Understanding how dementia-friendly communities support participation and inclusion for people living with dementia: a realist evaluation in Northern Ireland

Abstract Introduction Dementia-friendly communities (DFCs) have been developed internationally to support the participation and inclusion of people living with dementia (PLWD) in everyday community life and civic society, yet there is limited empirical evidence explaining how these communities operate in practice. This study aimed to explore how DFCs function within geographical communities in Northern Ireland (NI) and identify the contextual conditions that enable participation and inclusion for PLWD. Methods A realist evaluation was conducted to test and refine a candidate programme theory derived from a prior realist review. Data were collected between September 2022 and March 2024 across several DFC locations using three sequential phases: non-participant observations with PLWD in community settings ( n = 10), semi-structured interviews with the same participants ( n = 10), and four online focus groups with carers and individuals working or volunteering in DFCs ( n = 21). Data were analysed using theory-driven reflexive thematic analysis informed by context–mechanism–outcome configurations (CMOCs). Results Findings show that environmental design, interpersonal interactions, organisational commitment, and community resources shape how PLWD experience and engage with geographical DFCs. Supportive features such as accessible environments, familiar staff interactions, and community activities fostered mechanisms including reassurance, confidence, and belonging, while complex environments, sensory overload, and limited public awareness reduced ease of participation. Conclusion Dementia friendliness therefore emerges through the interaction of organisational, social, and environmental contexts that enable participation and inclusion for PLWD in everyday community settings. These findings highlight the potential of dementia-friendly communities as a public health approach to promoting participation, inclusion, and social connectedness for people living with dementia.