Identifying and Mapping Levels of Active Engagement Within an Arts-Based Intervention: A Qualitative Analysis and Conceptual Development

BACKGROUND: Active engagement is crucial in psychoeducational interventions for care partners of persons living with dementia, yet measurement is limited. This manuscript explores participant engagement in an arts-based intervention designed to increase engagement in addressing dementia-related behavioral symptoms. The intervention uses multisensory activities, including caregiver-informed vignettes, to foster engagement and process caregiving experiences. METHODS: Care partners of persons living with dementia (n = 9) participated in six focus groups. Focus group data were analyzed using process coding to define and map patterns of active engagement across 27 intervention activities. The findings informed development of a conceptual model of active engagement. RESULTS: Four levels of engagement were identified-Participating, Clarifying, Contributing, and Applying-and explored across participants, time points, and activities. The conceptual model illustrates that (1) antecedents contribute to (2) levels of engagement, leading to (3) the intervention's hypothesized mechanisms of action, proximal outcomes (capacity to adapt, appraisal of caregiving demands), and distal outcomes (perceived stress, caregiver well-being). CONCLUSION: This manuscript provides a clear framework for operationalizing and measuring active engagement and demonstrates how engagement patterns can be conceptually linked to the intervention's proposed mechanisms of action and outcomes. These findings provide transparency in reporting engagement patterns within an intervention, offering valuable insight into the components of active engagement and how these may be measured. The ability to track active engagement during intervention development and testing has the potential to improve our understanding of intervention dose and fidelity and how active engagement interacts with these to improve outcomes for participants.