# Caregiver-reported good practices and their associations with care-recipient condition in dementia care: a text-mining study

## TL;DR

This study identifies and validates good practices in dementia care reported by caregivers, using text mining and expert validation to create a training resource.

## Contribution

A validated list of 72 good practice items in dementia care derived from caregiver reports and expert consensus.

## Key findings

- Keywords like 'voice', 'explanation', and 'eye contact' were frequently associated with good practices in dementia care.
- Co-occurring clusters revealed context-specific practices, such as 'explanation' and 'menu' for eating and 'confirmation' and 'temperature' for bathing/dressing.
- 72 out of 79 extracted good practice items met the content validity ratio threshold after expert evaluation.

## Abstract

Dementia care requires specific “good practice” actions, which often involve tacit knowledge possessed by experienced caregivers. This study extracts and verifies caregiver-reported good practice actions that improve the condition of people with dementia and compiles them into a structured list.

An online survey was conducted on Japanese care and medical professionals (nurses, care workers, therapists, and care managers). Participants answered questions on basic attributes, dementia attitude scales, dementia knowledge scales, and the Approaches to Dementia Questionnaire (ADQ) and provided free-text descriptions of good practice in six care situations: eating, mobility/transfer, hygiene, toileting, bathing/dressing, and communication Free-response comments were analyzed using KH Coder, as follows: (1) cooccurrence network analysis was performed to identify clusters of related terms, and (2) participants were divided into two groups based on the median ADQ score and distinctive terms were extracted from the high ADQ score group. Subsequently, a list of items serving as good practice was compiled, and the item list was validated using the Delphi method. A panel of 16 experts evaluated the appropriateness of each good practice item using a content validity ratio (CVR).

A total of 724 valid responses were analyzed (from 897 respondents; 173 were excluded). Frequent term analysis using KH Coder identified keywords such as “voice,” “explanation,” “eye contact,” “pace,” and “confirmation.” Further, co-occurring clusters included “explanation” and “menu” with respect to eating and “confirmation” and “temperature” for bathing/dressing. Correspondence analysis highlighted terms such as “understanding,” “preference,” “safety,” and “consent,” enabling the derivation of good practice items such as “explain the content of meals,” “match the pace,” “make eye contact,” and “check the water temperature.” Among 79 items, 72 satisfied the CVR threshold.

By combining text mining and expert consensus, we created 72 validated good practice items representing tacit caregiver knowledge. These items, which are believed to reflect the principles of person-centered care, are expected to be useful in training programs on nonpharmacological interventions for caregivers of people with dementia.