Cultural Adaptation of the Reducing Disability in Alzheimer’s Disease (RDAD) Protocol for an Intervention to Reduce Behavioral and Psychological Symptoms of Dementia in Thailand

Article type: Research Article

Authors: Tongsiri, Sirinart^{a; *} | Levkoff, Sue^{b; c} | Gallagher-Thompson, Dolores^d | Teri, Linda^e | Hinton, Ladson^f | Wisetpholchai, Bussabong^g | Chuengsatiansup, Komatra^g | Sihapark, Siranee^h | Fritz, Stacyⁱ | Chen, Hongtu^j

Affiliations: [a] Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand | [b] College of Social Work, University of South Carolina, Columbia, SC, USA | [c] Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA | [d] Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA | [e] Department of Psychosocial and Community Health, University of Washington, Seattle, WA, USA | [f] Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA | [g] Society and Health Foundation, Nonthaburi, Thailand | [h] Boromarajonani College of Nursing, Khon Kaen, Thailand | [i] Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA | [j] Department of Psychiatry, Harvard Medical School, Boston, MA, USA

Correspondence: [*] Correspondence to: Sirinart Tongsiri, MD, PhD, Faculty of Medicine, Mahasarakham University, Nakorn Sawan Road, Tambon Talad, Muang, Mahasarakham 44000 Thailand. Tel.: +66 89 1380908; E-mail: sirinart.t@msu.ac.th.

Abstract: Background:The Reducing Disability in Alzheimer’s Disease (RDAD) program is an evidence-based intervention found to be feasible for implementation in community settings in the United States, and effective in reducing depression, one of the major behavioral and psychological symptoms of dementia (BPSD). Objective:The goal of the study is to culturally adapt the RDAD for persons with dementia living in community settings of Thailand. Methods:Key adaptation steps included: 1) assess the community, 2) understand/select the intervention, 3) consult with experts/stakeholders, 4) decide what needs to be adapted, 5) adapt the original program, 6) train staff, and 7) pilot test the adapted materials. Results:Modifications to the original RDAD protocol included changes in number of sessions, mode of delivery, and the specific pleasant activities targeted. The pilot test demonstrated the feasibility and acceptance of the adapted RDAD intervention protocol. Implementers were able to comprehend and implement the core components of the intervention, while family members demonstrated ability to follow instructions, gain knowledge about dementia, and improve skills for setting up realistic goals. Conclusion:Following the key adaptation steps outlined above, we were able to successfully modify the RDAD for the Thai cultural context, maintaining core components of the original protocol. Program implementers demonstrated their ability to supervise family caregivers and help them gain the knowledge and skills needed to provide care for older adults with dementia. Findings from the pilot studies were incorporated into final training and intervention protocols currently being implemented and evaluated in a randomized implementation trial in Thailand.

Keywords: Behavioral and psychological symptoms of dementia, care provision, cultural adaptation, dementia, depression, family caregivers, reducing disability in Alzheimer’s Disease

DOI: 10.3233/JAD-215253

Journal: Journal of Alzheimer's Disease, vol. 87, no. 4, pp. 1603-1614, 2022