Research overall question:

1. Research overall question: What kind of DFS initiativeswork, forwhom, in whatcircumstances, in what respect, towhatextent, why andhow are these related (Pawson, et al; 2005)

2. Over de realist approach

3. Over de realist approach

4. Researchquestionsphase A • What outcomes are defined, achieved and measured in achieving DFS? • What kind of dementia friendly intiativesare running in practice in NL and in UK? • What are the underlying mechanisms described in scientific and grey literature? • What contextual factors are described that play a role in DFS? • How do context, interventions, and mechanisms interact when contributing positively, or negatively, to the outcomes of DFS, according to different stakeholders?

5. Definities Dementia friendly communities (DFC) are those where people with dementia (PWD) and their carers feel understood, respected, have access to support, and feel confident they can contribute, participate and engage to community life. In a DFC, the physical and social environment is responsive to the needs of a PWD, people are aware of and understand dementia, and PWD and their carers feel included and involved, and they have choice and are supported to have as much as possible control over their day-to-day lives. Adapted from Alzheimer’s Society, 2013. Guidance for communities registering for the recognition process for dementia-friendly communities.& Smith K, Gee S, Sharrock T, Croucher M.(2016) Developing a dementia-friendly Christchurch: perspectives of people with dementia. Australas J Ageing. 35:188–192. [PubMed: 27061350]

6. Definities Dementia friendly initiatives (DFI) are activities that share an individualized and holistic approach that promotes dignity, empowerment, engagement, and autonomy to enable well-being of persons with dementia and the needs of their caregivers throughout the dementia trajectory. Adapted from: Hebert, C.A., Scales, K. (2017) Dementia friendly initiatives: A state of the science review. Dementia 0(0) 1–38

7. In en exclusiecriteria Inclusion criteria (full text) • Addressing initiatives, activities or expected outcomes • accessible for both pwd with dementia, their carers or habitants of the community • aiming at improving dementia friendliness in the community • Studies with empirical data, review studies that include empirical studies, qualitative or quantitative research • English or Dutch language Exclusion criteria • Medical interventions, • Therapeutic interventions at home, Individual activities or -initiatives which are not embedded in a social or physical environment. • Home care or daycare on medical grounds. • Description of theory, model (without empirical data), Policy papers • Educational activities or outcomes related to students.

8. Literatuuronderzoek in phase A

9. DEMFACT; categorisation of DFI Williamson, 2016

10. DEMFACT; hoeveel artikelen?

11. DEMFACT; welke initiatieven gevonden?

12. DFI; vergelijking met de kennisbank https://www.dementievriendelijk.nl/hoe-kunnen-wij-je-helpen/kennisbank-2018

13. DEMFACT; CMO voorbeelden

14. DEMFACT; CMO voorbeelden

15. DEMFACT; CMO voorbeelden

16. Voorbeelden van CMO; samengevat • Een bekende en overzichtelijke sociale en fysieke omgeving geeft pwd de mogelijkheid om hun capaciteiten te gebruiken waardoor hun (gevoel van) onafhankelijkheid versterkt wordt en zij zich in hun buurt kunnen redden. • Als mantelzorgers van pwd deelnemen aan een dementiecafé zullen zij zich minder snel sociaal geïsoleerd voelen omdat zij zich (h)erkend voelen in hun zorgen. • Wanneer mensen met en zonder dementie welkom zijn bij een activiteit en naar elkaar omkijken, voelen pwd zich als ‘een van hen’ omdat ze zich zowel verbonden als beschermd voelen. • In een sfeer waar prestatie en plezier met elkaar in evenwicht zijn, zullen pwd en hun mantelzorgers gemotiveerd zijn om deel te nemen aan activiteiten omdat zij zich zowel uitgedaagd als gesteund voelen. • Als de ervaringen en capaciteiten van de pwd en hun mantelzorgers ingezet worden, wordt de bejegening naar hen positiever omdat hun bijdrage duidelijk wordt, waardoor pwd en mantelzorgers zich meer welkom en geïncludeerd voelen. • Werknemers en vrijwilligers die weten hoe ze met dementie om moeten gaan, hebben meer plezier in hun werk omdat ze zich competenter voelen, waardoor pwd en hun mantelzorgers zich meer welkom en geïncludeerd voelen.

17. Bespreken CMO / Feedback In groepjes Noteer je bevindingen op de sheet

18. Mantelzorger Outcomes voor mantelzorgers worden vooral gekenmerkt door: Ervaren steun door erkenning van zorgen, stress Plezier hebben in een activiteit waar ze samen met de pwdaan meedoen. Vraag: welke andere outcomes en mechanismen voor mantelzorgers zouden ook zichtbaar moeten worden? Waarom? Is daar een bewering (als…dan) bij te formuleren?

19. Mantelzorger

20. Rol PWD De PWD heeft in de verschillende categorieën een andere rol. Vragen: Wat vind jij kenmerkend voor de rol van de pwd in de verschillende categorieën? Welke andere rollen en kenmerken zouden (meer) zichtbaar mogen worden? Waarom? Is daar een bewering (als…dan) bij te formuleren ?

21. Rol PWD

22. Vrijwilligers-professionals De mechanismen om professionals en vrijwilligers betrokken te laten zijn/voelen liggen vooral op het gebied van (werk)plezier o.a door nieuwe dingen te leren en waardering te krijgen. Vraag: Welke andere mechanismen voor profesionals en vrijwilligers zouden ook zichtbaar moeten worden? Waarom? Is daar een bewering (als…dan) bij te formuleren?

23. Vrijwilligers-professionals

24. Terugkoppeling en dank

25. Achterzakdia’s

26. DFI Kennisbank

27. Over de realist approach Context & Interventie Uitkomst

28. Over de realist approach Context & Interventie Uitkomst

29. Conceptualmodel of the realist approach, appliedforPhase A&B of Mentality Context, includinginterventions + Mechanisms. (Contextsandactivities/initiativesandtheirsuccesfactors.) Outcomes (dimensions of Dementia friendliness) Definitions Context, MechanismsandOutcomes Context: Context includes the pre-existing organizational structures, the cultural norms and history of the community, the nature and scope of pre-existing networks, and geographic location effects -> all parameters that have causal impact (cultural norms and values, participants characteristics, history of the place/environment/ economic conditions, geographic elements, public policy, outcomes of previous implementation of programmes, anything of social and physical environment that has an impact on program outcomes) (Jagosh, 2011 ) Outcomes refer to intended or unexpected intervention outcomes. the result of how people react to the mechanisms. (can be intended, unintended, expected or unexpected). Outcomes can be process or final results. Outcomes can be captured by qualitative or quantitave data collection (health, social outcomes, service oriented outcomes, uptake, engagement outcomes) The intended and unintended consequences of the programme, whether behavioral, attitudinal or clinical, can be classified as outcomes. Outcomes may become context in a ripple effect. (Jagosh, 2011) Mechanisms usually pertain to cognitive, emotional or behavioral responses to intervention resources and strategies. Mechanism-resource’ refers to what is triggered by the DFI among the context participants/stakeholders (, Dalkin,2015) Mechanisms response' refers to the response of the participants, All that suggests a change in people’s minds and actions. (Dalkin, 2015)

30. Conceptual model of the realist causalmechanisms, appliedforPhase C of Mentality Context, includinginterventions. Contextsincluding dementia friendlyintiatives Outcomes Dimensions of Dementia friendliness Mechanisms Succesfactors Definitions Context, MechanismsandOutcomes Context: Context includes the pre-existing organizational structures, the cultural norms and history of the community, the nature and scope of pre-existing networks, and geographic location effects -> all parameters that have causal impact (cultural norms and values, participants characteristics, history of the place/environment/ economic conditions, geographic elements, public policy, outcomes of previous implementation of programmes, anything of social and physical environment that has an impact on program outcomes) (Jagosh, 2011, ) Outcomes refer to intended or unexpected intervention outcomes. the result of how people react to the mechanisms. (can be intended, unintended, expected or unexpected). Outcomes can be process or final results. Outcomes can be captured by qualitative or quantitave data collection (health, social outcomes, service oriented outcomes, uptake, engagement outcomes) The intended and unintended consequences of the programme, whether behavioral, attitudinal or clinical, can be classified as outcomes. Outcomes may become context in a ripple effect. (Jagosh, 2011) Mechanisms usually pertain to cognitive, emotional or behavioral responses to intervention resources and strategies. Mechanism-resource’ refers to what is triggered by the DFI among the context participants/stakeholders (Dalkin,2015) Mechanisms response' refers to the response of the participants, All that suggests a change in people’s minds and actions. (Dalkin,2015)

31. Modelling a realist programAdapted from : Pawson R, & Tilley N. 1997 [2003]. Realistic Evaluation. Thousand Oaks, CA: Sage Publications What are theresults of the program? What are thecriticalcharacteristics of the context forthis program? (Context ) + (Resources -> Responses/reactions) Outcomes what is triggeredby the programamongthestakeholders/ context participants? What are thereasoning, feelings, beliefsand/or thoughts of theparticipants, in respons tothe resources? Program Theories (interventions, programmes)

32. Context and dementia friendlyactivities/initiatives Context, includinginterventions + Mechanisms. (Contextsandactivities/initiativesandtheirsuccesfactors.) Outcomes (dimensions of Dementia friendliness) • Activitiesundertakenwithpwdandcarers, sometimesintergenerational, • Educational events co-designedandfacilitatedwith persons with dementia & theircarers • Built environment forgoing outdoor • Physicalandsocialaccessibility of public and commercial buildings

33. What outcomes are defined, achieved and measured in achieving DFS? Context, includinginterventions + Mechanisms. (Contextsandactivities/initiativesandtheirsuccesfactors.) Outcomes (dimensions of Dementia friendliness) • Enjoyment of activities, learning new things • Goingoutdoors more often. • Increasedconfidence • Perception of dementia, awareness andtolerance • Feeling of engagement, contributingandbelonging in the community

34. Voorbeeld configuratie Aihara, Y. et al. (2016) Public attitudes towards people living with dementia:Across-sectional study in urban Japan(innovative practice) Dementia 0(0) 1–9

35. Public attitudes towardspeople living with dementia Understanding someone’sbehavior Confidence in howto handle

36. Hypotheses: • 1.The frameworkwith manual is feasibleto support localsocieties • toacknowledge: • needs & practical support for PWD & carers, • reliabletravel options & easy tonavigate environments; • 2. The frameworkwith manual is feasibleto support localsocieties • tocreatesustainable DFS with well-connected collaborating • agencies & services • socialnetworks • toenhancesocialparticipation PWD & carers & increaserelated health benefits.

37. Research questions: • Workpackage A (academic & greyliterature) & • Workpackage B (participatoryobservations & interviews): • 1a. Whichinitiatives are/were running in practice? • 1b. How are/were these initiativesexperiencedby PWD & carers? • 2a. What are goodinitiativesaccordingto PWD, carers, (non-)health & • welfare stakeholders? • 2b. What are accordingtotheminfluencing factors? • 3. What are components & underlyingmechanisms? • Workpackage B: • 4a. How does a frameworkfordevelopinggood DFS, • based on these components, factors & mechanisms, look like?

38. Research questions: • Workpackage C: • 4b. What are positiveoutcomes? • What is thisframeworksfeasibilitywhentesting in 5 different societies in a • tailor-made way? • 6. What are recommendationsforcreatingfuturesustainable DFS? • 7a. How shouldaninterventionadvice manual based on theframework, expert • advice, andrecommendations of stakeholders look like? • 7b. What information is neededfornationwidedissemination of this • frameworkwith manual to policy makers?

39. Time frame workackages(WP) in months: • 0 6 24 48 • WPA WPB WPC