Group experiences of cognitive stimulation therapy (CST) in Tanzania: a qualitative study

Jasmine Morrish,Richard Walker,Catherine Dotchin,Aimee Spector,Stavros Orfanos,Sarah Mkenda,Esther Peniel Shali

doi:10.1080/13607863.2021.1872489

Abstract

Background Tanzania is a low-income country in which medication for dementia is largely unavailable. Cognitive Stimulation Therapy (CST) is a group-based psychological treatment for people with dementia (PwD), shown to improve cognition and quality of life (QoL). It has previously been culturally adapted and piloted in Tanzania, shown to produce similar outcomes. UK research into CST suggests processes inherent to the group nature are key to its success. This study sought to identify group processes within CST in Tanzania and understand their impact on CST principles and outcomes. Methods Data collection took place in rural Hai District, through qualitative semi-structured interviews. Sixteen PwD and four facilitators were recruited through convenience sampling and interviewed about their experiences of CST. Interviews were audio-recorded, translated, transcribed and analysed by thematic analysis. Results Two main themes emerged: ‘Positive group experiences’ and ‘Negative group experiences’. From this, a number of group processes were identified, such as helping behaviours and feeling understood by the group. Positive processes supported CST principles and participant improvement. Facilitators were influential over group dynamics. The group processes identified impacted CST principles and treatment outcomes. Conclusions This is the first study on group mechanisms of CST in Tanzania. It provides deeper insight into participants’ experiences of CST, thus identifying specific processes underlying the quantitatively measured positive outcomes of CST in Tanzania by previous studies. It also reveals further cultural barriers to implementation, enabling amendments for optimization of treatment efficacy.

Highlights

The global burden of dementia is rapidly increasing
This study sought to gain insight into these group processes occurring within Tanzanian Cognitive Stimulation Therapy (CST) and understand their impact on CST principles and outcomes
CST is cost-effective and the only non-drug treatment recommended by the UK National Institute of Clinical Excellence (NICE) to treat cognitive symptoms in dementia (Knapp et al, 2006)

Summary

Introduction

The global burden of dementia is rapidly increasing. This is largely attributable to increased cases in low- and middle- income countries (LMICs) as the populations undergo demographic transition with result in increase in the older population (Prince et al, 2008). Cognitive stimulation therapy (CST) is a non-pharmacological, evidencebased intervention for dementia (Spector et al, 2003). Cognitive Stimulation Therapy (CST) is a group-based psychological treatment for people with dementia (PwD), shown to improve cognition and quality of life (QoL). It has previously been culturally adapted and piloted in Tanzania, with findings showing similar benefits. Conclusions: The group processes identified in this study impacted upon CST principles and outcomes. These findings support previous studies, explaining how CST improves PwDs’ QoL and cognition.

Objectives

Methods

Results

Discussion

Conclusion