Interaction as care in advanced dementia: protocol for a qualitative video-based study of routine care practices

Interaction plays a central role in the delivery of care and in supporting participation and well-being in healthcare. For people living with advanced dementia, cognitive and communicative impairments can restrict participation in everyday care activities while increasing reliance on interaction to obtain support. Although participation is widely promoted in dementia care, empirical evidence on how it is enacted in routine care interactions, particularly in advanced stages of dementia, remains limited. This study aims to examine how healthcare professionals create opportunities for participation for people with advanced dementia during everyday care activities and how these opportunities are taken up, negotiated or resisted in interaction.

This is a qualitative multimethod study conducted across six long-term care nursing homes in French-speaking Switzerland. Data collection comprises three phases: (1) ethnographic observations to contextualise care practices and identify target activities; (2) audio-video recordings of naturally occurring interactions between healthcare professionals and people with advanced dementia during routine care activities and (3) collection of complementary sociodemographic, medical and professional data. Approximately 80 residents with advanced dementia and 60 professionals will be involved, yielding an estimated 160-300 recorded interactional sequences. Data will be analysed using conversation analysis, focusing on the sequential and multimodal organisation of interaction. Analysis will examine interactional practices through which professionals create opportunities for participation, residents' responses to these opportunities and variations across activities, professional roles and care contexts. Findings will inform the identification of interactional competencies relevant for communication skills training.

Ethical approval has been granted by the Ethics Committee of the Canton of Vaud (205-01373). Informed consent will be obtained from legal representatives of residents and from participating professionals, and assent will be sought from people with advanced dementia. Findings will be disseminated through peer-reviewed publications, academic conferences and feedback to participating institutions and will contribute to the development of communication skills training for healthcare professionals.