Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives

Tucker, Rachael; Vickers, Robert; Adams, Emma J.; Burgon, Clare; Lock, Juliette; Goldberg, Sarah E.; Gladman, John; Masud, Tahir; Orton, Elizabeth; Timmons, Stephen; Harwood, Rowan H.

Abstract

Background
Despite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia, using a dementia friendly exercise and physical activity-based intervention (PrAISED [Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment]) as a case study.

Methods
Qualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from health and social care, local government, the voluntary and community sector, universities, and research centres in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis.

Results
Fourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals. Data were represented in 33 constructs across the five CFIR domains. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces.

Conclusion
Several barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources.

Citation

Tucker, R., Vickers, R., Adams, E. J., Burgon, C., Lock, J., Goldberg, S. E., Gladman, J., Masud, T., Orton, E., Timmons, S., & Harwood, R. H. (2024). Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives. Archives of Public Health, 82(1), Article 54. https://doi.org/10.1186/s13690-024-01283-8

• Journal Article Type: Article
• Acceptance Date: Apr 6, 2024
• Online Publication Date: Apr 23, 2024
• Publication Date: 2024
• Deposit Date: Apr 11, 2024
• Publicly Available Date: Apr 24, 2024
• Journal: Archives of Public Health
• Electronic ISSN: 2049-3258
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 82
• Issue: 1
• Article Number: 54
• DOI: https://doi.org/10.1186/s13690-024-01283-8
• Keywords: Physical activity, Implementation, Cognitive impairment, Barriers, Facilitators, Commissioning, Dementia
• Public URL: https://nottingham-repository.worktribe.com/output/33563194
• Publisher URL: https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-024-01283-8
• Additional Information: Received: 12 December 2023; Accepted: 6 April 2024; First Online: 23 April 2024; : ; : The study received research governance approvals and ethical approval from the Bradford Leeds Research Ethics Committee (18/YH/0059; 236099). All participants provided consent before taking part.; : All participants agreed to the publication of findings of this study.; : Rachael Tucker is a Scientific Editor at Elsevier Cell Press. The work presented in this paper was carried out whilst RT worked as a Research Assistant at the University of Nottingham. All other authors have no competing interests to declare. The study was funded by the NIHR Programme Grants for Applied Research funding scheme [RP-PG-0614-20007]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.