PT  - JOURNAL ARTICLE
AU  - Aimee Spector
AU  - Charlotte R Stoner
AU  - Mina Chandra
AU  - Sridhar Vaitheswaran
AU  - Bharath Du
AU  - Adelina Comas-Herrera
AU  - Catherine Dotchin
AU  - Cleusa Ferri
AU  - Martin Knapp
AU  - Murali Krishna
AU  - Jerson Laks
AU  - Susan Michie
AU  - Daniel C Mograbi
AU  - Martin William Orrell
AU  - Stella-Maria Paddick
AU  - Shaji KS
AU  - Thara Rangawsamy
AU  - Richard Walker
TI  - 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)
AID  - 10.1136/bmjopen-2019-030933
DP  - 2019 Aug 01
TA  - BMJ Open
PG  - e030933
VI  - 9
IP  - 8
4099  - http://bmjopen.bmj.com/content/9/8/e030933.short
4100  - http://bmjopen.bmj.com/content/9/8/e030933.full
SO  - BMJ Open2019 Aug 01; 9
AB  - 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.