Longitudinal realist evaluation of the Dementia PersonAlised Care Team (D-PACT) intervention: protocol

• Published in: BJGP open 2023-09, Vol.7 (3), p.BJGPO.2023.0019
• Main Authors: Wheat, Hannah, Weston, Lauren, Oh, Tomasina M, Morgan-Trimmer, Sarah, Ingram, Wendy, Griffiths, Sarah, Sheaff, Rod, Clarkson, Paul, Medina-Lara, Antonieta, Musicha, Crispin, Spicer, Stuart, Ukoumunne, Obioha, Allgar, Victoria, Creanor, Siobhan, Clark, Michael, Quinn, Cath, Gude, Alex, McCabe, Rose, Batool, Saqba, Smith, Lorna, Richards, Debra, Shafi, Hannah, Warwick, Bethany, Lasrado, Reena, Hussain, Basharat, Jones, Hannah, Dalkin, Sonia, Bate, Angela, Sherriff, Ian, Robinson, Louise, Byng, Richard
• Format: Article
• Language: English
• Subjects: caregivers; dementia; personalised care; primary health care; realist evaluation
• ISSN: 2398-3795; 2398-3795
• DOI: 10.3399/BJGPO.2023.0019

Different dementia support roles exist but evidence is lacking on which aspects are best, for whom, and in what circumstances, and on their associated costs and benefits. Phase 1 of the Dementia PersonAlised Care Team programme (D-PACT) developed a post-diagnostic primary care-based intervention for people with dementia and their carers and assessed the feasibility of a trial. Phase 2 of the programme aims to 1) refine the programme theory on how, when, and for whom the intervention works; and 2) evaluate its value and impact. A realist longitudinal mixed-methods evaluation will be conducted in urban, rural, and coastal areas across South West and North West England where low-income or ethnic minority populations (for example, South Asian) are represented. Design was informed by patient, public, and professional stakeholder input and phase 1 findings. High-volume qualitative and quantitative data will be collected longitudinally from people with dementia, carers, and practitioners. Analyses will comprise the following: 1) realist longitudinal case studies; 2) conversation analysis of recorded interactions; 3) statistical analyses of outcome and experience questionnaires; 4a) health economic analysis examining costs of delivery; and 4b) realist economic analysis of high-cost events and 'near misses'. All findings will be synthesised using a joint display table, evidence appraisal tool, triangulation, and stakeholder co-analysis. The realist evaluation will describe how, why, and for whom the intervention does or does not lead to change over time. It will also demonstrate how a non-randomised design can be more appropriate for complex interventions with similar questions or populations.