Henriette Geralde Van der Roest

Background: Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective: We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods: A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results: The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions: This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia.

Background: In recent years, the integration of robotic systems into various aspects of daily life has become increasingly common. As these technologies continue to advance, ensuring user-friendly interfaces and seamless interactions becomes more essential. For social robots to genuinely provide lasting value to humans, a favourable user experience (UX) emerges as an essential prerequisite. Aim: This article aimed to evaluate the usability of the MINI robot, highlighting its strengths and areas for improvement based on user feedback and performance. Method: In a controlled lab setting, a mixed-method qualitative study was conducted with ten individuals aged 65 and above diagnosed with mild dementia (MD) and mild cognitive impairment (MCI). Participants engaged in individual MINI robot interaction sessions, completing cognitive tasks as per written instructions. Video and audio recordings documented interactions, while post-session System Usability Scale (SUS) questionnaires quantified usability perception. Ethical guidelines were followed, ensuring informed consent, and the data underwent qualitative and quantitative analyses, contributing insights into the MINI robot's usability for this demographic. Results: The study addresses the ongoing challenges that tasks present, especially for MD individuals, emphasizing the importance of user support. Most tasks require both verbal and physical interactions, indicating that MD individuals face challenges when switching response methods within subtasks. These complexities originate from the selection and use of response methods, including difficulties with voice recognition, tablet touch, and tactile sensors. These challenges persist across tasks, with individuals with MD struggling to comprehend task instructions and provide correct answers and individuals with MCI struggling to use response devices, often due to the limitations of the robot's speech recognition. Technical shortcomings have been identified. The results of the System Usability Scale (SUS) indicate positive perceptions, although there are lower ratings for instructor assistance and pre-use learning. The average SUS score of 68.3 places device usability in the "good" category. Conclusion: Our study examines the usability of the MINI robot, revealing strengths in quick learning, simple system and operation, and integration of features while also highlighting areas for improvement. Careful design and modifications are essential for meaningful engagement with people with dementia. The robot could better benefit people with MD and MCI if clear, detailed instructions and instructor assistance are available.

Background: Support directly after the diagnosis dementia is often experienced as inadequate by people with dementia and their family carers. Often, available support is focused on practical matters and not on the emotional impact of the diagnosis. The innovative intervention SHARE [Support, Health, Activities, Resources, Education] was developed in the USA for dyads (i.e. person with dementia and their family carer) dealing with early‐stage dementia. Its primary goal is to enhance communication between members of the dyad and to prepare them for the future. The intervention has been adjusted and pilot‐tested in the Netherlands, with positive results. The aim of this study was to investigate the impact of the intervention on dyads on a number of primary and secondary outcome measures.Method: A pre‐post study with three measurements (T0; pre‐ intervention, T1; post‐ intervention, and T2; six months post‐intervention) was conducted. Additionally, a process evaluation took place and qualitative data were collected. Primary outcomes were the quality of life of the person with dementia and self‐efficacy of the family carer. Secondary outcomes were stress, quality of the relationship, confidence in the future, usability and applicability of the intervention and (for family carers only) empathy. Data was collected through structured questionnaire research among 50 dyads, structured interviews with 18 dyads, 19 psychologists and 31 referring professionals, analysis of 55 intervention logs and a group discussion with case managers.Result: No significant effects were found on the primary and secondary outcomes. However, qualitative results demonstrated the added value of the intervention for dyads, psychologists and referring professionals. Usability, acceptability and applicability of the intervention were all positively assessed.Conclusion: As no significant effects were found, we theorize that the intervention protects dyads. Usually, with a progressive disease like dementia, scores on the primary and secondary outcome measures decline, as time and hence the disease progresses. Our findings may indicate a protective effect of the intervention, among others on a further decline in quality of life of the person with dementia, and it may help maintain a stable level of self‐efficacy for the family carer.

Background: e‐Health interventions have shown to be effective in supporting informal caregivers of people living with dementia (PLwD) and have been explored as a solution to overcome the accessibility issues of conventional face‐to‐face interventions. However, uptake and retention in such interventions might be hindered by a lack of user‐centred design and poor usability. Understanding the usability and acceptability of e‐health interventions may help save costs and improve user experience and engagement. The methods and results from three usability and acceptability studies of three culturally adapted versions of WHO’s iSupport for dementia (Brazil, Portugal and Spain) are presentedMethod: Three mixed‐methods studies have been conducted in Brazil, Portugal, and Spain. Participants were caregivers of PLwD (combined n = 79) and health/social support professionals (n = 12). The usability and acceptability assessment protocols included pre and post‐usability testing surveys, task performance on iSupport’s interface, validated scales (System Usability Scale and Computer System Usability Questionnaire), structured and semi‐structured interviews, and focus groups. Thematic analysis was used to analyze text data.Result: Participants’ perceptions of iSupport’s usability were excellent for both the Brazilian and the European‐Portuguese versions (86.5 and 89.5 points in the SUS, respectively). When measured, success rates were high for tasks performed in the interface, suggesting easiness of use. In its different country‐specific versions, iSupport’s interfaces were described as user‐friendly, and its contents as useful and responsive to caregivers’ needs. Several suggestions associated with the program’s layout, functional requirements, and content were identified as necessary to improve the usability and acceptability of iSupport.Conclusion: The Brazilian and European‐Portuguese versions of iSupport were considered acceptable and usable by family caregivers of PLwD. Lessons learned, challenges identified, and methods used to assess the usability and acceptability of iSupport may be replicated and/or used to inform the development of other country‐specific versions within iSupport’s network, potentially lowering the development costs and improving the appropriateness of those versions. Usability and acceptability studies of iSupport are key to discovering design problems and usage patterns of the program, and are therefore valuable for planning feasibility studies and effectiveness trials.

Background: Person‐centred care (PCC) is seen as the golden standard for dementia care. PCC is characterized by care and support that are in line with the needs, preferences and capacities of people with dementia. Previous research showed that PCC has beneficial effects on the quality of life of people with dementia and improve healthcare professional’s working conditions. Within long‐term care PCC seems to hinge on different factors on integrated levels of care provisioning. The current study aims to provide healthcare organizations and policy makers with more insight into the modifiable factors that contribute to PCC for people with dementia living in long‐term care facilities. To this end, we aim to identify whether and which intrapersonal factors (care professional’s attitude towards dementia, attitude towards technology use, and working experience), interpersonal factors (learning potential of the workplace, vision of care, transformational leadership, emotional job demands and resources), and organizational factors (learning climate of the organization, small‐scale setting and amount of residents per care professional) contribute to higher levels of PCC.Method: Data were derived from the fifth assessment of the Living Arrangements for people with Dementia (LAD)‐study, which had a cross‐sectional design. The study was performed amongst 58 long‐term care facilities providing clustered care for people with dementia under the Chronic Care Act (WLZ) in the Netherlands. Care professionals completed an adapted version of the ‘Person‐centred care questionnaire’ (PCCq) to assess the level of PCC in the participating facilities. We performed multilevel analyses, controlling for clustering effects.Result: In total 606 care professionals participated. On the intrapersonal level, care professional’s attitude towards dementia and working experience contributed significantly to PCC. Interpersonal factors that contributed significantly to PCC were possibilities of learning during day‐to‐day work, transformational leadership, and job resources. Organizational factors were not found to significantly contribute to PCC in the model.Conclusion: Several intra‐ and interpersonal factors, rather than organizational factors, contribute to person‐centred care.

BACKGROUND Despite positive results of use of assistive technologies (ATs) in dementia, the uptake of AT lags behind. It is considered important to assess determinants of (un)successful implementation of AT. OBJECTIVE The objective was to explore factors that influence implementation of AT for community-dwelling people with dementia, with the aim to get a better understanding of potentially effective implementation strategies. METHODS A cross-sectional survey was conducted on factors influencing either successfully implemented or unsuccessfully implemented AT’s among 21 researchers in this field from eight European countries, describing AT they were involved in. The survey consisted of closed and open questions. RESULTS Determinants of Implementation were described for 21 ATs, of which 12 were successfully and nine were unsuccessfully implemented. Various types of ATs were included, for example online platforms, sensors or physical aids. Main determinants of implementation success were related to the AT itself, contextual factors, research activities and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness research. CONCLUSIONS This study provided insight in some main barriers and facilitators in implementation of AT in dementia, related to the AT itself, context, research-related activities and applied implementation strategies. Lessons were formulated for various stakeholders to improve implementation effectiveness of AT in dementia.

Background: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. Objective: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. Methods: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. Results: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. Conclusions: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD’s preferences and demands and MC policies, which will contribute to the MINI robot’s effective adoption and deployment.

Background: Involvement of patients and public in research have been disrupted by the consequences of the COVID‐19 pandemic, forcing a rapid transition from face‐to‐face meetings to digital working as an alternative to engage experts by experience. This project presents a co‐production experience of a Participant and Public Involvement (PPI) group implementing a framework in dementia research, during this transition period.Method: A PPI activity was developed with the participation of the MindTech Involvement Team (PPI group) through the entire process. A group of experienced researchers, facilitators, and contributors in PPI in dementia research, and an active PPI group during the pandemic were targeted. Three online workshops were performed, and thematic analysis was chosen for the data analysis.Result: Conflicting positions were identified regarding the transition from face‐to‐face meetings to digital working by using a refine version of the ‘E‐nabling Digital Co‐production' Framework as the coding structure. Regarding e‐PPI (digital PPI), the participating groups shared two perspectives associated to the non‐geographical constraints and the more business‐like sessions. For dementia research, e‐PPI was identified to decrease the supportive and respite environment associated to face‐to‐face meetings, however, it was considered to allow the participants to attend more meetings.Conclusion: The project gives feedback on the digital working in PPI by identifying concerns and fortes of this transition, both for general PPI and in the field of dementia research. It contributes further co‐production initiatives by introducing the ‘E‐nabling Digital Co‐production' Framework as a tool to reflect on future public involvement.

Background: E-learning has shown to be an effective intervention in helping informal caregivers of people living with dementia. It has the potential to reach people living in remote areas, increasing service coverage. As a response to the demographic context in Spain associated with a higher percentage of ageing, depopulation, and the complexities of health service delivery in rural areas, this paper describes the cultural adaptation and co-design of the iSupport online training and support programme for Castilla y León, Spain, as a potential e-health intervention to mitigate these constraints. Methods: The translation and cultural adaptation were performed following the WHO guidelines, with some adaptation due to the cultural context of Spain. Three focus groups were conducted with informal caregivers, health professionals, and a group of experts on cognitive impairment and dementia. The co-design process was performed as a Patient and Public Involvement activity with three groups consisting of people living with dementia, informal caregivers, rural population and experts on technology and dementia. Results: A total of 435 suggestions were proposed for adaptation associated with erroneous terminology, rewording text/writing, grammatical or punctuation marks errors, and repeated information or need for additional content. Several recommendations were exposed during the co-design process: preference for interactive material such as videos or images, a forum to receive feedback from health care professionals and to leave satisfaction comments, availability in multiple platforms (e.g., tablet, laptop, mobile), slide format for information presentation, and availability to edit letter size and background colours. Conclusions: A culturally adapted version of the iSupport was developed for Castilla y León, Spain. The need for modification of words and expressions, information links to local resources websites, adjustments of characters’ names and caregivers’ scenarios, and additional content to some sections were recommended. Suggestions for the design should be taken into account for further adapted versions and platform developments.