The sustainability of community interventions for people affected by dementia: A realist review

Background
Community‐based support for people with dementia and their care partners (family/friends), such as regularly‐meeting groups and activities, can play an important part in post‐diagnostic care: from combating isolation and maintaining positive self‐image, to delaying decline and hospitalisation. However, in countries such as the UK these are typically delivered piecemeal by a variety of agencies with inconsistent funding. This has led to fragmented provision with significant gaps and, to add to this, many such interventions are forced to fold after only a short period. The SCI‐Dem review is investigating what can promote, or get in the way of, community interventions for people affected by dementia becoming sustainable over time.

Method
This review is utilising a Realist approach. Key sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking and snowballing. Data were interrogated, assessed and organised with the aid of NVivo software, and a Realist logic of analysis was applied to trace context‐mechanism‐outcome configurations as part an overall programme theory, indicating what works for whom, in what circumstances, in what respects and how, with regards to sustaining community interventions. Consultation with stakeholders, involved with a variety of such interventions in various roles, informed this process throughout.

Result
Due to complete in September 2020, this review will produce an evidence‐informed programme theory mapping how different contexts can trigger mechanisms (processes in people and organisations) to produce outcomes that help or hinder the sustainability of a community group or activity. Early findings suggest a range of factors affecting four key areas for sustainability: whether a group or activity can get or keep 1) members; 2) appropriate staff and volunteers; 3) necessary resources; 4) necessary funding.

Conclusion
Conclusions will focus upon how best to implement community‐based interventions, with recommendations to those commissioning, planning or running such schemes, based upon our programme theory. Accessible publications and online materials will be produced, aiming to provide an evidence‐informed ‘blueprint’ for other community settings. Recommendations about what could be useful at both regional and national policy and infrastructure levels will also be made.