International implementation of Cognitive Stimulation Therapy in Brazil, India and Tanzania: Findings from the CST-International study
International implementation of Cognitive Stimulation Therapy in Brazil, India and Tanzania: Findings from the CST-International study
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认知刺激疗法在巴西、印度和坦桑尼亚的国际实施：CST-国际研究的结果
DOI：
10.1002/alz.078872
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Fisher E
中科院分区：
文献类型：
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作者：
Fisher E
背景目前迫切需要有效和负担得起的干预措施来支持痴呆症患者的生活质量和认知能力。制定了许多心理社会干预措施，但很少有规模和常规做法。团体认知刺激疗法（CST）是美国国家健康与护理卓越研究所（NICE）推荐的唯一一种非药物治疗方法，可改善轻度至中度痴呆症患者的认知和健康状况，其全球实施已被阿尔茨海默病国际推荐。CST已经在文化上适应了至少36个国家的使用，但这并没有导致在常规实践中广泛交付。MethodsMethodology包括四个阶段：1）通过利益相关者与临床医生，政策制定者，痴呆症患者和护理人员的参与，探索实施障碍; 2）为每个国家制定实施计划; 3）各国采用混合方法对儿童支助小组进行的前后研究（共103例），探讨其可行性、可接受性、成本及认知和生活质量等结果;（4）完善执行战略，成果在利益攸关方参与的基础上，为每个国家制定了执行计划。由于新型冠状病毒疫情，CST交付几乎在巴西和印度进行。我们将根据实施研究综合框架（CFIR），提出在不同环境下实施CST的障碍和促进因素，并反思实施战略的成功。这些措施包括补贴费用和差旅费，确定接受儿童支助小组的参与者人数，宣传和推销儿童支助小组，教育家庭照顾者了解心理社会干预的作用并争取他们的支持，以及为儿童支助小组领导人制定“培训培训员”模式。我们将讨论的可行性和可接受性的人和虚拟CST在不同的设置，利用定量和定性的研究结果，从前-后研究的CST.ConclusionIt不仅是文化适应的内容是至关重要的心理社会干预，但也定制实施策略的独特设置，考虑到经济现实，健康公平和医疗保健的访问。广泛实施CST的关键下一步是长期供资安排和区域或地方指导方针的认可。
BackgroundThere is a pressing need for effective and affordable interventions to support quality of life and cognition in people with dementia. Many psychosocial interventions are developed but few are delivered at scale and in routine practice. Group Cognitive Stimulation Therapy (CST) is the only non‐pharmacological treatment recommended by the National Institute for Health and Care Excellence (NICE) to improve cognition and wellbeing in mild to moderate dementia, and its global implementation has been recommended by Alzheimer’s Disease International. CST has been culturally adapted for use in at least 36 countries, but this has not resulted in widespread delivery in routine practice.MethodsMethodology consisted of four phases 1) Exploring barriers to implementation through stakeholder engagement with clinicians, policy‐makers, people with dementia and caregivers; 2) Development of implementation plans for each country; 3) A mixed‐methods pre‐post study of CST in each country (total n = 103), exploring feasibility, acceptability, cost and outcomes including cognition and quality of life; and 4) Refinement of implementation strategies, with an aim of creating ongoing and sustainable CST programmes.ResultsImplementation plans were developed for each country based on stakeholder engagement. CST delivery took place virtually in Brazil and India due to the Covid‐19 pandemic. We will present the barriers and facilitators to CST implementation in different settings based on the Consolidated Framework for Implementation Research (CFIR), and reflect on the success of implementation strategies. These include subsidising cost and travel, establishing a caseload of participants to receive CST, promotion and marketing of CST groups, educating family caregivers on the role of psychosocial interventions and enlisting their endorsement, and developing a ‘train the trainer’ model for CST group leaders. We will discuss the feasibility and acceptability of in‐person and virtual CST in varied settings, drawing on quantitative and qualitative findings from the pre‐post study of CST.ConclusionIt is crucial to not only culturally adapt the content of a psychosocial intervention, but also tailor implementation strategies for unique settings, considering economic realities, health equity and healthcare access. Key next steps to widespread CST implementation are long‐term funding arrangements and endorsement from regional or local guidelines.