Discussion
The MEETINGDEM project intends to adaptively implement and evaluate the Meeting Centers Support Program in three European countries. In Phase One activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country and context-specific implementation plans and materials. In Phase Two training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact, cost-effectiveness, user satisfaction and implementation process.
The study will provide relevant information on conditions for successful implementation of the combined MCSP for people with dementia and their carers in three very different European countries (Italy, Poland and the UK), which will be useful also for other countries in Europe who are interested to implement MCSP, or other combined support programs. It will also provide information on the effect of MCSP on behavior, mood, social support, experienced stigma and quality of life of people with dementia as well as loneliness, general health, caregiver distress and sense of competence of informal caregivers, and on the costs of MCSP in the different countries. This will enable us to compare the results of the MCSP in other European countries with those previously found in the Netherlands in terms of clinical outcomes and costs.
The project will deliver different type of data, results and products (‘deliverables’) of which some will be posted on the public project website (
www.meetingdem.eu), such as: regional data bases of national/regional organizations involved in dementia care; initiative groups of representatives of organizations who prepare the adaptive implementation of MCSP in the participating countries; a report on the structure of the health care system and the patient and caregiver ‘pathway to a professional for dementia care’ in the three participating countries; a translated checklist (in English, Italian and Polish) on facilitators and barriers of implementation of MCSP; country specific implementation plans and materials (toolkit); a ‘train the trainer’/pioneer course; a course for personnel per country; trained personnel; operational meeting centers in each country; people with dementia and carers participating in the MCSP; a guide and toolkit for supporting successful implementation of the MCSP in Europe; scientific and professional publications and congress lectures on the efficacy, cost-effectiveness and user satisfaction of MCSP in different European countries, and on facilitators and barriers when implementing MCSP; (inter)national plans for dissemination of MCSP, a project website reporting on the implementation of MCSP in Europe; a database with stakeholders in Europe who are interested in the MCSP; and finally, in each country a national dissemination event.
Because the (cost)effectiveness study is conducted within an implementation study this may entail the following risks: the MCSP is not yet fully implemented during the experimental period or the personnel does not yet fully work according to the vision and principles of MCSP. This will decrease the effectiveness of the intervention, and may lead to recruitment problems in the starting period. If the first meeting centers in the three countries do not reach the number of participants required according to the power analysis (25 per country, taking into account an expected drop-out rate of 15%), more meeting centres are needed to be included in the study. This may be difficult due to funding and finding suitable locations. To minimize these risks a long preparation period of 12 months is planned, before the actual start of the centers. This will give the initiative groups enough time to prepare the implementation, arrange the necessary funding and location(s), communicate the new service offer to public and care and welfare providers in the region, recruit participants and train the personnel. Also during the first year of implementation, recruitment of participants will be continued (9 months) and, as a follow-up of the training, the personnel will receive supervision and guidance from one of the trainers and trained project leader in each country (five group supervision meetings).
Though country specific implementation plans will be created, the three meeting centres may encounter different barriers to implementation (such as difference in staff competencies and collaboration with other care partners), which can have an effect on the care received by people with dementia and their informal caregivers. A clear description of the adaptive implementation of MCSP in practice will help to identify these differences and if necessary, take these into account in the effect analyses.
There is a great need for high quality implementation research to demonstrate how care interventions can be put into practice in a variety of settings. Hence, this study of MCSP should make a major contribution to our understanding of the difficulties and key factors involved in making things work in other countries and services by providing an effective model for implementation which could be adapted for other care interventions. The results will also help in future policy and decision making on post diagnostic support and care for people with dementia and their carers. This will promote further dissemination of MCSP in Europe and may also serve as an example for dissemination and implementation of other effective psychosocial interventions for people with dementia and carers in and outside Europe.
Acknowledgements
Not applicable