Process evaluation of a New psychosocial goal-setting and manualised support intervention for Independence in Dementia (NIDUS-Family)

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ABSTRACT Introduction We report a process evaluation embedded within a UK Randomised Controlled Trial (RCT), which demonstrated that New Interventions for independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over one year. We aimed to test and refine a hypothesised theory of change model delineating key causal assumptions for impact mechanisms. Methods In 2021-22, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions. We interviewed dyads and their intervention facilitators, purposively selected for diverse follow-up GAS scores and sociodemographic diversity. Matching observational data were collected from intervention session recordings, using a checklist developed to test causal assumptions. We thematically analysed data, then integrated qualitative and quantitative data. Results 174/204 (85.3%) dyads allocated to NIDUS-Family, fully completed the intervention, 18 partially completed it, while 12 received none. 47/192 (24.5%) of carers receiving any sessions completed the acceptability questionnaire. 27/58 (47%) dyads purposively selected, and 9/10 facilitators participated in qualitative interviews; and we observed 12 sessions. We identified four themes: A) ‘Someone to talk to helps dyads feel supported’; B) ‘NIDUS-Family helps carers change their perspective’; C) ‘Personalisation helps people living with dementia maintain their identity’; and D) ‘Small steps help dyads move forward’. Conclusion Key causal pathway mechanisms were: regular sessions with a consistent facilitator providing space to discuss priorities, supporting carers to consider new perspectives and approaches to personalising care; and planning small actionable steps towards goals. Findings will support NIDUS-Family implementation.

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