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Global health
Protocol
Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)
  1. Aimee Spector1,
  2. Charlotte R Stoner1,
  3. Mina Chandra2,
  4. Sridhar Vaitheswaran3,
  5. Bharath Du4,
  6. Adelina Comas-Herrera5,
  7. Catherine Dotchin6,7,
  8. Cleusa Ferri8,
  9. Martin Knapp5,
  10. Murali Krishna4,
  11. Jerson Laks9,
  12. Susan Michie1,
  13. Daniel C Mograbi10,11,
  14. Martin William Orrell12,
  15. Stella-Maria Paddick13,
  16. Shaji KS14,
  17. Thara Rangawsamy15,
  18. Richard Walker6,7
  1. 1 Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
  2. 2 Department of Psychiatry, Centre of Excellence in Mental Health, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
  3. 3 Dementia Care, Schizophrenia Research Foundation (SCARF), Chennai, India
  4. 4 Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
  5. 5 Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
  6. 6 North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  7. 7 Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
  8. 8 Postgraduate Program of the Psychobiology Department, Universidade Federal de Sao Paulo, São Paulo, Brazil
  9. 9 Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  10. 10 Department of Psychology, PUC-Rio, Rio de Janeiro, Brazil
  11. 11 Institute of Psychiatry, King's College London, London, UK
  12. 12 Institute of Mental Health, University of Nottingham, Nottingham, UK
  13. 13 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
  14. 14 Department of Psychiatry, Government Medical College, Kerala, India
  15. 15 Department of Research, Schizophrenia Research Fondation (SCARF), Chennai, India
  1. Correspondence to Dr Charlotte R Stoner; c.stoner{at}ucl.ac.uk

Abstract

Introduction In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income).

Methods and analysis Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation.

Ethics and dissemination Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer’s Disease International, and via ongoing engagement with key policymakers.

  • cognition
  • Alzheimer’s disease
  • developing countries
  • quality of life
  • feasibility

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-030933

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    Footnotes

    • Contributors AS conceived the research, was primarily responsible for writing the protocol and acts as Chief Investigator for CST-International. CRS assisted in the writing of the protocol, costed the grant and prepared this manuscript for submission. CRS is the Programme Manager for CST-International. MC, SV, MKr, SKS and TR are the India coapplicants and researchers who assisted in developing the methodology for the proposal and writing the protocol. BD from the Mysore site contributed to the protocol. DCM, JL and CF are the Brazil leads and assisted in the writing of the protocol. RW, S-MP and CD are the Tanzania leads and assisted with the writing of the protocol. MWO and SM are UK based coapplicants, who commented on the protocol. AC-H and MKn provided information for the economic analysis of CST.

    • Funding This work is supported by the following Global Alliance for Chronic Diseases (GACD) funding agencies: The United Kingdom Medical Research Council (MRC: MR/S004009/1) and the Indian Council of Medical Research (ICMR: Indo-foreign/67/M/2018-NCD-I). No funding bodies were involved in the design, collection, analysis, interpretation or writing of the research or manuscript.

    • Disclaimer The views expressed are those of the authors and not necessarily those of GACD, the MRC or ICMR.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was granted by the relevant body in each country. In Brazil, an ethics amendment was granted by the Federal University of Rio de Janeiro Institute of Psychiatry REC (ref: 57019616.5.0000.5263) to incorporate the current research programme. In India, approval was granted by Institutional Ethics Committees (IECs) in each of the four sites (Schizophrenia Research Foundation; SCARF: Chennai; 28 November 2017, Government Medical College: Thrissur; B6-8772/2016/MCTCR, PGIMER Dr RML Hospital: New Delhi; 219(38/2017)/IEC/PGIMER/RMLH43, All India Institute of Speech and Hearing: Mysuru; SH/Extramural/1/2017–18). In Tanzania, approval was granted by KCMC and nationally by the National Institute of Medical Research, Dar-es-Salaam.

    • Provenance and peer review Not commissioned; externally peer reviewed.