Tailored Activity Program Research Articles

The "Continu-A-mente" project: an interdisciplinary program to promote the continuity of care between hospital and community for people with dementia and their caregivers. Study Protocol.

Background: Nonpharmacological approaches are recommended as first-line treatment for the neuropsychiatric symptoms of persons living with dementia. Tailored Activity Program is a non-pharmacological approach which has shown to reduce neuropsychiatric symptoms and functional dependence of persons living with dementia at the community, as well as caregiver’s distress. The aim of the study is to assess the feasibility of a project in which the Tailored Activity Program is delivered partially at an acute hospital ward and partially at the patient's home. Material and Methods: The study is aimed at enrolling 50 dyads (patients/caregivers) from the memory clinic, acute geriatric ward, or short-stay emergency department at the IRCCS San Gerardo dei Tintori, Monza (Italy). Inclusion criteria are: the patient’s clinical diagnosis of dementia, clinically detectable neuropsychiatric symptoms (Neuro Psychiatric Inventory, NPI score >6 in at least one item), the ability to participate in activities of daily living (Katz’s index ≥ 2), the presence of a caregiver (aged ≥ 21 years; minimum 4 hours of daily care), and the willingness of the dyad patient/caregiver to participate in the project. Treatment is delivered both i) in hospital (2 sessions) and ii) at home (6 sessions), including occupational therapy, telemedicine and nursing care provided once a week. The following variables are measured: Neuro Psychiatric Inventory, Time Up and Go Test, Katz’s Index and the level of caregiver’s sense of competence with the Sense of Competence Questionnaire. Data are collected both at baseline, at the end of the treatment, with a follow-up scheduled at 4 months after enrollment. Primary outcome measure is the dyad's retention rate at 4-month follow-up. Secondary outcomes are the reduction in the patient’s frequency and severity of NPS; the improvement in the patient’s Time Up and Go Test score; the improvement in the patient's levels of autonomy and participation in activities of daily living and improvement in the caregiver’s Sense of Competence Questionnaire score. Results and Conclusion: We seek to evaluate whether the Tailored Activity Program is well-received by the patient/caregiver dyad and, consequently, whether our project is feasible. If this objective is achieved, and if we also report some improvement in the secondary outcomes, we can then plan a larger multicenter study aimed at evaluating the effectiveness of this approach, partly delivered at the hospital and partly at patient’s home.

Cross‐country Effects of the Tailored Activity Program to Reduce Neuropsychiatric Symptoms and Other Dementia‐related Symptoms: Results from Randomized Trials

AbstractBackgroundThe Tailored Activity Program (TAP) is a nonpharmacological approach shown to reduce neuropsychiatric symptoms and other dementia‐related clinical symptoms in people living with dementia and family caregivers.MethodTAP has been tested in 8 different randomized trials (stage 3 efficacy) in four different countries and is currently used in over 9 countries with varying results.ResultAcross 8 trials, TAP was found to have a wide range of benefits including reducing functional dependence and neuropsychiatric symptoms, improving quality of life of both people living with dementia and their caregivers, and enhancing caregiver well‐being. Findings from trials also demonstrate differences in outcomes among samples. For example in a USA trial involving 250 families, TAP compared to attention control resulted in differential effects for Black and White families. Statistically and clinically significant reductions in agitation and aggression (frequency and severity scores) were found for Black families in TAP compared to White families in TAP and those in the control group. In contrast, White caregivers receiving TAP reported less depressive symptoms than other groups.ConclusionComparing outcomes across trials highlights the role of contextual factors and how country specific needs for dementia care may impact outcomes from nonpharmacological interventions. The comparison also reveals multiple challenges concerning dissemination and implementation of TAP (stage 4 and 5) such as lack of workforce preparation, payment mechanisms, and knowledge and acceptability of nonpharmacological approaches.

Occupational Therapy Interventions for Dementia Caregivers: Scoping Review.

Background and purpose: caregivers of people with dementia (PwD) often experience a significant caregiver burden. Occupational Therapy (OT) is a helpful discipline for improving quality of life and other health factors for these caregivers. We conducted a Scoping Review to describe OT interventions for caregivers of PwD. Methods: two authors searched PubMed, Scopus, EMBASE and Web of Science databases and OT journals indexed in the Journal Citation Reports. Terms included in the search strategy were: dementia, Alzheimer, Parkinson, caregivers and OT. We included articles with experimental design in which an OT intervention in caregivers of PwD was carried out, written in Spanish or English and with the full text available. Results: a total of 2121 articles were obtained, 31 of which were included; 22 of them described home-based OT interventions: Tailored Activity Program (TAP) (n = 5), Environmental Skill-Building Program (ESP) (n = 4) and Advancing Caregiver Training (ACT) (n = 3) and other household interventions (n = 10); the remaining studies described OT interventions in other settings (n = 9). Conclusions: OT interventions for caregivers of PwD were mainly carried out at home. The most commonly used interventions were TAP focused on caregivers of people with Alzheimer’s disease, aimed at lessening the burden, depression and stress experienced by caregivers.

Non-pharmacological Intervention for Wandering Behavior in Dementia: A Systematic Review and Meta-analysis

Purpose: The present study aimed to explore the types of non-pharmacological interventions and evaluate their effectiveness in reducing wandering behavior in patientis with dementia.Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. Searching eight databases (Cochrane, Ovid-MEDLINE, EMBASE, CINAHL, PubMed, PsycInfo, RISS, KISS, and KMBASE) yielded 899 related studies. Two reviewers independently assessed the quality of these studies, using Revised Cochrane risk of bias for randomized trials (ROB) 2.0 and Risk of Bias Assessment tool for Non-randomised Study (ROBANS) 2.0, based on this study design. The Algase Wandering Scale related to wandering behavior reported the standardized mean differences and their 95% confidence intervals.Results: A total of seven studies, consisting of four randomized controlled trials (RCTs) and three quasi-experimental studies, met the inclusion criteria. Among non-pharmacological interventions, aromatherapy was the most common. However, therapeutic contact, therapeutic companion robot, tailored activity program, combining physical activity, memory recall, music therapy, and multisensory stimulation were also performed in one study, respectively. In a meta-analysis (RevMan 5.4), non-pharmacological interventions reduced wandering behavior in patients with dementia and mild to moderate functional impairments (p=.003).Conclusion: The result of this meta-analysis suggests that non-pharmacological interventions are generally associated with reduced wandering behavior among patients with dementia and mild-moderate functional impairment. However, it is necessary to develop a more detailed non-pharmacological intervention for patients with dementia and wandering behavior according to their disease stage and characteristics.

Programa Personalizado de Atividades (TAP-BR): proposição de uma versão ambulatorial e avaliação dos seus impactos na demência - Estudo piloto

Abstract Introduction The Tailored Activity Program (TAP-BR) is an occupational therapy intervention program that presents promising results in reducing the behavioral and psychological symptoms of dementia (BPSD). Objectives To propose adaptations to the TAP-BR to create an outpatient care version of this program and assess its impact and applicability. Methods The TAP-BR was adapted for use and application in an outpatient care setting, and the applicability of this version was assessed according to the perception of occupational therapy interns and family caregivers. The Neuropsychiatric Inventory (NPI) and the Depression, Anxiety and Stress Scale (DASS 21) were used as outcome measures to evaluate the impact of the adapted version. Results The following changes in the application process of the TAP-BR were proposed for its outpatient format: adaptation of terms in the Intervention Manual and in the Documentation Folder; adequacy of the environmental assessment to be carried out based on an interview with the caregiver; reduction in session duration from 90 to 60 min. From the point of view of the interns and family caregivers, the program can be easily applied. The outcome measures showed that there was improvement in caregiver distress in relation to the BPSD of the older persons with dementia (Cohen’s d=0.49) and in their emotional state (Cohen’s d=0.59), especially regarding the variable depression (Cohen’s d=0.81). Conclusion: The outpatient version of TAP-BR can be easily applied, has a positive impact on reducing the BPSD in older people, and improves the emotional state of caregivers, with emphasis on the variable depression.

A Meta-Analysis of the Effects of Tailor Activity Program (TAP) for People with Dementia

Ninety eight percent of people with dementia are accompanied by neuropsychiatric symptoms (NPS). NPS is an important predictor of the negative prognosis of dementia. It also increases the burden on caregivers and lowers the quality of life. The tailored activity program (TAP), which is occupation-based intervention, have a positive effect on reducing NPS through meaningful activities. The aim of this study was to provide an integrated effectiveness of the TAP on NPS in people with dementia and caregiver burden through meta-analysis. We searched for studies that indicated the effectiveness of TAP through Embase, ProQuest, Pubmed, and RISS. We included a total of seven TAP studies written in Korean and English. Of these seven study designs, five were randomized control trials (RCTs) and two were one group non-RCTs. The result of meta-analysis shows that the effect size of the NPS was 0.62 (95% confidence interval [CI]=0.40-0.83, p<0.001), the caregiver burden was 0.68 (95% CI=0.29-1.07, p=0.001). Both variables indicated moderate effect. These results indicate that the TAP is an effective intervention for reducing NPS of people with dementia and the burden of caregivers. Therefore, TAP is clinically useful approach, we expect TAP to be actively applied to people with dementia in the community.

Feasibility of the occupational therapy protocol TAP (Tailored Activity Program) for the management of behaviors in a dementia hospital unit: Preliminary results from a pilot study

AbstractBackgroundBPSD may have a significant impact on the quality of life of people with dementia (PWD), cause significant burden in their caregivers (CG) and rise probability of hospitalization .The Tailored Activity Program (TAP) is an evidence‐based OT program based on meaningful activities of PWD. The primary goal of the program is to prevent and reduce BPSD. The intervention is delivered also toward professional and non professional CG to help them with the implementation of the identified strategies, delivered as tailored non‐pharmacological “prescriptions". OBJECTIVE: verify the applicability in Italy of the TAP OT program.MethodsThe program was adapted for the Italian cultural context in agreement with the main author. It consisted of 6 sessions to be carried out at the SCU‐B after being selected by the Geriatrician. Inclusion criteria for PWDs: MMSE &lt;24, CDR &lt;5, absence of psychiatric comorbidities.In addition to the applicability of the program, other parameters were also detected, specifically BPSD (UCLA‐NPI), autonomy (Barthel), quality of life (QUALID), the use of psychotropic drugs, the confidence of the CG in use of strategies.ResultsA total of 10 patients (age 80.7 ± 5.12) and their primary caregivers were recruited. The TAP program proved to be feasible in all its parts as required by the protocol within a specialist hospital dementia unit. There was also a reduction in BPSDs at NPI (median IN = 42; OUT = 12.5), an improvement in autonomy (Barthel median IN = 52.5; OUT = 57.5) and quality of life (Median QUALID IN = 31; OUT = 26). Caregivers reported greater confidence in using activities (M ± SD IN = 2.60 ± 1.96; OUT = 6.75 ± 2.31), communication (M ± SD IN = 4.40 ± 2.64; OUT = 7.63 ± 1.06) and environmental strategies (M ± DS IN = 3.30 ± 2.836; OUT = 7.25 ± 1.69) for the management of BPSDs at the end of the program.ConclusionsTAP was overall feasible and applicable in all its parts and has shown to be useful for both PWD and CG in different outcomes. It is necessary to enlarge the sample to confirm these preliminary positive results.

Effects of the tailored activity program (TAP) on dementia-related symptoms, health events and caregiver wellbeing: a randomized controlled trial

BackgroundPeople living with dementia (PLWD) and caregivers are adversely impacted by lack of meaningful activity leading to worse symptoms and impaired quality-of-life. There is a critical need to develop effective and well-tolerated treatments that mitigate clinical symptoms, engage PLWD and support caregiver wellbeing. We tested whether, compared to attention control, the Tailored Activity Program (TAP) reduced clinical symptoms and health-related events, and improved caregiver wellbeing, and if TAP activities were well-tolerated.MethodsWe conducted a single-blind randomized controlled trial among 250 dyads recruited from Baltimore-Washington DC (2012–2016) with a dementia diagnosis and clinically significant agitation/aggression. Dyads were randomized to TAP (n = 124) or attention control (n = 126), and interviewed at baseline, 3 (endpoint) and 6-months (follow-up) by interviewers masked to group allocation. TAP assessed PLWD abilities/interests, instructed caregivers in using prescribed activities, and provided dementia education and stress reduction techniques. Attention controls received disease education and home safety tips. Both groups had up to 8 home visits over 3-months. The primary outcome was frequency by severity scores for agitation/aggression subscales of Neuropsychiatric Inventory-Clinician using caregiver ratings. Secondary outcomes included number of instrumental (IADL) and activities of daily living (ADL) needing assistance, caregiver wellbeing, and confidence using activities. Health-related events (PLWD death, hospitalizations, caregiver hospitalization, depression) and perceived study benefits were captured over 6 months. PLWD tolerability of prescribed activities was examined.ResultsOf 250 dyads, most caregivers were female (81.2 %, n = 203), non-spouses (54.4 %, n = 136), white (59.2 %, n = 145) or African American (36.7 %, n = 90) with mean age = 65.4 (SD = 12.6). PLWD were mostly female (63.2 %, n = 158) with mean age = 81.4 (SD = 7.9), and mean MMSE = 14.3 (SD = 7.8). At 3-months, compared to controls, TAP conferred no benefit to agitation/aggression (p = 0.43, d = 0.11), but resulted in less IADL (p = 0.02, d=-0.33), and ADL (p = 0.04, d=-0.30) assistance, improved caregiver wellbeing (p = 0.01, d = 0.39), and confidence using activities (p = 0.02, d = 0.32). By 6-months, 15 PLWD in TAP had ≥ 1 health-related event versus 28 PLWD in control, demonstrating 48.8 % improvement in TAP (p = 0.03). TAP caregivers were more likely to perceive study benefits. Prescribed activities were well-tolerated.ConclusionsAlthough TAP did not benefit agitation/aggression, it impacted important outcomes that matter to families warranting its use in dementia care.Clinical trial registrationClinicaltrials.gov # NCT01892579 at https://clinicaltrials.gov/; Date of clinical trial registration: 04/07/2013; Date first dyad enrolled: 15/11/2013.

Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program.

Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.

A longitudinal evaluation of family caregivers' willingness to pay for an in-home nonpharmacologic intervention for people living with dementia: results from a randomized trial.

To determine the willingness-to-pay (WTP) of family caregivers to learn care strategies for persons living with dementia (PLwD). Randomized clinical trial. Community-dwelling PLwD and their caregivers (dyads) in Maryland and Washington, DC. 250 dyads. Tailored Activity Program (TAP) compared to attention control. TAP provides activities tailored to the PLwD and instructs caregivers in their use. At baseline, 3 and 6 months, caregivers were asked their WTP per session for an 8-session 3-month in-home nonpharmacologic intervention to address behavioral symptoms and functional dependence. At baseline, 3 and 6 months, caregivers assigned to TAP were willing to pay $26.10/session (95%CI:$20.42, $33.00), $28.70 (95%CI:$19.73, $39.30), and $22.79 (95%CI: $16.64, $30.09), respectively; attention control caregivers were willing to pay $37.90/session (95%CI: $27.10, $52.02), $30.92 (95%CI: $23.44, $40.94), $27.44 (95%CI: $20.82, $35.34), respectively. The difference in baseline to 3 and 6 months change in WTP between TAP and the attention control was $9.58 (95%CI: -$5.00, $25.47) and $7.15 (95%CI: -$5.72, $21.81). The difference between TAP and attention control in change in the proportion of caregivers willing to pay something from baseline to 3 and 6 months was -12% (95%CI: -28%, -5%) and -7% (95%CI:-25%, -11%), respectively. The difference in change in WTP, among caregivers willing to pay something, between TAP and attention control from baseline to 3 and 6 months was $17.93 (95%CI: $0.22, $38.30) and $11.81 (95%CI: -$2.57, $28.17). Family caregivers are willing to pay more for an intervention immediately following participation in a program similar to which they were asked to value.

Translating Behavioral Interventions: It Is More Than Just Language

In the United States, over 5 million people are living with Alzheimer’s disease or a related dementia. Providing care are an estimated 16 million unpaid caregivers and millions of paid caregivers. Neuro-psychologic symptoms (NPS) such as agitation, aggression, depression, rejection of care, and apathy are almost universal in persons living with dementia (PLwD). Caring for NPS often leads to poor physical, mental and financial outcomes. There have been hundreds of non-pharmacologic interventions tested and found efficacious to help caregivers with NPS and daily care challenges. However, very few of these interventions have been widely adopted in different languages and settings. One promising intervention used in various countries is the Tailored Activity Program (TAP). TAP, delivered by occupational therapists, customizes activities to PLwD’s current capabilities and prior roles and interests and instructs caregivers in their use. This session will examine TAP’s reach and how it has been translated and adapted. First, Ms. Sokha Koeuth will present modifications needed to the program to facilitate widespread dissemination including placing training in the program online and virtual. The next two presentations will discuss adaptations to TAP in different countries and cultures; Dr. Marcia Novielli will present TAP-Brazil, and Dr. Jean Gajardo Jauregui will present TAP-Chile. Finally, Dr. Katherine Marx will examine the adaptations needed to place TAP into a long-term care setting with both family and paid caregivers. These papers highlight the cross-cultural adaptations that need to be considered in taking a program from research to different real world clinical and community-based settings. Behavioral Interventions for Older Adults Interest Group Sponsored Symposium.

Adaptations for TAP in a Long-Term Care Setting

One of the most difficult aspects of caring for people living with dementia is managing neuropsychologic symptoms and functional decline. Although there are hundreds of efficacious non-pharmacologic interventions tested in homes, few are adapted for and tested in long-term care. The purpose of this pilot study was to identify the adaptations needed for the Tailored Activity Program (TAP) to make it feasible and acceptable in a long-term care facility. TAP provides tailored activities matched to interests and abilities to address dementia-related clinical symptoms. Two sites, under the umbrella of one company, participated. A total of five persons living with dementia, their family caregivers, two direct care staff and an interventionist participated, and occupational therapist who contracts with the site on a regular basis. Adaptations included shorter sessions and changes to forms to fit with workflows and documentation. Additional considerations challenging implementation of TAP included staff turn-over and training. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Scaling an Evidence-Based Program: The Case of the Tailored Activity Program

The Tailored Activity Program (TAP) is a proven program delivered primarily by occupational therapists addressing dementia-related clinical symptoms including caregiver well-being. Although used in 9 countries including the United States, scaling and widespread dissemination is challenging. We discuss key revisions to TAP to facilitate dissemination including matching assessments to those used in different practice settings, translation of materials into different languages, providing worksheets to help trainees adapt TAP to local contexts and a training/certification online experience using story board, an interactive media integrated onto the Blackboard learn management system, to provide on-demand training modules. The learning platform allows learners to engage with others, preview modules and share experiences. Revisions enable greater flexibility for program adaptation yet adherence to its core principles. With over 150 trainees, we use REAIM to evaluate effectiveness of modifications and to understand implications for its reach. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Cultural Adaptation of the Home-Based Tailored Activity Program in Chile

Chile is currently implementing policies addressing dementia care with efforts to translate evidence-based programs towards culturally sensitive models of care. This study describes the cultural adaptation of the Tailored Activity Program (TAP). A complementary mixed-method design was performed following the 4-phase Dynamic Adaptation Process (DAP) model by Aarons et al, 2012. Ten dyads (family caregivers and people with dementia) completed a regular 8-session home-based TAP intervention during 2017-2018. Qualitative data was collected through interviews and observation with caregivers, and weekly follow-up and a focus group with provider occupational therapists. Quantitative data in pilot testing was obtained through assessments at baseline and after intervention. The TAP was well accepted by family caregivers, and sociocultural adaptations on content, context, target level, and training were identified. Significant reduction of frequency and severity of neuropsychiatric symptoms in individuals with dementia was found, and caregivers reported reduction of depressive symptoms, improved perceived well-being & self-confidence. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Where to Begin: Assessing Caregiver Readiness

There have been many interventions targeting family caregivers for people living with dementia (PLwD) that have been found to have efficacy and effectiveness. However, very few of these interventions have been widely adopted. One reason may be that clinicians and other professionals working with caregivers are unsure of what intervention to use. One measure that may help with where to begin is Caregiver Readiness. This presentation will provide case studies on the use of the Caregiver Readiness Scale in one intervention, the Tailored Activity Program (TAP). We will highlight three cases that have low, moderate and high readiness scores and how the TAP interventionists use the readiness scores to tailor the intervention to match the caregiver’s need. Knowing a caregiver’s readiness to receive an intervention may help clinicians and providers identify where to being in helping the caregiver.

Family Caregiver Assessments: What Have We Learned From Assessments Across Populations and Health Conditions?

This symposium will bring together research on assessments of family caregivers for older individuals with different health conditions and discuss the components of effective assessments. Comprehensive characterizations of caregivers are essential due to an increase in the demand on caregivers, and how intense care contexts contribute to the caregiver’s decline in health and diminished capacity to provide quality care. According to Caregiving in the U.S. 2020 (n=1,400), only 13% of caregivers were asked by healthcare professionals what they needed to take care of themselves. Peer-reviewed studies have reported that caregivers are often reluctant to self-identify and to ask for the help that they need for themselves and those in their care. Since supports to caregivers have historically relied on this self-identification, the first presentation (Grace Whiting) will focus on the work NAC has done to build pathways between caregivers and supportive services to increase availability, accessibility, and patient-centeredness. The second presentation (Esther Friedman) will identify and discuss the barriers to fully incorporating family caregivers into the health care team, as well as the solutions for removing barriers. The next two presentations, respectively, will focus on characterizing the prevalence, burden, and unmet needs of caregivers of cancer patients (Erin Kent), and the unmet needs of families of adults with intellectual and development disabilities (Tamar Heller). The final presentation will explore caregiver readiness in dementia care using the Tailored Activity Program (TAP) and how TAP interventionists can use readiness scores to determine caregiver’s capacity (Katherine Marx).

Cross-Cultural Adaptation of the Tailored Activity Program for Brazilian Portuguese

Brazil lacks an Occupational Therapy methodology of action, justifying the cross-cultural adaptation of TAP. Objectives were to adapt TAP reference materials to the Brazilian culture and evaluation of the applicability of the Portuguese version by perceptions of Occupational Therapists (OT) and family caregivers. The methodology used translation, back translation, evaluation of semantic, idiomatic, conceptual and cultural equivalences and pre-test of materials for production in Portuguese. The OT applied the translated version and evaluated its applicability. Caregivers evaluated the social impact of the adapted program. The cross-cultural adaptation process adapted the entire materials program to Portuguese culture. The OT perception is a need to include one session to guide caregivers and to modify the cognitive assessment used. The caregivers pointed out that TAP helps them in understanding and caring for the elderly with dementia. The TAP-BR has been adapted to the Brazilian culture. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Policy makers' perception on the potential of adoption of the Tailored Activity Program (TAP) in Chile

AbstractBackgroundThe Tailored Activity Program (TAP) is an evidenced‐based program targeting behavioral and psychological symptoms of dementia and caregivers’ readiness, among other outcomes. TAP has been tested and implemented in different settings and countries. Evidence‐based interventions face the challenge of transference and adoption with a complexity of dimensions. This study explored the perception of key stakeholders and policy makers related to dementia care on the potential adoption of TAP in Chile, utilizing Roger’s Model of Innovation‐Decision Process (1983).MethodQualitative study. Key policy makers related to Chile’s Ministry of Health, Ministry of Social Development, and National Plan of Dementia, were introduced to TAP’s main features, process, and outcomes, and later interviewed to describe the following five attributes of TAP: relative advantage, compatibility, complexity, trialability, observability. These attributes were extracted from the Persuasion Phase of Rogers’ Model of Innovation‐Decision Process (1983). Interviews were recorded and transcribed, and narrative content analysis was used to produce content categories. Ethical approval was obtained from the Scientific Ethics Committee of Adults, Metropolitan Health Service, Santiago, 2019. Informed consent was completed by all participants.ResultSeven interviews were performed to policy makers at a national level part of Chile’s National Plan of Dementia. Participants described TAP in a low‐level of complexity, easy to understand, and highly feasible for implementation, as well as highly compatible with existing efforts on dementia care in Chile, highlighting its observable results, pertinence for local testing and its comparative advantage to existing interventions.ConclusionPolicy makers value positively TAP’s features and its adoption is highly feasible within current initiatives on dementia care in Chile.

Stakeholders' perception of the adoption potential of TAP: Lessons from Chile

AbstractBackgroundChile’s National Plan of Dementia has been implemented since 2017. This national strategy has the urgent need to develop or adopt non pharmacological interventions targeting people with dementia and caregivers. The Tailored Activity Program (TAP) is an evidenced‐based program that has been translated to different contexts, however, its outreach in Chile is still under development. This study describes how key stakeholders involved in the National Plan of Dementia in Chile perceive this intervention’s characteristics.MethodThis is a qualitative study addressing the perceptions of key policy makers involved in the National Plan of Dementia on the characteristics of the TAP. Interviews were recorded and transcribed, and content analysis was used to describe stakeholders’ perception. Written consent was completed by all participants. Ethical approval was obtained from the Scientific Ethics Committee of Adults, Metropolitan Health Service, Santiago, 2019.ResultSeven stakeholders were interviewed, all directly involved in the design, implementation, or evaluation of the actions part of the National Plan of Dementia in Chile. Six main categories describing stakeholders’ perception of TAP were produced: 1) Feelings towards TAP, 2) How they see TAP, 3) What to expect from TAP, 4) Institutional fit, 5) Profiles of providers, and 6) Suggestions for a pilot study.ConclusionStakeholders in Chile show a positive perception of the TAP, offering relevant information on the potential adoption of the TAP in a new context.

Cultural adaptation of the Tailored Activity Program (TAP) in Chile: Implementation challenges and pilot testing

AbstractBackgroundThe Tailored Activity Program (TAP) provides people with dementia with activities tailored to their capabilities and trains caregivers in their use. The TAP has been previously cross‐culturally adapted in different settings and countries. This study was aimed to develop a cultural adaptation of the TAP in Santiago, Chile.MethodComplementary mixed‐method study following the 4‐phase Dynamic Adaptation Process (DAP) model (Aarons et al, 2012). Qualitative data was collected by conducting 1) interviews and ethnographic observation with caregivers, 2) weekly follow‐up meetings to provide ongoing feedback, and 3) a focus group with provider occupational therapists after the Implementation phase based on the DAP. Grounded theory (Strauss &amp; Corbin, 1998) was used to guide qualitative analysis, to access the experiences of caregivers and providers, and to identify and describe adaptations and implementation outcomes based on the Framework and Coding System for Modifications and Adaptations of Evidence‐based Interventions (Stirman et al, 2013). Quantitative data for pilot testing was obtained through assessments at baseline and after intervention. Wilcoxon‐test and T‐test at p&lt;0.05 were used to estimate the effect of the intervention on outcomes. Ethical approval was granted by the Ethics Scientific Committee "Servicio de Salud Metropolitano Oriente" in June 2017.ResultTen dyads (family caregivers and people with dementia) were recruited in this study after being referred from a neurologist specialized in dementia and they completed a regular 8‐session home‐based intervention of the TAP during 2017‐2018. Content, context, target level, and training adaptations were identified. After intervention, there was a statistically significant reduction on the number and severity of neuropsychiatric symptoms among individuals with dementia. Caregivers reported reduced depressive symptoms, improved perceived well‐being, and improved self‐confidence.ConclusionSociocultural adaptations were identified in the adaptation of the TAP to the local context in Chile. The TAP was highly accepted by participants, especially caregivers, who acknowledged its personalized problem‐solving approach and positive effects. Positive outcomes were shown in both people with dementia and caregivers, in consistence with previous studies.