Papers by Michelle Heward
Ageing & Society, Dec 14, 2020
Article (Accepted Version) Heward, Michelle, Adams, Amanda, Hicks, Ben and Wiener, Jan (2020) 'We... more Article (Accepted Version) Heward, Michelle, Adams, Amanda, Hicks, Ben and Wiener, Jan (2020) 'We go for a homely feel… not the clinical dementia side': Care home managers' experiences of supporting residents with dementia to orientate and navigate care environments. Ageing and Society. pp. 1-27.
Laboratory-based experiments show ageing negatively impacts navigation abilities, yet a paucity o... more Laboratory-based experiments show ageing negatively impacts navigation abilities, yet a paucity of research explores lived experience. This exploratory study examined older people with self-reported memory difficulties experiences of declining navigation abilities during sixteen semi-structured telephone interviews. Findings reveal: (i) ‘Behavioural drivers’ that underpinned the participants’ experiences and actions when engaging with their environments (ii) ‘Avoidance’ and (iii) ‘Active’ strategies that were adopted by the participants. Declining cognitive function appeared to have a negative impact on participants perceived abilities and confidence to navigate unfamiliar outdoor environments, which in turn influenced the strategies they chose to adopt. Future psychosocial interventions should draw on neuropsychological theory to ensure retention of navigation skills and confidence for as long as possible.
Dementia
Use of digital technologies to support meaningful engagement of people with dementia and carers i... more Use of digital technologies to support meaningful engagement of people with dementia and carers increased during the COVID-19 pandemic. The purpose of this scoping review was to determine the effectiveness of digital technologies in supporting the engagement and wellbeing of people with dementia and family carers at home and in care homes. Studies published in peer reviewed literature were identified across four databases (CINAHL, Medline, PUBMED, PsychINFO). Sixteen studies met the inclusion criteria. Findings indicate that digital technologies can potentially support the wellbeing of people with dementia and family carers, although only a few studies had measured impact on wellbeing, as many were reporting on technology at proof-of-concept stage rather than commercially ready products. Moreover, current studies lacked meaningful involvement of people with dementia, family carers, and care professionals in the design of the technology. Future research should bring together people w...
Journal of Frailty, Sarcopenia and Falls, 2022
of participants to trials in six major journals, Toerien et al 3 noted that it was difficult to a... more of participants to trials in six major journals, Toerien et al 3 noted that it was difficult to assess best practice as details were not reported well. Historically, the trend in trials research has been to report on what happens to the Abstract Objectives: Randomised control trials (trials) involving people with dementia lack detailed analysis of recruitment and retention strategies. To address this, we examined the effectiveness of strategies in "The TACIT Trial: TAi ChI for people with demenTia". Methods: We recruited dyads (people with dementia and carers) from 3 South of England sites utilising different strategies. Recruitment strategy effectiveness was measured by percent yield (number randomised of total referrals) and cost per randomised participant. Our retention strategy (maintaining contact with participants during weekly telephone calls) was measured by percent yield (number retained by six-month follow-up). Results: Of 359 dyads, 24% were randomised into the study (n=85). The most resource-intensive strategy (research nurses spending 30 minutes explaining the study) had the highest referral to randomisation rate. An incremental cost-effectiveness ratio suggested an alternative approach (nurses and doctors spending 5 minutes explaining the study) was most cost-effective. Retention rates were 86% (n=36/42; intervention group) and 81% (35/43; control group); main reasons for attrition were worsening health and lack of study interest. The results demonstrate person-centred strategies enabling staff to spend time with participants were effective in supporting recruitment and retention. Those designing future trials must consider such strategies and the associated costs.
Supplemental Material, Supplementary_Material for People living with dementia and their family ca... more Supplemental Material, Supplementary_Material for People living with dementia and their family carers' adherence to home-based Tai Chi practice by Yolanda Barrado-Martín, Michelle Heward, Remco Polman and Samuel R Nyman in Dementia
Over 100,000 people in the UK have concurrent visual impairment and dementia, resulting in isolat... more Over 100,000 people in the UK have concurrent visual impairment and dementia, resulting in isolation, falls and reduced independence. However, current models of care and support tend to focus on each condition separately, meaning that individual needs are rarely addressed. This can lead to high levels of anxiety and distress as well as placing great demands on carers, highlighting the need for support for informal carers and separate assessment of carer’s needs. This presentation reports on a new study exploring the lived experience of people with both dementia and visual impairment and the views of professionals. The aim was to investigate how best to provide care and support for adults living with both conditions in a range of housing settings, and develop evidence-based practice guidance to improve social care and support. 26 qualitative face-to-face interviews with people with dementia and sight loss, sometimes with their family carers, were conducted. In addition, focus groups ...
The European health psychologist, 2017
Background: Falls are a public health issue amongst older adults. Exercise interventions are effe... more Background: Falls are a public health issue amongst older adults. Exercise interventions are effective in preventing falls, however, few intervention studies have involved people living with dementia and explored their experiences. This study identifies the factors that influence participants’ acceptability of a group- and home-based Tai Chi intervention delivered with dyads (older people living with mild-to-moderate dementia and their informal family carers). This will inform how to make exercise interventions more attractive to them. Methods: 10 dyads from two localities in the South of England took part in weekly Tai Chi classes and practised at home over a period of 3 or 4 weeks. Field notes were used to record researcher’s observations during classes, as well as dyads and instructor’s feedback at the end of the classes. Feedback and improvement suggestions from participants were sought at the end of the 3/4 weeks through 2 focus groups (1 at each locality). Thematic analysis of...
The aim of this study was to explore the acceptability of a Tai Chi exercise intervention among d... more The aim of this study was to explore the acceptability of a Tai Chi exercise intervention among dyads formed of an older person living with mild-to-moderate dementia and their informal family carer. This study was conducted as part of a pilot intervention phase of a randomised controlled trial, and designed to inform further trial refinements and future exercise research involving people living with dementia. Ten dyads from two localities in the South of England took part in weekly Tai Chi classes over a period of 3-4 weeks, during this time they were also encouraged to practice at home. Field notes were used to record researchers’ observations during the classes and participants and instructors’ feedback at the end of each class. One focus group per locality was held at the end of the last class to gather participants’ views (n=7 dyads). Thematic analysis was used to inductively code the field notes and transcripts. Findings suggest that both members of the dyads were able to follo...
The world’s population is ageing and will continue to do so (World Health Organization, 2002). Th... more The world’s population is ageing and will continue to do so (World Health Organization, 2002). This means that more and more people will be diagnosed with age-related conditions such as dementia and sight loss. Previous research does not recognise the care and support needs of people who have both dementia and sight loss, noting only one empirical study (Lawrence, et al., 2009). Therefore, this study explores the care and support needs of people with both dementia and sight loss.
BMC Health Services Research, 2021
Background Despite approaches to provide effective dementia training in acute care settings, litt... more Background Despite approaches to provide effective dementia training in acute care settings, little is known about the barriers and enablers to implement and embed learning into practice. We were commissioned by Health Education England to develop and evaluate a new dementia training intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), an innovative simulation toolkit to support delivery of dementia training in acute care across England. This study aimed to explore barriers and enablers experienced by trainers implementing DEALTS2 and extent to which it impacted on delivery of training and staff clinical practice. Methods We conducted twelve one-day DEALTS2 train-the-trainer (TTT) workshops across England in 2017 for National Health Service Trust staff employed in dementia training roles (n = 199 trainers); each receiving a simulation toolkit. Qualitative data were collected through telephone interviews 6–8 months after TTT workshops with 17 of the trainers...
Nurse Education Today, 2021
Background: Gaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Inn... more Background: Gaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Innovative training approaches that improve the delivery of care for people with dementia are needed. We were commissioned by Health Education England to develop and evaluate a new dementia education intervention 'Dementia Education And Learning Through Simulation 2' (DEALTS2), a simulation toolkit to enhance delivery of dementia training nationally across England. Objectives: Evaluate differences in trainer dementia knowledge scores pre and post training, satisfaction with DEALTS2 Train-The-Trainer (TTT) workshops and simulation toolkit, confidence to use training approaches, and spread of implementation. Design: A questionnaire survey using a pre-testpost-test design with measures completed: before (pre-test); after (T1); and 12 months post training (T2). Setting: Twelve one-day DEALTS2 TTT workshops delivered across England in 2017. Participants: National Health Service Trust staff employed in dementia training roles (n = 199 trainers). Methods: Trainers attended DEALTS2 TTT workshops and received the simulation toolkit. Data were collected between 2017 and 2018 using a questionnaire capturing differences in dementia knowledge scores, Likert scales and closed-ended questions measured satisfaction, confidence and implementation. Data were analysed using quantitative methods. Results: Response rate was 92% (n = 183) at pre-test/T1 and 26% (n = 51) at T2. Trainer dementia knowledge scores increased from pre-test to T1 (p < 0.001) and were retained after 12 months in 5 of the 6 areas measured (pre-test to T2, p < 0.002); largest gains in 'humanised approaches to dementia care'. 96% (n = 176/183) were satisfied with DEALTS2 TTT workshops and simulation toolkit; 66.7% (n = 34/51) felt confident to deliver dementia training informed by DEALTS2. Adherence rates were good with 45% (n = 23/51) using the innovative training approaches within twelve months. Conclusions: The results show DEALTS2 effectively increased trainer dementia knowledge and confidence to utilise innovative dementia training approaches. Implementation of DEALTS2 varied across organisations, therefore further research should explore factors determining successful implementation.
Journal of Aging and Physical Activity, 2020
The objective of this study was to understand the experiences of people living with dementia and ... more The objective of this study was to understand the experiences of people living with dementia and their informal carers’ taking part together (in dyads) in Tai Chi classes and the aspects influencing their adherence. Dyads’ experiences of taking part in Tai Chi classes for 20 weeks within the TACIT Trial were explored through class observations (n = 22 dyads), home-interviews (n = 15 dyads), and feedback. Data were inductively coded following thematic analysis. Tai Chi classes designed for people with dementia and their informal carers were enjoyable and its movements, easy to learn. Facilitators of participants' adherence were the socializing component and their enjoyment of the classes, whereas unexpected health problems were the main barrier. Finding the optimal level of challenge in the class setting might be crucial for people with dementia to feel satisfied with their progression over sessions and enable their continued participation.
Dementia, 2020
Objectives The aim of this study was to understand what influenced people living with dementia an... more Objectives The aim of this study was to understand what influenced people living with dementia and their family carers’ adherence to the home-based component of a Tai Chi exercise intervention. Method Dyads, of people living with dementia and their family carers, who participated in the intervention arm of the Tai Chi for people living with dementia trial, were invited to join weekly Tai Chi classes for 20 weeks and practice at home. Semi-structured dyadic home interviews were conducted on average after 16 weeks of classes. The views of 15 dyads with a range of home practice adherence were sought in semi-structured interviews. The interviews were analysed using an inductive thematic approach. Results Most participants found time to practise Tai Chi at home and practised for 18 hours on average. Amongst the barriers to adherence were participants’ competing commitments and a booklet not sufficiently conveying the Tai Chi movements. Hence, a video or DVD was requested by participants....
International Psychogeriatrics, 2019
ABSTRACTBackground:There is a paucity of simulation-based dementia education programmes for acute... more ABSTRACTBackground:There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate ‘DEALTS 2’, a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England.Methods:Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and roll...
Dementia (London, England), 2018
This article reports on outcomes from the evaluation of a collaborative project between a Univers... more This article reports on outcomes from the evaluation of a collaborative project between a University and a Fire and Rescue Service where research and education were developed to inform understanding of fire risks associated with dementia. Project outcomes were determined using a mixed-methods approach (survey, reports, statistics, case studies, course evaluation forms). Main outputs were a research report that identified dementia-specific fire risks and safety strategies, and an education package for Fire and Rescue Service staff and volunteers. The evaluation demonstrates the value of collaborative partnerships to develop understanding of risks pertinent to particular vulnerable groups and research-informed education.
Journal of Aging and Physical Activity, 2018
Exercise is effective in preventing falls among older adults. However, few studies have included ... more Exercise is effective in preventing falls among older adults. However, few studies have included people living with dementia and their carers and explored their experiences. The aim of this study is to explore what affects the acceptability of exercise interventions to better meet the needs of people with dementia and their carers as a dyad. Observations, field notes containing participant's and instructor's feedback, and focus groups with 10 dyads involved in Tai Chi classes for 3 or 4 weeks in two sites in the South of England were thematically analyzed to understand their experiences. Findings suggest that dyads' determination to achieve the benefits of Tai Chi facilitated their adherence, whereas a member of the dyad's low sense of efficacy performing the movements during classes was a barrier. Simplifying class content and enhancing the clarity of instructions for home-based practice will be key to support the design of future exercise interventions.
Aging & mental health, 2017
This study explored the social care and support needs of people with dementia and visual impairme... more This study explored the social care and support needs of people with dementia and visual impairment, and the barriers and facilitators for meeting these needs. Twenty-six semi-structured interviews were conducted: 21 joint and 5 individual interviews with the person with dementia and visual impairment (n=4) or their family/paid carer (n=1). Interviews were analysed thematically. Three themes are presented. (1) Social care needs: having dementia can reduce an individual's ability to cope with their visual impairment, and lead to increased dependency and reduced daily stimulation. (2) Barriers to using technology to meet social care needs: difficulties were reported with learning to use unfamiliar technology and the cost of visual impairment aids, and for some, the presence of dementia made visual impairment aids unusable and vice versa. (3) Familiarity as a facilitator for meeting social care needs: living at home or taking furnishings and ornaments into a new home facilitated in...
Health & Social Care in the Community, 2016
Dementia-Friendly Communities (DFCs) are a UK policy initiative that aims to enable people with d... more Dementia-Friendly Communities (DFCs) are a UK policy initiative that aims to enable people with dementia to feel supported and included within their local community. Current approaches to DFC creation rely on stakeholder involvement, often requiring volunteer assistance. There is though a lack of evidence that examines the reality of achieving this. This paper critically assesses the challenges and strategies for achieving stakeholder involvement in DFCs. The evidence base is drawn from an inter-agency project funded by the National Health Service in the South of England where seven DFCs were developed by steering group partners and four part-time project workers (PWs). Data from the independent evaluation undertaken in the first year (2013-2014) of the project was analysed: 14 semistructured interviews and a focus group examined PWs experiences; whilst progress and key milestones are determined from monthly progress forms, good news stories, locality steering group minutes and press releases. Analysis was undertaken using a directed content analysis method, whereby data content for each locality was matched to the analytical framework that was drawn from Alzheimer's Society guidance. Challenges to achieving stakeholder involvement were identified as: establishing networks and including people representative of the local community; involving people affected by dementia; and gaining commitment from organisations. Strategies for achieving stakeholder involvement were recognised as: a sustainable approach; spreading the word; and sharing of ideas. By highlighting these challenges and the approaches that have been used within communities to overcome them, these findings form the foundation for the creation of DFC initiatives that will become embedded within communities. Stakeholder involvement is unpredictable and changeable; therefore reliance on this approach questions the long term sustainability of DFCs, and must be considered in future policies designed to enhance quality of life for people affected by dementia.
Journal of Popular Television, The, 2015
This article explores the mutual contribution television and disability studies can make to one a... more This article explores the mutual contribution television and disability studies can make to one another, focusing on the role of television and visual media in raising awareness and challenging gaps in understanding of dementia, a health condition that carries stigma and is framed as a disability. The Living Well with Dementia Dorset Video (LWDDV) project demonstrates the duality of how creating and disseminating a video featuring people with dementia and carers talking about what it means to live well with the condition, provides a way to use media to raise awareness of dementia. Portraying real-life experiences of people affected by dementia was crucial, and enabled these often marginalized voices to be heard. Participants discussed experiences of diagnosis, post-diagnostic support, adjustments to lifestyle, social activities and family relationships. The video was disseminated through YouTube, and the impact on understandings of dementia was established through a questionnaire. F...
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Papers by Michelle Heward