Inside the black box: Refining programme theory in the PriDem dementia care study.

Area of Science:

• Implementation Science
• Health Systems Research
• Dementia Care

Background:

• Refining programme theory post-feasibility testing is crucial for complex interventions but often unreported.
• Lack of transparency hinders understanding of intervention mechanisms and effective scale-up.
• Post-diagnostic dementia support in primary care is fragmented, needing guidance for system-level interventions.

Purpose of the Study:

• To demonstrate a structured exemplar of theory refinement following feasibility testing.
• To address the 'black box' in implementation science for complex interventions.
• To refine the programme theory for a primary care-led dementia support intervention.

Main Methods:

• Deductive thematic analysis using the logic model as a coding framework.
• Synthesis of previous findings with new qualitative data (interviews, fieldnotes, records, reflections).
• Identification and updating of theoretical components within the logic model.

Main Results:

• Original theory elements confirmed: improved reviews, personalized care plans, increased staff confidence.
• New mechanisms identified: service mapping as relational tool, review templates as educational resources.
• Pre-implementation activities (CDL training, champion identification) critical; role ambiguity and capacity concerns were negative mechanisms.

Conclusions:

• Theory refinement post-feasibility testing adds significant value to complex intervention development.
• Provides a transparent model for optimizing interventions in primary care dementia support.
• The revised logic model guides future scale-up and adaptation of the intervention.