Developing a national strategy to support implementation of reablement for community-dwelling people living with dementia.

Abstract

Background: Dementia reablement is globally recommended to support people living with dementia to maximise their independence. Despite this, dementia reablement is not broadly available and there is currently no consensus around how it should be implemented. This study aimed to develop a national strategy by reaching expert consensus on the barriers, enablers, and potential implementation strategies to promote uptake of evidence-informed dementia reablement.

Methods: A modified online Delphi survey process was used to gain national consensus on the determinants and implementation strategies pertaining to implementing community-based dementia reablement in Australia. Purposive sampling and snowballing were used to recruit a range of knowledge and experience-based expert interest holders, including people living with dementia, informal/family carers, allied health professionals, program managers/referrers, policy makers, experts and thought leaders. Using the Consolidated Framework for Implementation Research (CFIR), round one sought consensus around a range of determinants (i.e. barriers and enablers) to implementing reablement for community dwelling people living with dementia across four domains: (1) the system, (2) service providers, (3) family, and (4) the person living with dementia. Using the Expert Recommendations for Implementing Change (ERIC) strategies compilation, round two sought consensus on a range of implementation strategies, presented across the same four domains. Across each domain in both survey rounds, participants were invited to provide written comments to supplement their ratings. Consensus for inclusion of each item was defined as ≥ 70% agreement across experts.

Results: Fifty participants completed the round one survey, and n = 35 (70%) participants completed round two. In round one, a range of determinants (barriers (n = 11) and enablers (n = 17)) for implementing community-based dementia reablement reached consensus. In round two, n = 28 implementation strategies reached consensus. Taken together, outcomes from this Delphi process highlight four key themes relating to the implementation of dementia reablement: (1) education and promotion, (2) engaging consumers and providing support to carers and people living with dementia, (3) service provider capacity to deliver reablement, and (4) funding, policy, and access to services.

Conclusions: Effectively implementing dementia reablement will take a sector-wide approach that involves top-down and bottom-up support, focuses on education and promotion of reablement, and leverages policy and funding.