Identifying influences on take up
of a community occupational
therapy intervention for people
with dementia and family carers
Becky Field
(PhD student, Occupational Therapist, Researcher)
University of Sheffield
Royal College of Occupational Therapists Conference
Birmingham, 2017
Aim today ...
• Highlight why considering influences on
take up of community occupational
therapy intervention is important
• Present findings - interviews with people
with mild to moderate dementia and
their family carers
• Identify implications for practice
Clarifying definitions
‘Dementia’: using as an umbrella term
Family carer: spouse, child, friend, relative,
neighbour
Background (1)
‘Valuing Active Life in Dementia’ (VALID)
NIHR research programme
Development phase: adapted and developed
the intervention for UK (COTiD->COTiD UK)
RCT phase: evaluate intervention v. usual care
Background (2)
The intervention
‘Community Occupational Therapy in Dementia’
promotes independence, meaningful activity
and quality of life
for people with mild to moderate dementia
and family carers, living in the community
Background (3)
The interviews
Person with dementia and family carer
interviewed together, after intervention
(VALID’s aim: to explore acceptability and
help intervention development)
My aim: explore if influences on take up of
this intervention could be identified (in these
interviews)
Why research this topic?
• Policy promotes living well with dementia: key
role for Occupational Therapists…
• Services for this client group still
developing: key role for Occupational
Therapists...
• Recruiting people to this occupational therapy
intervention was a challenge +++!!
Methods
• Existing, post-intervention, semi-structured
interviews with people living with mild to
moderate dementia and family carers
• Existing publicly funded data (Lewis & Nicholls, 2014)
• Secondary analysis
• Thematic analysis (Braun and Clarke, 2006)
Main findings
• Convenience sample (VALID research participants;
people living with dementia & family carers
interviewed together)
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17 interviews
7 women, 10 men
13 spouses, 3 parent-child, 1 friend
2 UK sites
20 initial codes
4 main themes
Theme 1:
“Grabbing at straws and keen to take
part”
“Well, for me, I suppose I was grabbing at
straws really and I was very very keen to take
part..... because of everything that was
happening in my life, perhaps it wasn't the
right time. On the other hand, it was the right
time because it was someone coming in”
(Wife, family carer)
Theme 2:
“Trying to put a routine in”
“…my mum already goes to one club….but we said that
she needed more, cause we're trying to put a routine in
…we've found that's a good thing…we feel that she
needed more...my Mum, she says ‘don't really like to go,
I like the club’ ... once we knew that so we're looking at
something else aren't we?” (Daughter, family carer)
“Yes well so I said well I'll stick to my Tuesday club” (Person
living with dementia)
Theme 2...
“...we had decided we weren't going
to go on it [the intervention]...well we are
going out regular, we are going to all these
memory cafes, we are doing several things, we
are joining in with all that...I mean problem
wise, we are sort of managing alright, we
have not got a real lot of bad problems, not
compared to some people at the moment...”
(Wife, family carer)
Theme 3:
‘Didn’t know what to expect’
Range of expectations, mostly limited…
“I had no preconceived ideas at all
about it” (Husband, living with dementia)
Theme 4:
“Give it a go”
“...I was very, not nervous, but we were dubious
of having somebody we didn’t know every
week, but my husband and I discussed it…we
said it has been offered to us and we would try
anything that is offered to us to help…”
(Daughter, family carer)
Influences on take up
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Potential for meeting needs
Struggling to adjust or cope
Valuing activity and routine
Willingness to ‘give it a go’, despite
uncertainty, limited expectations or
apprehension
‘push’ towards take up
Family carer accounts dominated
However….
"Oh dear, I don't know really. I mean to say I
suppose so, I don't know. Was it a bit early I
would say. I mean, I am not conscious of
having any memory difficulties really” (Wife,
person with dementia)
"No, you have had a few difficulties” (Husband)
“Well there you are, other people notice but it is
difficult for me to say” (Wife)
Implications
for occupational therapy?
1. Are occupational therapists offering similar
interventions for people with early dementia?
2. How is occupational therapy offered to
people with early dementia?
3. How to engage people with dementia
themselves - people without carers and within
the ‘dyad’ ?
4. Considering readiness to engage and
influences on take up
Valuing Active Life in Dementia (VALID)
This is independent research funded by the National
Institute for Health Research (NIHR) under its Programme
Grants for Applied Research scheme (RP-PG-0610-10108).
The views expressed in this presentation are those of the
author(s) and not necessarily those of the NHS, the NIHR or
the Department of Health.
Thank you for listening!
Any questions?
References
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Braun, V, and Clarke, V. 2006. “Using Thematic Analysis in Psychology.” Qualitative Research in
Psychology 3 (2): 77–101.
Doncaster, E, Hodge, S and Orrell, M. 2014. “Memory Services National Accreditation Programme
(MSNAP): Standards for Memory Services.” Royal College of Psychiatrists.
Graff, Maud J L, J M Vernooij-Dassen et al 2006. “Community Based Occupational Therapy for
Patients with Dementia and Their Care Givers: Randomised Controlled Trial.” BMJ (Clinical Research
Ed.) 333 (7580) (December 9): 1196.
Heaton, J. 2004. Reworking Qualitative Data : SAGE Research Methods. Sage.
Lewis and McNaughton-Nicholls. 2014. “Design Issues.” In Qualitative Research Practice. A Guide
for Social Science Students & Researchers, edited by Jane Ritchie, Jane Lewis, Carol McNaughton
Nicholls, and Rachel Ormston, 2nd ed., 48–76. London: Sage.
Department of Health and Prime Minister’s Office. 2013. “G8 Dementia Summit Declaration.”
Prime Minister ’s Challenge on Dementia: Delivering Major Improvements in Dementia Care and
Research by 2015.” 2012. London.
Prime Minister’s Challenge on Dementia 2020. 2015. London.
Prime Minister’s Challenge on Dementia 2020 Implementation Plan.” 2016.
Wenborn, J et al Community occupational therapy for people with dementia and family carers
(COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID] programme): study
protocol for a randomised controlled trial Trials 2016 17:65 DOI: 10.1186/s13063-015-1150
What next ?
Phase 2 of PhD…
Explore how people with early stage
dementia respond to offers of NHS provided
psychosocial interventions
Primary data collection, qualitative interviews
People living with dementia, family carers and
staff
Memory services accreditation
Programme: implications for OT
6.2 ....timely access to psychosocial interventions for cognitive aspects of
dementia
....local programme of age appropriate group cognitive stimulation therapy
(CST)
Guidance: i.e. engagement in a range of activities and discussions aimed at
general enhancement of cognitive and social functioning
6.3 .... timely access to psychosocial interventions for emotional aspects of
dementia
..Guidance: e.g. • Life story work • Cognitive behaviour therapy
6.4 timely access to psychosocial interventions for occupational and functional
aspects of dementia
People with dementia have access to occupational therapy
The memory service has access to advice and support on assistive technology
and telecare solutions designed to assist people with activities of daily living