Understanding Dance Facilitation in Dementia Care: A Qualitative Study Using Socio-Ecological-Relational Framework

Dance-based interventions are increasingly recognised as valuable psychosocial approaches to support the wellbeing and social participation of people living with dementia. However, existing research has largely focused on outcomes, with limited attention to how such programmes are facilitated and experienced in practice. This study explored how dance facilitators understand and navigate the multi-level influences shaping the organisation, delivery and perceived impact of dance sessions for people living with dementia and their informal caregivers. An exploratory descriptive qualitative design was adopted, using semi-structured interviews with six facilitators involved in a dance-based programme in Malta. Data were analysed using reflexive thematic analysis, guided by a socio-ecological-relational framework. Findings showed that dance facilitation is a relational and adaptive practice embedded within interacting individual, interpersonal, organisational, community and societal contexts. Facilitators continuously adjusted activities in response to participants' cognitive, physical and emotional needs, using embodied and non-verbal approaches to support engagement. Relational processes, including shared movement and caregiver involvement, were central to fostering connection and inclusion. However, participation and sustainability were shaped by organisational environments, accessibility and persistent stigma, highlighting constraints beyond the control of facilitators. These findings emphasise that the value of dance lies in how it is enacted in practice, underscoring the need for supportive contexts.