Hongtu Chen1, Sue Levkoff1, Komatra Chuengsatiansup1, Siranee Sihapark1, Ladson Hinton1, Dolores Gallagher-Thompson1, Sirinart Tongsiri1, Bussabong Wisetpholchai1, Stacy Fritz1, Andrea Lamont1, Ariel Domlyn1, Abraham Wandersman1, Andrea Horvath Marques1. 1. Department of Psychiatry (Chen) and Department of Global Health and Social Medicine (Chen, Levkoff), Harvard Medical School, Boston; College of Social Work (Levkoff), Department of Exercise Science (Fritz), and Department of Psychology (Lamont, Domlyn, Wandersman), University of South Carolina, Columbia; Society and Health Foundation and Sirindhorn Anthropology Center, Bangkok, Thailand (Chuengsatiansup); Boromarajonani College of Nursing, Khon Kaen, Thailand (Sihapark); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Hinton); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Gallagher-Thompson); Quality of Life Research Unit, Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand (Tongsiri); Society and Health Institute, Ministry of Public Health Thailand, Nonthaburi, Thailand (Wisetpholchai); Wandersman Center, Columbia, South Carolina (Lamont, Wandersman); Center for Global Mental Health Research, National Institute of Mental Health, Bethesda, Maryland (Horvath Marques).
Abstract
BACKGROUND: Thailand has a rapidly aging population yet lacks evidence for effective and scalable evidence-based psychosocial interventions to support persons living with dementia and their family caregivers. In this study of a culturally adapted and evidence-based clinical program (Reducing Disabilities in Alzheimer's Disease [RDAD]), designed to reduce behavioral and psychological symptoms of dementia in older adults, the authors test the hypothesis that an implementation support strategy, Getting To Outcomes (GTO), would produce better implementation and clinical outcomes compared with usual implementation of RDAD in Thailand. METHODS: The study uses a hybrid type III cluster-randomized design to compare eight geographical districts that receive training on both implementing the RDAD clinical intervention and on GTO implementation support strategies (intervention arm) with eight other districts that receive the same RDAD training but without training in GTO implementation support strategies (control arm). GTO is an evidence-based intervention designed to support implementers to better plan, implement, and evaluate innovative intervention programs in a novel setting. Primary outcomes, including implementation and clinical outcomes, will be assessed at baseline, month 3 (posttreatment), and month 6 (3-month follow-up). RESULTS: The research team anticipates that there will be significantly more improvements in the delivery of the RDAD intervention program in the experimental group than in the control group. NEXT STEPS: If clinical trial findings are positive, the authors plan to replicate and scale up the proposed implementation science approach across Thailand to enhance and expand mental health services for older adults with dementia.
BACKGROUND: Thailand has a rapidly aging population yet lacks evidence for effective and scalable evidence-based psychosocial interventions to support persons living with dementia and their family caregivers. In this study of a culturally adapted and evidence-based clinical program (Reducing Disabilities in Alzheimer's Disease [RDAD]), designed to reduce behavioral and psychological symptoms of dementia in older adults, the authors test the hypothesis that an implementation support strategy, Getting To Outcomes (GTO), would produce better implementation and clinical outcomes compared with usual implementation of RDAD in Thailand. METHODS: The study uses a hybrid type III cluster-randomized design to compare eight geographical districts that receive training on both implementing the RDAD clinical intervention and on GTO implementation support strategies (intervention arm) with eight other districts that receive the same RDAD training but without training in GTO implementation support strategies (control arm). GTO is an evidence-based intervention designed to support implementers to better plan, implement, and evaluate innovative intervention programs in a novel setting. Primary outcomes, including implementation and clinical outcomes, will be assessed at baseline, month 3 (posttreatment), and month 6 (3-month follow-up). RESULTS: The research team anticipates that there will be significantly more improvements in the delivery of the RDAD intervention program in the experimental group than in the control group. NEXT STEPS: If clinical trial findings are positive, the authors plan to replicate and scale up the proposed implementation science approach across Thailand to enhance and expand mental health services for older adults with dementia.
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Authors: Joie Acosta; Matthew Chinman; Patricia Ebener; Patrick S Malone; Susan Paddock; Andrea Phillips; Peter Scales; Mary Ellen Slaughter Journal: Implement Sci Date: 2013-08-07 Impact factor: 7.327