Pilot feasibility study of the WHO Lay Health Worker Dementia Care, with Internal Facilitation (WLDC+IF) in rural Uganda - 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.
