A pragmatic evaluation of a county-wide approach to scaling Meeting Centres for people living with dementia and their unpaid carers

Background and aims: The aim of this research was to evaluate the Worcestershire Meeting Centres Programme (WMCP). Meeting Centres (MCs) provide post-diagnostic community-based support for people and families affected by dementia. WMCP is a novel approach to replicating MCs county-wide (i.e. scaling out). Understanding the programme development and implementation, and the social and economic value created for individuals and society are key reporting requirements.
Methodology: Pragmatic evaluation approaches are recommended for evaluating complex interventions. Systems thinking and theory of change were used to capture and model what and how change happened and fed into a Social Return on Investment (SROI) analysis to measure and monetise the costs and outcomes of MCs based on what was important to diverse stakeholders.
Design and methods: An exploratory sequential mixed-methods research design was used. Qualitative methods were employed to collect data at three MCs with people with dementia (n = 5), unpaid carers (n = 6), staff (n = 4), volunteers (n = 7), and senior managers (n = 4), and remotely from healthcare and other professionals involved with the WMCP (n = 6). These data were used to i) report WMCP development and implementation using the Template for Intervention Description and Replication (TIDieR) checklist, and ii) explore and socially construct a theory of change applying thematic analysis. Quantitative methods were used at the MCs to i) measure and descriptively analyse outcomes to quantify individual level impacts for people with dementia (n = 27), unpaid carers (n = 19), staff and volunteers (n = 11), and ii) capture and value, monetarily, costs and outcomes at the MCs to evaluate social value and SROI. Finally, the results across data sets were analysed using a multiple triangulation approach.
Results: i) The complexity of WMCP inner contexts, structure of the local social care markets, and capabilities and culture of providers and professionals affected scaling processes and outcomes (e.g., uptake, fidelity, adoption, equity, sustainability). ii) People with dementia, unpaid carers, staff, and volunteers reported social, emotional, and practical outcomes. Providers reported changes to their organisational capabilities such as raised profile and monitoring and evaluation practices. However, accessibility, quality of support, equity of reach, and sustainability of MCs were concerns. iii) When measured outcomes were found to be highly valued by individuals and providers and to be occurring in most cases, although negative changes in some outcomes was also reported. Effectiveness could not be confirmed or rejected because of small samples, high attrition rates, and a non-systematic approach to data collection. iv) Monetary valuation of costs found large variation in overall costs between MCs. SROI analysis estimated that MCs create from £2.28 to £3.02 of social value for every £1 invested (2.28:1-3.02:1). It was estimated that £2 of social value was created for every £1 invested in the WMCP based on 10 MCs (2:1).
Conclusion: This is the first research on approaches to scale MCs, and only the second on MC cost-effectiveness. By taking a pragmatic evaluation approach, important and usable evidence has been constructed to inform the development, implementation, and evaluation of MCs at different scales. TIDieR proved to be a feasible way to report WCMP antecedents, key components, implementation strategies, and modifications that are essential information points for translating knowledge into action and replicating interventions. A myriad of implementation issues challenged programme fidelity, reach, equity, sustainability, and the overall feasibility of scaling out MCs in this way. Data collection issues highlighted the practicality of using routine and nonroutine measures for full-scale evaluation of WMCP, therefore, unbiased conclusions could not be made about the effectiveness of WMCP. Despite this, the added value WMCP created suggests it has many benefits for individuals and society. Furthermore, positive SROI ratios at the three MCs indicate that this intervention is good value for money. Recommendations made from this research project should be adopted to leverage social value and for continuous refinement of WMCP programme theory