Seen as a person; evaluation of a person-centred tablet intervention to promote the social interaction between people with dementia, family and professional caregivers

Background: Becoming known as a person, having social contact and meaningful activities are essential for the experienced quality of life. Recent studies show that the majority of people with dementia in nursing homes experience unmet needs in this regard, resulting in loneliness and behavioural and mood disorders. This is difficult for next of kin who transfer care to professionals. Although person-centred work in the care of people with dementia has been promoted since the 1990s, it is still far from being used optimally. Person-centred interventions that can change this problem in a simple, effective way are highly desirable. Previous research has shown that viewing art on a tablet can positively influence the wellbeing of people with dementia and their carers (Tyack et al., 2015). That is why artist Laurence Aëgerter developed a photographic intervention. For each person, a selection of artistic photographs (that match their interests and express positive emotions) is used in a communication activity. The interests are asked in advance to the next of kin, the person himself/herself and professional caregivers. The goal is that people with dementia have fun, experience social contact and feel known and respected. This creates a connection, a more authentic and deeper contact than when looking at everyday 'snapshots' from the past. Showing artistic photos does not put any pressure on the person to recognize their own photos, which they do not always recognize anymore. A pilot study shows promising results of this photo intervention (Theijsmeijer et al., 2018).

Goal: The aim of the study is to evaluate the impact and implementation of a tablet version of the photo intervention, so that it can also be used by relatives and caregivers in communicating with people with advanced dementia. In a playful way the relationship between the person with dementia and caregiver will be strengthened as well as the relationship between relatives and caregivers.

Methods: The feasibility and effectiveness of the photo-intervention on 14 nursing home wards will be explored in a Randomized Controlled Trial (RCT) with three measurements: T0: baseline, T1: end of intervention, after 4 weeks, T2: follow-up, 2 weeks after T1. People with moderate to severe dementia (n=45) participating in the photo-intervention are compared with people with dementia with whom general conversations are held in the same frequency and during the same period (n=45). Qualitative and quantitative methods are used to investigate whether the intervention strengthens the relationship between people with dementia, their relatives and caregivers, and what the effect of the intervention is on the mood, social interaction and quality of life of people with dementia and on the empathy and personal attitude of relatives and caregivers.
During the project, a process evaluation will also be carried out in which people with dementia, relatives and caregivers will be questioned and observed: (a) to understand factors that promote or hamper the implementation of the photo-intervention, and (b) to evaluate the user-friendliness and usefulness of the intervention.To this end, both quantitative and qualitative data will be collected in individual semi-structured interviews and focus groups with relatives, caregivers and people with dementia.

Results: the results of the study will be published in scientific and professional journals. If the foto-intervention proves to have favourable outcomes, together with the target group, and based on the process evaluation, an implementation package and plan will be developed to stimulate the scaling up of the photo intervention to other care institutions.

Main research questions:
1) Does the photo intervention, compared to having a general conversation, have more positive effect on mood, social interaction and quality of life of people with dementia in nursing homes, personal attitude and empathy of caregivers providing the photo intervention and feeling of competence of family carers?
2) Do participants in the photo intervention (and next of kin) feel better known by carers than people with dementia (and next of kin) who do not participate in this intervention?
3) Does the photo intervention strengthen the relationship between people with dementia, next of kin and carers?
4) What are the conditions for successful implementation of the intervention at user and organisational level?
5) What implementation materials are needed to secure and disseminate the intervention?

It is expected that people with dementia receiving the photo intervention, compared to those with whom general conversations are held, will feel more familiar, have increased social interaction, experience more positive emotions and improved quality of life; that their family caregivers will accept the care in the nursing home better and experience a higher sense of competence and that the professional caregivers providing the photo intervention, by giving them the tools to work in a more person-centred way, will develop more empathy and a more person centered attitude towards the persons with dementia to whom they provide care.

T0 (baseline), T1 (after one month intervention), T2 (follow-up two weeks after end interventions)

Experimental intervention: tablet based photo intervention, three times a week 30 minutes, during four weeks (caregivers are instructed to provide the intervention on beforehand)
Control intervention: general conversations, three time a week 30 minutes, during four weeks (caregivers are instructed to provide the intervention on beforehand)