How does a video feedback intervention work for people with dementia and distress behaviour living in a nursing home, for whom and under which circumstances? A realist interview study

Distress behaviour of people living with dementia is associated with negative effects for the person concerned, their family, and care staff. Video feedback interventions seem promising to use in nursing homes in cases of distress behaviour. In the Netherlands, a video feedback intervention “VIO” (Video Interventie Ouderenzorg) – in which the care team reflectively watches video footage, is asked stimulating questions by the VIO counsellor, and practises with assignments – can be used. This study aims to explain how VIO works, for whom, and under which circumstances. A purposive sample of eight VIO counsellors and three care team members was interviewed in this realist interview study conducted in the Netherlands in 2022. The data was analysed by building Context-Mechanism-Outcome configurations. Participants reported that VIO can improve verbal and nonverbal communication with the person living with dementia and can work because team members become aware of their contribution to the interaction with that person and change their behaviour accordingly. According to the participants the impact of VIO can be determined by different factors, such as safety and trust within the care team, having a team member with an exemplary role, trust between the VIO counsellor and the care team, as well as by organisational conditions, such as the lack of staff, high sick leave, and managerial support. The role of family was rarely mentioned. The design of VIO aligns with the way in which the care team learns. The intended outcomes of improved verbal and nonverbal communication and a decrease in distress behaviour are more likely to be achieved when team’s and organisational conditions, and the VIO counsellor’s approach are satisfactory. Future research should focus on testing and refining the discovered Context-Mechanism-Outcome configurations in practice. For daily practice, it is recommended to explore how to overcome incorrect expectations, and how to increase the role of family.