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BackgroundThe Normalization Process Theory (NPT) is increasingly used for evaluating and understanding implementation processes of complex care interventions. One key tool for applying the NPT in research and practice is the NoMAD questionnaire, which offers a structured approach to examination of the four constructs that according to the NPT are central in implementation and normalisation processes. We aimed to evaluate the psychometric properties of the Swedish version S-NoMAD.

MethodsSecondary analysis was performed on pooled S-NoMAD survey data from six implementation studies in different health and social care contexts. The NPT factor structure was tested by confirmatory factor analysis (CFA). Internal construct reliability was tested using Cronbach’s alpha. Validity was confirmed by assessing the fit of the CFA using the fit measures Comparative Fit Index, Tucker-Lewis Index, root mean square error of approximation and standardised root mean square residual. Pearson correlations amongst the latent construct and general questions about the intervention were calculated.

ResultsThe estimation results of the CFA indicate that the four-factor model implied by the NPT fits the data reasonably well. The factor loadings are of good sizes and the fit indices do not imply a mis-specified model. A good internal construct validity, indicated by a good model fit to the NPT four-construct model and acceptable to good internal reliability, was shown. External validity was also demonstrated.

ConclusionsThe CFA results indicate that the S-NoMAD has good psychometric properties for capturing perceptions of people involved in various Swedish implementation studies conducted in both health and social care contexts, demonstrating its general applicability. They show that the S-NoMAD, unlike the majority of instruments for evaluation of implementation processes, is not context- and intervention-specific. The findings highlight the utility of the S-NoMAD and show that it meets some important criteria for pragmatic measures. Further studies are warranted on different interventions implemented in diverse contexts regarding the meaning of the magnitude of the NoMAD scores in order to clarify its potential value as a tool for assessment of implementation strategies and on psychometric properties beyond construct validity and internal construct reliability, for example on test–retest reliability and longitudinal studies focusing on responsiveness.

People with dementia are living longer in the community and reliance on informal caregivers is increasing. Few studies have focused on the experiences of adult-daughter caregivers (daughter caregivers), who may have increased risk of depression and lack of support compared with spousal caregivers. We aimed to explore the experiences of accessing and receiving formal and informal support among daughter caregivers of people living with dementia in Sweden. We conducted semi-structured interviews with 23 daughter caregivers. A topic guide was used to explore experiences of accessing and receiving formal and informal support in their caregiving role. We analyzed the interviews using reflexive thematic analysis. We generated two themes: Types of support, and Mismatched support. The first theme, with subthemes Sharing experiences, Professional support, and Getting some relief, captured the caregiver support context with different types of support accessed and received by daughter caregivers, with peer support and informational support identified as important components of caregiver support. The second theme, with subthemes Lack of tailoring to daughter caregivers’ needs and Difficulties navigating support, captured how daughter caregivers perceived existing support to be inadequate to meet their specific needs and the complex structure of available support limited their opportunities to access support. Daughter caregivers experience a mismatch between the type of support accessed and received and their specific support needs. Support better tailored to the needs and situation of daughter caregivers of people with dementia in Sweden is required. The potential of utilizing peer support for caregivers warrants further research.

Background: It is of utmost importance to identify older adults at risk of cognitive impairment at the earliest possible stage. Previous research supports the potential of investigating step parameters and turn duration during Timed Up and Go (TUG) during single and dual-task (TUGdt) conditions to detect subtle impairment. The aim of this study was therefore to investigate the test-retest reliability and measurement error of novel outcomes related to TUG and two TUGdt tests, TUGdt-NA (naming animals) and TUGdt-MB (reciting months in reverse order), in older adults with perceived memory impairment.

Methods: Thirty-four participants (18 women, mean age 76) were included and assessed with TUG, TUGdt-NA and TUGdt-MB on two different occasions, 5-10 days apart. Tests were video recorded for data extraction of spatiotemporal step parameters and turn duration. Reliability of motor and cognitive outcomes were analyzed with intraclass correlations (ICC^2.1), standard errors of measurement and minimal detectable change (MDC). The proportional measurement error was presented with MDC%.

Results: The results showed very good reliability (ICC^2.1 ≥ 0.85) regarding total completion times, although the measurement error and proportional measurement error (MDC%) was higher during TUGdt conditions than TUG. The reliability of cognitive outcomes during TUGdt favored TUGdt-MB (ICC^2.1 ≥ 0.77, MDC% ≤ 39.8). Step length was the step parameter with highest reliability (ICC^2.1 ≥ 0.86) and lowest proportional measurement error (MDC% ≤ 21.4) across conditions, whereas turn duration showed good reliability during TUG and TUGdt-MB (ICC^2.1 ≥ 0.74, MDC%≤ 38.9).

Conclusion: The results support the potential of including TUG and TUGdt outcomes in cognitive risk evaluations among older adults.

Objectives

Experiences of daughter caregivers are underrepresented in the broader caregiving literature, with studies commonly focusing on spousal caregivers. We aimed to explore challenges experienced by daughter caregivers, reporting varying severity of depressive symptoms, of a parent with dementia in Sweden. This study is situated within a wider research program to inform the development of psychological support for this underserved caregiver group.

Method

Following a semi-structured topic guide, we interviewed 23 daughter caregivers. We used reflexive thematic analysis to analyze the interviews. We did not compare and contrast challenges expressed by daughter caregivers experiencing different levels of depression severity; however, symptom severity is reported to contextualize findings.

Results

We generated one overarching theme, Changing Roles and Expectations Over Time, and four themes: Caregiver Role – Expectations; Puzzle of Life – Balancing Roles; Relationship with the Parent – Reciprocity, and Anticipating the Inevitable – Loss and Grief. Daughter caregivers reported challenges balancing multiple roles, difficulties prioritizing their own well-being, relationship difficulties with their parent, and anticipatory grief, with challenges changing over the dementia trajectory.

Conclusion

Future research should explore support needs across specific phases of the dementia trajectory to inform the development of tailored psychological support.

Introduction: Public contribution is increasingly prioritised by research institutions, funding bodies, and policymakers globally. However, the evidence base for the impact of public contribution remains limited. Researchers and public contributors' experiences of such activities are also rarely reported. We worked alongside a Public Advisory Group (PAG) consisting of informal caregivers of people with dementia during a series of studies to inform the development and adaptation of a guided low-intensity behavioural activation intervention for people with dementia (INVOLVERA). The overall aim of the current study was to explore the experience, process, and impact of involving caregivers of people with dementia as public contributors during the intervention development phase of INVOLVERA.

Methods: Public contribution activities were recorded using impact logs from PAG meetings, from which public contributors' suggestions for the intervention were extracted and categorised, and the implementation rate calculated. Semi-structured interviews were conducted with public contributors (n = 4) and researchers (n = 3), and analysed using manifest content analysis.

Results: Public contributors made 158 suggestions across nine PAG meetings, with 76% of these implemented by the researchers. Analysis of interviews generated three categories: Perceived impacts, Interactions and facilitators, and Future challenges and opportunities. Interviews suggested public contribution activities positively impacted the research (e.g., improving intervention acceptability) and those involved (e.g., new knowledge and skills). Public contributors provided valuable recommendations for involving people with dementia and male caregivers in future activities.

Conclusions: Findings illustrate a positive impact of public contribution activities on the research and those involved. This underscores the important role of public contribution during the development of complex interventions and further emphasises the need for comprehensive reporting on the impact of such activities. We believe this study strengthens the evidence base for public contribution and offers practical insights into fostering effective partnerships with public contributors.

Public Contribution: A PAG consisting of wives and daughters (n = 4) of people with dementia worked alongside the researchers throughout the intervention development phase of the project. Contributions included (1) sense-making and interpreting results from a series of intervention development studies, (2) co-designing the intervention, and (3) disseminating findings, including co-writing the current paper.

Background

Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability.

Methods

Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI⁹⁵) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated.

Results

Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤ . 67, CI⁹⁵: .45-.99, p = ≤ . 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR = .51, CI⁹⁵:.29- .87, p = .014), whereby the area under the curve was calculated (c-statistics = .700). The optimal cut-off indicated a step length of less than 32.9% (CI⁹⁵ = 22.1–43.0) of body height to identify SCI compared with controls.

Conclusions

The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment.

Trial registration number

NCT05893524 (retrospectively registered 08/06/23).