Constructive engagement in cognitive stimulation therapy groups among people with dementia: A mixed-methods study

Clinical guidelines recommend personalized activities and group cognitive stimulation therapy (CST) for promoting cognition, independence, and well-being in persons with dementia. Constructive engagement (CE), the state of being occupied positively in purposeful activities, is theoretically an essential process in personalized activities and CST. However, whether CE develops over time and what contributes to it are unknown. We investigated changes in CE during CST and its contributors.

This is a mixed-methods study. We used time sampling to record the time proportion of persons with dementia (n = 113) spent in constructive, passive, non-task-related engagement and non-engagement during early, middle, and late phases in a 14-session group CST. We tested changes in time proportion between phases using repeated analysis of variance (ANOVA). We analyzed qualitative interviews of CST facilitators (n = 12) thematically to explore contributors to CE.

Persons with dementia spent 51% and 46% of their time in constructive and passive engagement, respectively. Time of engagement in non-task-related activities and non-engagement was minimal. CE remained stable at around 50% of activity time throughout the intervention course, except for a slight increase from the early to middle phase (48% to 55%, F (2224) = 3.779, p < 0.05). Age (r = -0.26, p < 0.01), cognitive function (r = -0.29, p < 0.01), and activities of daily living (r = 0.20, p < 0.05) at baseline were significantly correlated with CE, but gender and education were not. Contributors to CE include (1) tailoring activities, (2) using group dynamics, and (3) promoting positive experiences.

Group CST engages persons with dementia well, regardless of their differences in gender and literacy levels. CE remained relatively stable during CST, and younger, more physically and cognitively able people showed slightly greater CE. In group-based interventions, facilitators' skills and techniques could enhance CE. Future studies may focus on how CE as a plausible change mechanism further improves the intervention outcomes of persons with dementia.

Cognitive stimulation therapy (CST) is a non-pharmacological intervention that involves group-based activities and exercises to improve cognition and quality of life for persons with dementia, but the specific mechanisms behind it are not yet fully understood.This study is the first to investigate constructive engagement (CE), which describes active involvement in meaningful activities or complex interventions, specifically CST, for persons with dementia.CST engages them well, regardless of gender and literacy differences. CE time increases at the early intervention phase and stabilizes later on. CE occupies around half of the intervention time throughout CST, which can still be further increased by activity design and facilitators' skills.