Bradley, Kate, Smith, Robyn, Hughson, Jo-anne, Atkinson, David, Bessarab, Dawn, Flicker, Leon, Radford, Kylie, Smith, Kate, Strivens, Edward, Thompson, Sandra, Blackberry, Irene, and LoGiudice, Dina (2020) Let’s CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Services Research, 20. 208.

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Abstract

Background: Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment.

Methods/design: The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation.

The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families.

Discussion: The Let’s CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment.

Item ID:	77390
Item Type:	Article (Scholarly Work)
ISSN:	1472-6963
Keywords:	Dementia, Alzheimer’s disease, Cognitive impairment not dementia, Aboriginal and Torres Strait islander, Aboriginal community controlled health services
Copyright Information:	© The Author(s) 2020. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Funders:	National Health and Medical Research Council Australia (NHMRC)
Projects and Grants:	NHMRC Boosting Dementia Research grant (2017–2020), NHMRC Targeted Call for Research in Indigenous Health grant (mid-2018-2023)
Date Deposited:	14 Feb 2023 02:56
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420301 Aged health care @ 50% 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 50%
SEO Codes:	21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210302 Aboriginal and Torres Strait Islander health status and outcomes @ 70% 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 30%
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