Process Evaluation of APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle Behaviour Change and Technology to build Resilience), a Dementia-Prevention Study focused on Health and Lifestyle changes

Abstract

Introduction: In a mixed-methods process evaluation embedded within a randomised controlled trial, we aimed to investigate how the APPLE-Tree secondary dementia prevention intervention might support behavioural and lifestyle goal attainment, through determining contexts influencing engagement and testing intervention theoretical assumptions. Methods: We measured intervention reach and dose. We selected interviewees for setting (urban/rural, NHS/non-NHS), gender and ethnic diversity, from the 374 APPLE-Tree trial participants randomised to the intervention-arm. We interviewed 25 intervention participants (including six who withdrew), 12 facilitators and three study partners (family members or friends). Additionally, we analysed 11 interviews previously conducted during or after intervention delivery for an ethnography and 208 (55.6%) facilitator-completed participant goal records. We thematically analysed data, combining inductive/deductive approaches informed by the COM-B (Capability, Opportunity, and Motivation) behaviour change model. We audio-recorded a randomly-selected tenth of sessions and rated fidelity. Results: 346/374 (92.5%) intervention-arm participants received some intervention (reach), and 305/374 (81.6%) attended ≥5 main sessions (predefined as adhering: dose). According to facilitator records, participants met a mean of 5.1/7.5 (68.3%) goals set. We generated three themes: (1) Building Capability and Motivation: Increased capability and reflective motivation altered automatic motivation; (2) Connecting with other participants and facilitators helped increase social opportunity, motivation and capability; (3) A flexible, tailored approach increased capability, motivation, and opportunity for engagement. Conclusion: The intervention supported behaviour change, through increasing knowledge and providing space to plan, implement and evaluate new strategies and make social connections.