Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility and Lessons for Implementation (Preprint)

Abstract

Cognitive Stimulation Therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, which has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention, but has recently been adapted for online delivery.

This study explores the feasibility and acceptability of online or virtual CST delivery (vCST) in India and Brazil, emphasizing barriers and facilitators to implementation.

A single-group, multi-site feasibility study, with nested qualitative interviews. Primary feasibility outcomes were attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and post-intervention measures, including cognition and quality of life, were administered. Qualitative interviews with people with dementia, family caregivers, and group and organizational leaders followed intervention delivery, analyzed using the Consolidated Framework for Implementation Research (CFIR).

Seventeen vCST groups with 59 participants took place over seven weeks, with 52.5% of participants attending all 14 sessions. Attrition rate was 6.8%, and outcome measure completion rate at follow-up was 67.8%. Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders, and enabled vital access to services during pandemic restrictions. Whilst virtual services broadened geographical access, challenges related to computer literacy, technology access, and building interpersonal connections virtually were raised. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities and activities of daily living.

vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic. However, challenges relate to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST whilst emphasizing ongoing development and solutions to address implementation challenges.