Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)
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Introduction: In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income). Methods and analysis: Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation. Ethics and dissemination: Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer’s Disease International, and via ongoing engagement with key policymakers.
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Cognitive stimulation therapy has been evaluated in Tanzania and Nigeria, appears feasible and beneficial, and is becoming available in Tanzania.
“Cognitive stimulation therapy (CST) has been evaluated in Tanzania and Nigeria, appears feasible and beneficial and is becoming available in Tanzania.25,26”
From Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania (2021) · cites this paper as [25]
The Introduction reports positive CST feasibility or pilot work in Tanzania, and Phase IV describes routine CST teaching there and plans to train providers. The References identify work adapting CST for rural Tanzania and Nigeria, but our copy does not establish a beneficial clinical evaluation in Nigeria. The Tanzania availability described is also partly planned rather than already in place. (LLM, conf=0.82)
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Cites
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- Authors
- Spector, A., Stoner, C. R., Chandra, M., Vaitheswaran, S., Du, B., Comas-Herrera, A., Dotchin, C., Ferri, C., Knapp, M., Krishna, M., Laks, J., Michie, S., Mograbi, D. C., Orrell, M. W., Paddick, S.-M., KS, S., Rangawsamy, T., & Walker, R.
- Affiliations
- University College London (GB)
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital (IN)
- Schizophrenia Research Foundation (IN)
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
- North Tyneside General Hospital (GB)
- Universidade Federal de São Paulo (BR)
- London School of Economics and Political Science (GB)
- Universidade Federal do Rio de Janeiro (BR)
- King's College London (GB)
- University of Nottingham (GB)
- Newcastle University (GB)
- Government Medical College (IN)
- Corresponding author
- Stoner, Charlotte R
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-08
- Volume
- 9
- Issue
- 8
- Pages
- e030933
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6707660
- OpenAlex
- W2969637389
- Cited by
- 33
- References
- 3
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 4 · 2019: 1
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion, cc-by)
- Greenwich Academic Literature Archive (University of Greenwich) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion, cc-by)
- RePEc: Research Papers in Economics (acceptedVersion)
- UCL Discovery (University College London) (acceptedVersion)
- HighWire Press Open Archive (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bhopal Memorial Hospital and Research Centre (Indo-foreign/67/M/2018-NCD-I)
- Medical Research Council (MR/S004009/1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- cognitive stimulation therapy, dementia, implementation research, low- and middle-income countries, non-pharmacological treatment, barriers and facilitators, trainer training, stakeholder engagement, activities of daily living, quality of life, Brazil, India, Tanzania
- MeSH terms
- Clinical Studies as Topic, Attitude of Health Personnel, Brazil, Clinical Protocols, Cognition, Dementia, Developing Countries, Humans, India, Quality of Life, Research Design, Tanzania, Cognitive Behavioral Therapy, Practice Guidelines as Topic
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