Clare Wilding

Background/Objectives: In rural communities, caregivers of people living with dementia face limited access to support services. Digital interventions offer potential solutions for support. This paper reports on the evaluation of Verily Connect, a web-based multicomponent intervention developed to support caregivers. The aim of this qualitative study was to critically evaluate the implementation of Verily Connect to better understand its barriers and enablers. Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative data were collected through semi-structured interviews with 24 health service professionals across 12 rural Australian communities. Thematic analysis was conducted to identify barriers and facilitators to implementation. Results: Key barriers included limited digital literacy, resistance to technology and privacy concerns, as well as competing organisational priorities, and inadequate technological infrastructure. Facilitators included organisational alignment and supportive management. Conclusions: The perceived relevance and usability of Verily Connect were enhanced by its co-design with caregivers and integration into health service models. Addressing digital literacy for caregivers, infrastructure limitations, and organisational readiness is essential for future technology-based health interventions in rural dementia care.

Maintaining and improving the health and well-being of older people in rural communities through integrated care is essential to address this cohort’s frailty risk. The Indigo 4Ms Tool for health workers is a rural-specific approach to providing care that addresses the common conditions of ageing. With Australian government funding, five small rural health services are implementing the tool. This paper describes the protocol for a hybrid type 2 implementation-effectiveness study to evaluate the tool’s impact on multidisciplinary comprehensive care planning and the implementation strategies that enhance the adoption and sustainability of the tool across diverse rural health settings.

Health graduates must competently apply theory in their practice, but this is challenging for students to learn. This study explored student experiences of a program-level curriculum design aimed at supporting theory-to-practice translation in occupational therapy. Annual ‘Transition Workshops’ targeted theoretical tenants of the program and supported students to transition their learning from one year to the next. The Transition Workshops were evaluated using pre- and post-workshop surveys and focus groups. There were 223 post-workshop surveys completed by student participants and four focus groups with 18 student participants. The quantitative survey data were analysed using Wilcoxon signed rank tests. Qualitative survey data were analysed using content analysis and group interview transcripts were inductively analysed using thematic analysis. Students conveyed that the Transition Workshops were beneficial and their perceived levels of theoretical knowledge, and confidence in applying that knowledge, increased after engaging in them. The workshops assisted students to transition their learning across the degree by providing opportunities to revise and prime for their next stage of learning, learn how to apply theory-into-practice, and build self-confidence for practice education learning within their degree. Transition Workshops, designed at a program-level, can be incorporated into curriculum to assist occupational therapy students to develop their theoretical knowledge and support theory-into-practice. This approach may be of value within other clinical and professional programs and that inclusion in university policy is required to guide academic practices.

Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers’ perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged <55 years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers’ social support and appeared to ease caregiver demand.

Background: Empathy is a critical skill required by disability workers. Virtual reality may increase access to staff training to foster empathy.Method: A mixed methods feasibility study investigated a custom‐built virtual reality program, IMercyVE, which aimed to immerse a disability worker in a first‐person perspective of having intellectual disability. Data were collected through online surveys (n = 9) completed before and after use of IMercyVE, and by videoconference focus groups (n = 6).Results: Qualitative findings included that IMercyVE delivered a novel experience for participants and a distinctive mode of learning that assisted participants to deepen their levels of empathy. Descriptive analyses of the surveys indicated that participants' empathy increased after engaging with IMercyVE.Conclusions: IMercyVE has the potential to be offered as a remotely delivered and flexible staff training modality suitable for building empathy. Further research with a larger sample is warranted.

Background: Informal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. Objective: This study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. Methods: A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. Results: Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. Conclusions: The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasf

Introduction: Occupational therapy entry‐level education is integral to how students obtain deep understanding of occupational therapy's core philosophy of occupation and its place in practice. However, there is a lack of research that explores occupation‐centred education from the perspectives of students. Therefore, this study aimed to identify Australian entry‐level occupational therapy students' experiences of learning about occupation, and its place in practice.Methods: A qualitative descriptive design was adopted. Overall, 20 students participated in four focus groups lasting between 45 and 75 min. Data were audio‐recorded and transcribed verbatim. Transcripts were analysed in two phases, using reflexive thematic analysis.Findings: There were three themes that encapsulated what helped students to better understand occupation and its place in practice: (1) making occupation real; (2) relating occupation to me; and (3) theory as a focussing lens. There was also a range of pedagogical strategies that helped students to better understand occupation: using active and interactive teaching and learning strategies. One additional theme indicated a challenge to helping the students understand occupation and its place practice: when practice education settings were not centred on occupation.Conclusion: Learning about occupation and occupation‐centred practice may be facilitated by using practice examples, encouraging students to think about occupation in their own lives, teaching and applying occupation‐centred theory, and employing interactive learning and teaching strategies. Student learning in practice settings where occupational therapy is centred on occupation is imperative. Further exploration of students' perspectives of learning about occupation across multiple occupational therapy programmes is warranted.

There is great potential for human-centred technologies to enhance wellbeing for people living with dementia and their carers. The Virtual Dementia Friendly Rural Communities (Verily Connect) project aimed to increase access to information, support, and connection for carers of rural people living with dementia, via a co-designed, integrated website/mobile application (app) and Zoom videoconferencing. Volunteers were recruited and trained to assist the carers to use the Verily Connect app and videoconferencing. The overall research design was a stepped wedge open cohort randomized cluster trial involving 12 rural communities, spanning three states of Australia, with three types of participants: carers of people living with dementia, volunteers, and health/aged services staff. Data collected from volunteers (n = 39) included eight interviews and five focus groups with volunteers, and 75 process memos written by research team members. The data were analyzed using a descriptive evaluation framework and building themes through open coding, inductive reasoning, and code categorization. The volunteers reported that the Verily Connect app was easy to use and they felt they derived benefit from volunteering. The volunteers had less volunteering work than they desired due to low numbers of carer participants; they reported that older rural carers were partly reluctant to join the trial because they eschewed using online technologies, which was the reason for involving volunteers from each local community.

Integrating theory-into-practice is an important skill for professionals to master during their university education; however, students and educators find learning and teaching about theory-into-practice challenging. To address these difficulties ‘Transition Workshops’ were implemented within a Bachelor of Occupational Therapy. A mixed methods evaluation was conducted using pre- and post-workshop surveys and focus groups. Qualitative findings, the focus of this paper, were that team teaching helped educators feel more confident in teaching theory-into-practice as it was more enlivening than solo teaching, it provided opportunity for professional development, it enabled better understanding of the whole curriculum, and it modelled a consolidated professional identity. Team teaching assisted students by providing them with multiple role-models. This study highlighted that some of the challenge in supporting students to learn how to integrate theory-into-practice may be addressed using team teaching.

BACKGROUND Informal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. OBJECTIVE This study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. METHODS A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. RESULTS Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. CONCLUSIONS The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasf INTERNATIONAL REGISTERED REPORT RR1-10.2196/33023