A co-designed digital educational intervention to reduce restrictive practices in dementia care homes

Background: Restrictive practices, such as physical and chemical restraints, are common in dementia care homes and negatively impact residents and staff. Despite guidelines advocating minimal use, uncertainty and moral conflict among staff necessitate effective educational interventions. This study evaluates the effectiveness and acceptability of a co-designed digital intervention to support decision-making and minimize restrictive practices in dementia care settings. The intervention's acceptability was assessed using the Theoretical Framework of Acceptability.<br/><br/>Methods: A mixed-methods study was conducted in 15 care homes in Northern Ireland that specialized in dementia care. The study employed a quantitative pre-test/post-test assessment of staff self-efficacy in identifying, assessing, and minimizing restrictive practices. Restrictive practices were also audited with care home managers before and three months after staff engagement with the digital intervention. Semi-structured interviews with care home staff explored the intervention’s acceptability and perceived impact. The digital intervention was developed through a seven-step accelerated experience-based co-design process involving healthcare professionals, care home staff, residents with dementia, and family members.<br/><br/>Results: A total of 214 care home healthcare professionals participated, with 67.3% reporting no prior training on restrictive practices in dementia care. Quantitative analysis showed a statistically significant increase in self-efficacy scores post-intervention (p &lt; 0.05). Audit data indicated a reduction in reported instances of physical, mechanical, and chemical restraint after three months. Qualitative interviews revealed high acceptability, with staff reporting increased awareness, improved decision-making, and greater confidence in managing dementia-related behaviors without resorting to restrictive practices.<br/><br/>Discussion: The co-designed digital intervention effectively enhanced care home staff’s self-efficacy and reduced the use of restrictive practices in dementia care. Its high acceptability and perceived practicality suggest its potential for routine integration into dementia care home settings. This supports the broader adoption of tailored digital education to promote ethical, person-centered dementia care and minimize restrictive practices.