Cultural adaptation of the Reducing Disability in Alzheimer’s Disease (RDAD) protocol for intervention to reduce behavioral and psychological symptoms of dementia (BPSD) in Thailand

Abstract

AbstractBackgroundThe Reducing Disability in Alzheimer’s Disease (RDAD) protocol is an evidence‐based intervention (EBI) found to be feasible for implementation in community settings, and effective for reducing behavioral and psychological symptoms of dementia (BPSD) and improving caregiver outcomes (Teri et al., 2003; 2008). This study adapted the RDAD for delivery in Thai community settings, so that core components of the intervention—knowledge, communication, pleasant events, behavioral modification and physical activity—could be implemented through home‐based care by community‐based health personnel.MethodAdaptation processes followed, sometimes recursively, 10 adaptation steps identified by Escoffery et al., (2018): (1) assess the current care delivery system and resources in the community, (2) understand relevant EBIs, (3) select appropriate EBI, (4) consult with experts in intervention design and implementation, (5) consult with stakeholders in implementation settings, (6) work with experienced implementers to decide what needs to be adapted, (7) adapt original intervention program, (8) train staff for implementation of modified intervention, (9) test adapted materials, and (10) implement and evaluate intervention.ResultBased on qualitative data collected through consultation and discussion meetings with experts in intervention and implementation research and stakeholders of care delivery from local communities (Steps 1‐7), a modified Thai‐RDAD protocol was developed to fit into the clinical, social, and cultural practice of Thai local settings. Protocols for training were pilot tested with 20 providers (Steps 8); and the Thai‐RDAD protocol was tested with persons with dementia and their family caregivers at four participating families (Step 9). Findings from the pilot study were incorporated into the intervention protocol, particularly concerning comprehension of the intervention activities, realistic goal setting, and improving communication among all parties involved, prior to implementation (Step 10) of the adapted intervention protocol in an NIMH‐funded large clinical trial in the long‐term care system of Thailand.ConclusionA systematic approach to adaptation of EBIs by synthesizing perspectives from both intervention and implementation researchers, as well as stakeholders of care delivery from local communities, and pilot testing the modified EBI protocol, are critical for effective adaptations to local clinical and cultural contexts.