Occupational therapy interventions for people with dementia from diverse groups: A realist inquiry

Abstract

Background: Occupational therapy interventions for dementia can improve outcomes for people with dementia and families; little is known about why they are effective. Diverse groups are underrepresented in dementia research; little is known about how interventions are being delivered. The purpose of this dissertation was to investigate occupational therapy interventions for dementia for diverse groups. Specifically, factors contributing to acceptable therapy, the experience of delivering/receiving interventions, how the interventions work for people from diverse groups. Methods: Realist inquiry, using the context + mechanism = outcome configuration heuristic, was used to develop a novel program theory. Multi-method data collection comprised a systematic review of cultural adaptation frameworks, literature synthesis, an online survey (n=61), interviews (n=8) and focus groups (n=10) with occupational therapists, and interviews (n=9) and workshops (n=21) with people from diverse groups with living experience of dementia. Analysis: Realist approach of retroductive reasoning was used to develop the program theory. Findings: The Meaningful Engagement Program Theory was built, explaining how and why occupational therapy interventions for dementia work for diverse groups. The desired outcome is meaningful engagement in the intervention. The theory explains that people from diverse groups’ responses to an intervention are influenced by situational contexts (e.g., power imbalance). The therapist draws on specific mechanisms to adjust their approach to each family (e.g., therapeutic use of self). In response people from diverse groups make a connection with the therapist, feel seen, heard and known. The therapist’s approach builds credibility and the families’ self-efficacy. Conclusions: The theory and practical recommendations presented in this thesis support the differentiated approach required to ensure diverse groups are meaningfully engaged in an intervention.