Implementation of the PrAISED (Promoting Activity, Independence and Stability in Early Dementia) intervention in practice: a mixed methods study

There is a paucity of evidence relating to the implementation of dementia care. The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a newly developed 12-month, home-based, individually tailored rehabilitation programme, delivered by therapists and rehabilitation support workers, with a focus on strength, balance, physical activity and activities of daily living. The aim of this study was to identify what is required to implement PrAISED, or similar interventions, in routine clinical practice. PrAISED was delivered as a pilot service in one National Health Service organisation in England. Patient characteristics and the number and duration of visits were recorded by intervention delivery staff. Quantitative data were explored using descriptive statistics. Semi-structured interviews were conducted with seven members of staff delivering the PrAISED service (two managers, five delivery staff) and eight members of staff from other sites involved in the PrAISED Randomised Controlled Trial (RCT) (four managers, four delivery staff). The Consolidated Framework for Implementation Research was used to inform interview guides and conduct a codebook thematic analysis. Adaptations were needed to deliver PrAISED as a service and referrals were lower than expected. Five themes were identified from interviews relating to the pilot service: operational processes; workforce capacity; referral; intervention delivery and patient impact. A further six themes were identified regarding the wider implementation of dementia therapy programmes: the need for support post-dementia diagnosis; acceptability; effective delivery; reach/referral; intervention design and adaptability; and intervention materials and training. There is a need for interventions like PrAISED to fill a gap in support immediately post-dementia diagnosis. Future implementation will require attention to the identification of intervention funding; leadership and management; time to establish operational processes; therapists with appropriate skills and experience; providing training and resources to support intervention delivery; defining patient eligibility and referral processes; and maintaining fidelity of the intervention.