# Implementation and effectiveness of an intervention to Prevent and Reduce Involuntary Treatment at Home (PRITAH) in people living with dementia: protocol for a hybrid design type 3 quasi-experimental study

## TL;DR

This study tests a program to reduce involuntary treatment of dementia patients at home by training caregivers and evaluating its real-world effectiveness and implementation.

## Contribution

The PRITAH intervention is evaluated using a hybrid quasi-experimental design to assess both implementation and effectiveness in professional homecare settings.

## Key findings

- The study evaluates PRITAH's implementation outcomes like adoption and acceptability among caregivers.
- Effectiveness is measured by involuntary treatment use in dementia patients at home.
- A quasi-experimental design is used to maintain real-world applicability while controlling for contamination.

## Abstract

Involuntary treatment refers to care where persons living with dementia are excluded from decision-making or do not provide consent. Despite serious consequences, involuntary treatment is often used in people with dementia receiving homecare. To address this, the Prevention and Reduction of Involuntary Treatment at Home (PRITAH) intervention was developed. A previous study indicated potential for scaling up PRITAH in professional homecare settings. However, implementing healthcare interventions like PRITAH is complex and often faces challenges. The current protocol describes a study that aims to: (1) gain a comprehensive understanding of the PRITAH- implementation in professional homecare settings, and (2) evaluate its effect on involuntary treatment use on people living with dementia at home.

This quasi-experimental Hybrid Design Type-3 effectiveness-implementation study includes 88 case managers in the field of dementia care (CMDs) from four professional homecare organizations in Southern Limburg, the Netherlands. CMDs are divided into an intervention and control group stratified by geographical location. The intervention group receives the PRITAH-intervention, while the control group continues usual care. Data collection occurs at baseline (T0), 8 weeks (T1), and 20 weeks (T2) using questionnaires with open-ended and closed (Likert-scale) questions. Primary implementation outcomes include adoption, acceptability, appropriateness, feasibility, fidelity, and sustainability. Additionally, qualitative data from focus groups will be analysed. The primary effectiveness outcome is involuntary treatment use in people living with dementia at home, assessed via self-administered questionnaires completed by CMDs regarding ten randomly assigned clients within their caseload. Outcomes on CMD level include attitude, subjective norms, perceived behavioural control, and intention, which are prerequisites for behavioural change. Both descriptive analysis (quantitative) and content analysis (qualitative) evaluate implementation outcomes, while mixed (multilevel) linear regression models assess the effect of the PRITAH-intervention on involuntary treatment use.

This study provides insight into both implementation and effectiveness of the PRITAH-intervention in professional homecare settings. Due to potential contamination from communication among CMDs within the same organization and region, strict randomization is not feasible. Instead, a quasi-experimental design ensures a controlled comparison while maintaining real-world applicability. Including all available CMDs in the region enhances study’s validity, strengthening the intervention’s potential for broader implementation.