suspected urinary tract infection in nursing homes - a qualitative study of barriers and enablers based on Normalization Process Theory. BMC Geriatr. 2022;22(1):265. https://doi.org/10.1186/s12877-022-02977-w.CrossRefPubMedPubMedCentral

66.

Nguyen T, Li X. Understanding public-stigma and self-stigma in the context of dementia: a systematic review of the global literature. Dementia (London). 2020;19(2):148–81. https://doi.org/10.1177/1471301218800122.CrossRefPubMed

67.

Odzakovic E, Hellström I, Nedlund AC, Kullberg A. Health promotion initiative: a dementia-friendly local community in Sweden. Dementia (London). 2021;20(6):1971–87. https://doi.org/10.1177/1471301220977736.CrossRefPubMed

68.

Nair P, Bhanu C, Frost R, Buszewicz M, Walters KR. A systematic review of older adults’ attitudes towards depression and its treatment. Gerontologist. 2020;60(1):e93–104. https://doi.org/10.1093/geront/gnz048.CrossRefPubMed

69.

Kenning C, Daker-White G, Blakemore A, Panagioti M, Waheed W. Barriers and facilitators in accessing dementia care by ethnic minority groups: a meta-synthesis of qualitative studies. BMC Psychiatry. 2017;17(1):316. https://doi.org/10.1186/s12888-017-1474-0.CrossRefPubMedPubMedCentral

70.

Parker M, Barlow S, Hoe J, Aitken L. Persistent barriers and facilitators to seeking help for a dementia diagnosis: a systematic review of 30 years of the perspectives of carers and people with dementia. Int Psychogeriatr. 2020;1–24. https://doi.org/10.1017/S1041610219002229.

71.

Wollney EN, Armstrong MJ, Bedenfield N, Rosselli M, Curiel-Cid RE, Kitaigorodsky M, et al. Barriers and best practices in disclosing a dementia diagnosis: a clinician interview study. Health Serv Insights. 2022;15:11786329221141828. https://doi.org/10.1177/11786329221141829.CrossRefPubMedPubMedCentral

72.

Wakefield S, Kellett S, Simmonds-Buckley M, Stockton D, Bradbury A, Delgadillo J. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: a systematic review and meta-analysis of 10-years of practice-based evidence. Br J Clin Psychol. 2021;60(1):1–37. https://doi.org/10.1111/bjc.12259.CrossRefPubMed

73.

Rivero-Santana A, Perestelo-Perez L, Alvarez-Perez Y, Ramos-Garcia V, Duarte-Diaz A, Linertova R, et al. Stepped care for the treatment of depression: a systematic review and meta-analysis. J Affect Disord. 2021;294:391–409. https://doi.org/10.1016/j.jad.2021.07.008.CrossRefPubMed

74.

Moroz N, Moroz I, D’Angelo MS. Mental health services in Canada: barriers and cost-effective solutions to increase access. Healthc Manage Forum. 2020;33(6):282–7. https://doi.org/10.1177/0840470420933911.CrossRefPubMed

75.

Bartram M. Expanding access to psychotherapy in Canada: building on achievements in Australia and the United Kingdom. Healthc Manage Forum. 2019;32(2):63–7. https://doi.org/10.1177/0840470418818581.CrossRefPubMed

76.

Cromarty P, Drummond A, Francis T, Watson J, Battersby M. NewAccess for depression and anxiety: adapting the UK improving access to psychological therapies program across Australia. Australas Psychiatry. 2016;24(5):489–92. https://doi.org/10.1177/1039856216641310.CrossRefPubMed

77.

Cano-Vindel A, Ruiz-Rodríguez P, Moriana JA, et al. Improving Access to Psychological Therapies in Spain: From IAPT to PsicAP. Psicothema. 2022;34(1):18–24. https://doi.org/10.7334/psicothema2021.113.CrossRefPubMed

78.

Lange KW. Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. Glob Health J. 2021;5(3):120–7. https://doi.org/10.1016/j.glohj.2021.07.001.CrossRef

79.

Donnelly C, Leclair L, Hand C, Wener P, Letts L. Occupational therapy services in primary care: a scoping review. Prim Health Care Res Dev. 2023;24: e7. https://doi.org/10.1017/S1463423622000123.CrossRefPubMedPubMedCentral

80.

Leong SL, Teoh SL, Fun WH, Lee SWH. Task shifting in primary care to tackle healthcare worker shortages: an umbrella review. Eur J Gen Pract. 2021;27(1):198–210. https://doi.org/10.1080/13814788.2021.1954616.CrossRefPubMedPubMedCentral

81.

Holloway I, Galvin K. Qualitative research in nursing and healthcare (Fourth edition). Chichester: John Wiley & Sons, Ltd; 2016.

82.

Collins N, Corna L. General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study. BJPsych Bull. 2018;42(3):115–8. https://doi.org/10.1192/bjb.2018.10.CrossRefPubMedPubMedCentral

83.

Boots LM, de Vugt ME, Smeets CM, Kempen GI, Verhey FR. Implementation of the Blended Care Self-Management Program for caregivers of people with early-stage dementia (partner in balance): process evaluation of a randomized controlled trial. J Med Internet Res. 2017;19(12): e423. https://doi.org/10.2196/jmir.7666.CrossRefPubMedPubMedCentral

84.

Leslie M, Khayatzadeh-Mahani A, MacKean G. Recruitment of caregivers into health services research: lessons from a user-centred design study. Res Involv Engagem. 2019;5:17. https://doi.org/10.1186/s40900-019-0150-6.CrossRefPubMedPubMedCentral

85.

Huddlestone L, Turner J, Eborall H, Hudson N, Davies M, Martin G. Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review. BMC Fam Pract. 2020;21(1):52. https://doi.org/10.1186/s12875-020-01107-y.CrossRefPubMedPubMedCentral

86.

Quinn C, Clare L, McGuinness T, Woods RT. Negotiating the balance: the triadic relationship between spousal caregivers, people with dementia and Admiral Nurses. Dementia (London). 2013;12(5):588–605. https://doi.org/10.1177/1471301212437780.CrossRefPubMed

87.

Band R, Bradbury K, Morton K, et al. Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach. Implement Sci. 2017;12(1):25. https://doi.org/10.1186/s13012-017-0553-4.CrossRefPubMedPubMedCentral

88.

Socialstyrelsen. Nationella riktlinjer – Målnivåer. Vård och omsorg vid demenssjukdom Målnivåer för indikatorer. Stockholm: Socialstyrelsen, 2020. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2020-9-6868.pdf. Accessed 01 Dec 2023.

89.

Hoddinott P. A new era for intervention development studies. Pilot Feasibil Stud. 2015;1:36. https://doi.org/10.1186/s40814-015-0032-0.CrossRef

90.

Bauer MS, Kirchner J. Implementation science: what is it and why should I care? Psychiatry Res. 2020;283: 112376. https://doi.org/10.1016/j.psychres.2019.04.025.CrossRefPubMed

91.

Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, et al. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun. 2020;1:42. https://doi.org/10.1186/s43058-020-00023-7.CrossRefPubMedPubMedCentral

92.

Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14(1):42. https://doi.org/10.1186/s13012-019-0892-4.CrossRefPubMedPubMedCentral

93.

Ross J, Stevenson F, Dack C, Pal K, May C, Michie S, et al. Developing an implementation strategy for a digital health intervention: an example in routine healthcare. BMC Health Serv Res. 2018;18(1):794. https://doi.org/10.1186/s12913-018-3615-7.CrossRefPubMedPubMedCentral

94.

Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated consolidated framework for implementation research based on user feedback. Implement Sci. 2022;17(1):75. https://doi.org/10.1186/s13012-022-01245-0.CrossRefPubMedPubMedCentral

95.

Narasimhan M, Allotey P, Hardon A. Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance. BMJ. 2019;365: l688. https://doi.org/10.1136/bmj.l688.CrossRefPubMedPubMedCentral

Title: 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
Authors: Frida Svedin
Oscar Blomberg
Anders Brantnell
Paul Farrand
Anna Cristina Åberg
Joanne Woodford
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Dementia
Dementia
Mood Disorders
Affective Disorder
Published in: BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-023-04522-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2023

A survey of Israeli physical therapists regarding reactive balance training

Health effects of long-term care insurance on spouses of disabled people: a quasi-experimental study

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

Is there a ubiquitous association between sleep disorder and frailty? findings from LASI (2017–18)

Sex-modified association between grip strength and mild cognitive impairment: a cross-sectional and follow-up study in rural China

In-hospital outcomes among older medical inpatients admitted to aged care wards after activation of a 2-tier rapid response system

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials