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Caregiver-provided and home-based individual cognitive stimulation: the cultural adaptation process guided by the systematic review method and community involvement approach
Advances in Evidence Synthesis: special issue Cochrane Database of Systematic Reviews 2020
Year (definitive publication)
2020
Language
English
Country
Canada
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Abstract
Background: Promoting successful aging in the community is a societal priority. Cognitive stimulation is
one of the interventions with a positive impact on older adults’ health and well-being, as it preserves
cognitive functioning, contributing to the maintenance of autonomy and quality of life.
Objective: To culturally adapt the Making a Difference 3 (MD3), an individual Cognitive Stimulation
program (iCSP) delivered by caregivers to people with mild to major Neurocognitive Disorder (PwNCD) in
a home-based setting.
Methods: The cultural adaptation of the MD3 was organized in five phases. Initially, we conducted the
systematic review (SR) on the effectiveness of the iCSP on older adults’ cognitive performance, according
to the Joanna Briggs Institute methodology. In phase II, the iCSP-MD3 was translated into the European
Portuguese language and culturally adapted based on the information generated by the SR and by the
academics, researchers, health professionals and caregivers involved (n = 12). Phase III consisted of
reviewing the culturally adapted MD3 with eight experts in nursing, psychology, occupational therapy
and social working using the Delphi method and with caregivers (n = 10) through focus groups. In phase
IV, to test the feasibility and effects of the MD3 Portuguese version, we conducted a randomized
controlled trial (RCT) involving 52 dyads (PwNCD and a caregiver, 28 allocated in the experimental group
and 24 in the control group. Phase V consisted of exploring through interviews (conducted with 2 PwNCD,
and 2 caregivers) the meanings attributed by the participants to the iCSP-MD3.
Results: The SR on the effectiveness of the caregiver-delivered iCSP has identified beneficial effects in
several cognitive domains, and thus generated evidence that underpinned the achievement of the
following phases. Phase II resulted in the iCSP preliminary version. Phase III allowed for the adaptation of
the verbal and structural contents of the iCSP program, creating an accessible and fitting version with
meaning to the target population. As for the RCT conducted (phase IV), results from the intention-to-treat
analysis revealed significant improvements in cognition (orientation and order comprehension) of
PwNCDs. Beneficial effects of the intervention were also observed in the quality of life of the PwNCDs, but
only from the caregiver’s perspective. Qualitative data collected in phase V showed that participation in
the iCSP-MD3 was evaluated as very positive and significant.
Conclusions: Through a thorough SR process, the research team was able to delineate essential
methodological choices based on previous studies conducted in this area, such as the active inclusion of
relevant stakeholders during the cultural adaptation of the iCSP-MD3. Moreover, the research team as
able to identify the main domains that can be potentially improved through iCSP, as well as identify
potential facilitators and barriers during its implementation in home-based settings. Overall, the iCSP-
MD3 proved to be a feasible and meaningful intervention for the Portuguese population.
Acknowledgements
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Keywords
older adults,neurocognitive disorders,informal caregivers,individual cognitive stimulation,community involvement
Fields of Science and Technology Classification
- Health Sciences - Medical and Health Sciences
- Psychology - Social Sciences
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