Realist Evaluation Comparison of Dementia-Friendly Communities in England and the Netherlands

Introduction. Dementia-friendly communities coordinate activities and events which offer social inclusion and participation of people with dementia. Initiatives can include memory cafes, sports, and tourist and heritage visits. This study explored how dementia-friendly initiatives are developed and sustained in England, drawing comparisons with an equivalent case study in the Netherlands. Methods. We present a case study of dementia-friendly initiatives, in one city in England. Selection of this case study was done on the basis of being a leading dementia-friendly community. We interviewed a variety of stakeholders, including people with dementia and their care partners, volunteers, and staff. Semistructured interviews were recorded, and transcripts were analysed using qualitative analysis software using a realist evaluation interpretation. Realist theories described within this English case study were compared with those described within the Dutch case studies. Findings. Five context mechanism outcome configurations were described. The Dementia Action Alliance for the city was a coordinator of initiatives and provided funding and resources. The alliance facilitated advocates to partner with organisations with a shared commitment to plan activities. On the level of individual interactions, staff or volunteers were involved in communicating with local community members, which may lead to improvement in awareness. Initiatives had various ways to listen and incorporate the views of people with dementia. The five mechanisms identified within the English case study resonated with the mechanisms identified within the larger Dutch case study, with differences in contexts due to local policies and practices. Conclusion. Strategic coordination is an important factor for development and sustainability. The national policy in England has set the pattern for local structures, while the Dutch approach is "bottom-up" with local leadership. Community advocates and public support were important factors in the development of dementia-friendly initiatives in both countries.