ABSTRACT
There is paucity of information on culturally tailored implementation strategies to promote interventions for
people with dementia and their caregivers from LMICs, and yet dementia is a growing concern in resource
limited settings (e.g., Uganda).
Approximately 80% of Uganda’s population
resides in the rural areas where
awareness about dementia is limited.
The proportion of households in rural Uganda with at least one older
adult =60 years is 23.2%, and yet data on the
prevalence of dementia in
Uganda
is scarce. While
the hallmark
of comprehensive dementia care should include early detection, management plan, and family caregivers
support,
dementia awareness and support services are virtually non-existent in Uganda.
The World Health
Organization (WHO) developed the dementia toolkit for community workers, consisting of evidence-based
practices for early detection and management of dementia and caregiver support. However, the toolkit has
not been adopted because there is lack of an appropriate and effective implementation strategy. Uganda’s
decentralized health delivery system leverages indigenous Lay Health Workers [LHWs]) at the village level
to address the human resources shortage countrywide. Working with an indigenous member of the
community to support implementation of interventions is a potentially effective strategy. In our prior work, we
demonstrated that training LHWs in the WHO dementia care toolkit was feasible. However, subsequent
implementation and delivery of dementia care was minimal and highly variable because there is lack of an
appropriate and effective implementation strategy. Our overall objective in this proposal is to develop and
evaluate the feasibility of a culturally tailored implementation strategy consisting of the WHO dementia toolkit
by indigenous village-based LHWs to provide dementia care at village level, supported by internal facilitation
from indigenous HAs as supervisors: the “WHO Lay Health Worker Dementia Care, with Internal
Facilitation (WLDC+IF)”. Our proposition is that internal facilitation by indigenous providers is feasible in
achieving adoption and implementation of WHO evidence-based dementia care by village-based LHWs in
rural settings. The pilot feasibility study is informed by the integrated Promoting Action on Research
Implementation in Health Services (i-PARIHS) framework. The framework allows us to use internal facilitation
as an ‘active ingredient’ to integrate action around the innovation, and recipients within the local,
organizational and wider health system context to enable successful adoption of WLDC+IF. We will co-
design an implementation strategy guide for the WLDC+IF (Aim1), and evaluate feasibility of the
implementation strategy consisting of WLDC+IF (Aim 2). Our expected outcomes are to establish the
feasibility, acceptability, adoption, fidelity, and appropriateness of a culturally tailored implementation strategy
for dementia care at village level by indigenous community members.
