Culturally Tailored Interventions for People Affected by Dementia: A Systematic Review and Conceptual Model About Implementation

Background: Dementia prevalence is higher in low- and middle-income countries (LMICs) and some minority ethnic (ME) groups but these groups are less likely to receive interventions. Methods: In this systematic review, we searched 11 electronic databases from inception to May 26th, 2019. We included non-drug cognitive, psychological or social interventions for people with dementia and their family carers tailored to people in LMICs and ME groups, and provided details of how they were culturally tailored. We assessed study quality and conducted a narrative synthesis of the acceptability, feasibility and effectiveness of culturally tailored interventions, distinguishing between evidence-based interventions, culturally adapted for a new setting and newly developed, culturally tailored interventions with no existing evidence base. This study was registered with PROSPERO: CRD42019133090. Findings: Our searches retrieved 40,558 results of which 23 were eligible for inclusion. Evidence-based, multicomponent interventions adapted for Latino carers were acceptable, feasible and effective in the US and Columbia. Interventions developed for carers in India were effective there but not in other LMICs. Culturally adapted Cognitive Stimulation Therapy was acceptable and feasible to people with dementia in Sub-Saharan Africa. Adaptations were made to peripheral intervention components with core therapeutic components unchanged. Interpretation: We propose a conceptual model based on our findings to aid implementation of culturally appropriate treatments for people affected by dementia in LMICs and ME groups. Evidence-based interventions need to be adapted for culturally different settings with therapeutic components retained, and tested for acceptability, feasibility and evidence that they remain effective. Full effectiveness trials are then unnecessary. Funding Statement: National Institute for Health Research Applied Research Collaboration North Thames and Alzheimer’s Society. Declaration of Interests: None.