Understanding and Overcoming Negative Attitudes That Hinder Adoption of Reablement in Dementia Care: An Explorative Qualitative Study

Hanne Tuntland,1,* Kiran Ashfaq,2,3,* Magnus Zingmark,4 Silke F Metzelthin2,3 1Department for Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway; 2Department of Health Services Research, Maastricht University, Maastricht, the Netherlands; 3Limburg Living Lab in Ageing and Long-term Care, Maastricht, the Netherlands; 4Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden*These authors contributed equally to this workCorrespondence: Hanne Tuntland, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway, Tel +47 55587839, Email [email protected]: Dementia refers to a group of neuro-cognitive disorders that affect people worldwide. Reablement may facilitate people to maintain or regain abilities, encourage engagement in activities important to them, promote continued societal participation, and foster a meaningful life experience. However, the adoption of reablement in dementia care has been slow. This study aimed to explore the negative attitudes that hinder the adoption of reablement and to identify strategies to mitigate these factors.Methods: An exploratory qualitative approach involving semi-structured interviews was adopted. Interviews were conducted with reablement and/or dementia experts in five countries, namely Australia, Denmark, the Netherlands, Sweden, and the United Kingdom. The interviews were recorded and transcribed verbatim. The interviews were analyzed using a thematic analysis approach.Results: This study explored the views of 10 experts and identified negative attitudes that impede the adoption of reablement. These attitudes were grouped into five themes: 1) lack of understanding of the preserved capabilities in people with dementia, 2) reluctance and fear among family caregivers about disrupting established routines, 3) institutional barriers, 4) misinterpretation of what reablement is, and 5) complexity of the healthcare system. The proposed strategies to address these negative attitudes include enhancing dementia awareness, educating family caregivers, understanding caregiver burden, taking care of community education and destigmatization, improving clinical leadership, raising awareness about reablement evidence and practice, integrating reablement in educational curriculum, developing comprehensive policies, and improving access to services.Conclusion: This study highlights the importance of addressing and mitigating negative attitudes which obstruct adoption of reablement. By identifying these attitudes and exploring their origin, strategies can be formulated to overcome them. Successful adoption of these strategies is anticipated to enhance the quality of life of people with dementia and their caregivers.Plain Language Summary: Why did we do this study?:Reablement is a way of supporting people with dementia to stay active, do things that matter to them, and stay involved in daily life. It helps people build on their strengths rather than focusing on their illness. But in many places, reablement is not yet widely used in dementia care. We wanted to understand why that is and what can be done about it.What did we do?:We talked with 10 experts from five different countries: Australia, Denmark, the Netherlands, Sweden, and the United Kingdom. These experts work with people with dementia or are involved in reablement. We asked them what they think stops reablement from being used more often, and how we could change that.What did we find?:The experts told us about five main reasons why reablement is not used enough:People often do not understand what someone with dementia can still do.Family members may worry that changing routines will make things worse.Health and care systems do not always support this way of working.People misunderstand what reablement really is.The care system is complicated and hard to navigate.The experts also shared helpful ideas to tackle these problems. These included raising awareness about dementia and what reablement can offer, supporting family caregivers, improving leadership in healthcare, adding reablement to staff training, and making policies and services more supportive.Why does this matter?:When we better understand and address the reasons why reablement is not used, we can make real changes. These changes can help people with dementia live more meaningful and independent lives, and also support their caregivers.Keywords: dementia, strategies, caregivers, capabilities, adoption