Promoting successful aging in the community is a societal priority. Cognitive stimulation is one of the interventions with a positive impact on older adults’ health and well-being, as it preserves cognitive functioning, contributing to the maintenance of autonomy and quality of life.
Objective: To culturally adapt the Making a Difference 3 (MD3) - an individual Cognitive Stimulation program (iCSP) delivered by caregivers to people with mild to major Neurocognitive Disorder (PwNCD) in a home-based setting.
Method: The cultural adaptation of the MD3 was organized in five phases. Initially, the systematic review (SR) on the effectiveness of the iCSP on older adults’ cognitive performance was conducted, according to the Joanna Briggs Institute methodology. In phase II, the iCSP-MD3 was translated into the European Portuguese language and culturally adapted based on the information generated by the SR and by the academics, researchers, health professionals and caregivers involved (n = 12). Phase III consisted of reviewing the culturally adapted MD3 with 8 experts in nursing, psychology, occupational therapy and social working using the Delphi method and with caregivers (n = 10) through focus groups. In phase IV, to test the feasibility and effects of the MD3 Portuguese version, a randomized controlled trial was conducted (RCT) involving 52 dyads (PwNCD and a caregiver, 28 allocated in the experimental group and 24 in the control group. Phase V consisted of exploring through interviews (conducted with 2 PwNCD, and 2 caregivers) the meanings attributed by the participants to the iCSP-MD3.
Results: The SR on the effectiveness of the caregiver-delivered iCSP has identified beneficial effects in several cognitive domains, and thus generated evidence that underpinned the achievement of the following phases. Phase II resulted in the iCSP preliminary version. Phase III allowed for the adaptation of the verbal and structural contents of the iCSP program, creating an accessible and fitting version with meaning to the target population. As for the RCT conducted (phase IV), results from the intention-to-treat analysis revealed significant improvements in cognition (orientation and order comprehension) of PwNCDs. Beneficial effects of the intervention were also observed in the quality of life of the PwNCDs, but only from the caregiver's perspective. Qualitative data collected in phase V showed that participation in the iCSP-MD3 was evaluated as very positive and significant.
Conclusion: Through a thorough SR process, the research team was able to delineate essential methodological choices based on previous studies conducted in this area, such as the active inclusion of relevant stakeholders during the cultural adaptation of the iCSP-MD3. Moreover, the research team as able to identify the main domains that can be potentially improved through iCSP, as well as identify potential facilitators and barriers during its implementation in home-based settings. Overall, the iCSP-MD3 proved to be a feasible and meaningful intervention for the Portuguese population.