Podcast – Virtual Cognitive Stimulation Therapy

Voice Over:

Welcome to the NIHR Dementia Researcher Podcast, brought to you by Dementia Researcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

Dr Anna Volkmer:

I’m Dr. Anna Volkmer and I’m delighted to be back in the hot seat today, hosting this week’s dementia researcher podcast. Now, we are going to be discussing cognitive stimulation therapy or CST. And for those of you who don’t know, this is a behavior intervention for people with mild to moderate dementia.

Dr Anna Volkmer:

Now, as a clinical academic speech and language therapist working with people with dementia in the UK National Health Service, I have often delivered this intervention myself and today I’m delighted to be joined by two researchers, Emily and Esther, who are from the department of clinical educational and health psychology at UCL. A couple of years ago, I actually attended an international CST or Cognitive Simulation Therapy conference in Hong Kong.

Dr Anna Volkmer:

So I feel that this is the wrong time to start boasting about international travel. But I do believe that Hong Kong is actually where one of our lovely guests, Esther is actually living or staying at the moment. Is that right, Esther?

Esther Hui:

Yeah. Hi everyone. I am Esther. I’m currently in Hong Kong right now because of the pandemic, but I’ll be returning to London very soon. I hope you had a great time, Anna, when you were in Hong Kong.

Esther Hui:

I guess a little bit about myself is I’m a final year PhD student. For my PhD, I am making and testing virtual versions of individual cognitive stimulation therapy in Hong Kong, as well as in the UK. I became interested in working with people with dementia after double majoring in psychology and biology during my undergrad in the States.

Esther Hui:

Dementia is a condition that combines a lot of my interests and my grandparents unfortunately also have it. So there’s also like a personal connection.

Dr Anna Volkmer:

Thank you for sharing that. Yeah. I love Hong Kong, by the way. It’s a beautiful city. The conference was at Hong Kong Uni on Cognitive stimulation therapy. It was superb. It was a really great combination between a clinical conference and an academic conference, which was really…

Dr Anna Volkmer:

It was one of the first kind of combined conferences I attended. That was great. Sorry.

Esther Hui:

Yeah, that’s really good.

Dr Anna Volkmer:

We’ve met you, but I’d really love for Emily also to introduce herself if possible.

Emily Fisher:

Yes, of course. Hey, hi everyone. I’m Emily Fisher and I’m currently the program manager for the CST international study which is based at UCL and the study explores implementation of CST in diverse settings across the world.

Emily Fisher:

That’s three countries, Brazil, India and Tanzania. I’ve also recently started a part-time PhD alongside my role in that studying and implementation of psychosocial interventions in the UK. And just a bit about my background. So I previously worked in the UK charity sector in dementia and aging charities before making the move into the research world through a master’s in dementia at UCL.

Dr Anna Volkmer:

Perhaps Emily, before we carry on, you could actually explain, I mentioned a little bit about what cognitive stimulation therapy is. Perhaps you could explain to our listeners what cognitive stimulation therapy actually is. Would that be all right?

Emily Fisher:

Yes. As you said, cognitive stimulation therapy or CST is a behavioral intervention. It’s a brief evidence based group intervention for people with mild to moderate dementia and it typically involves about 14 sessions twice a week, which run for around 45 minutes each.

Emily Fisher:

The sessions are structured with different activities, which are designed to be engaging and stimulating and each session follows a general theme. Examples of the themes are physical games, current affairs and being creative. One of the key things about CST is that it’s guided by some key principles and there’s 18 in total.

Emily Fisher:

I won’t go through them all that. Some of them include focusing on opinions rather than facts, using reminiscence as an aid to the here and now and generating new ideas, thoughts and associations. Overall, it’s a group intervention which is actively stimulating and engaging in a social and optimal learning environment.

Dr Anna Volkmer:

Thank you, Esther. I always find that key principle around focusing on opinions rather than facts particularly helpful. I think it really reminds people to not test people with dementia on their memory or their knowledge, but actually ask an opinion based question for which there may be many different answers or kind of positions.

Emily Fisher:

Exactly. Yeah. So it shouldn’t feel like school or a test or it’s challenging, but not putting people on the spot. It’s kind of getting them thinking and sharing ideas and opinions, but in a kind of low pressure supportive environment.

Dr Anna Volkmer:

That’s [inaudible 00:05:48]. I’m always trying to explain what those kind of opinion based questions look like. And I think I often say things like, “Which is your favorite?” Or, “Which of these do you think have something in common?” Or which of these… I guess it’s about asking people what they think of something, isn’t it? That kind of stuff. If I was somebody who had mild to moderate dementia in the UK, would I be able to access this through the National Health Service?

Emily Fisher:

Should I take this one?

Esther Hui:

Sure.

Emily Fisher:

Yeah. You would be able to access CST through National Health Service or NHS memory clinics. So these are the memory and assessment centers where people first get the diagnosis of dementia. And following the diagnosis, you’d be offered CST.

Emily Fisher:

We did an audit recently that found that about 85% of memory clinics are offering CST. It’s not everywhere, but it’s really widely available through the NHS as a post diagnostic intervention. There’s also other places where people could access CST. There’s longer term CST, which is known as maintenance CST as well as individuals CST. This doesn’t tend to be delivered as much to the NHS. It’s often delivered through [inaudible 00:07:18] organizations for [inaudible 00:07:21] UK. That’s one example.

Dr Anna Volkmer:

Thank you. That was a bit of a trick question, really. I had a hidden agenda. I have myself delivered CST in and actually in kind of outpatient settings, in day centers but also in nursing homes and wards and often it’s been myself and/or the occupational therapist and/or the psychologists who’ve kind of either collaborated or led on them. I think that’s really helpful for people to know, isn’t it?

Dr Anna Volkmer:

It’s not necessarily owned by one discipline. It’s actually something that spans across disciplines, is often delivered along by the multidisciplinary team. But perhaps Esther, you could tell us about the actual evidence. Is there any actual evidence and what are the outcomes from CST? Does it actually work. If it’s delivered, let’s hope so.

Esther Hui:

Yeah. That’s a great question. Yeah. It does work. So multiple clinical trials in the UK and also globally consistently demonstrates that CST significantly improves cognitive function, independence and wellbeing. These are some of the key outcomes of CST.

Esther Hui:

The CST research itself actually started quite a while ago now in 1998. The first major study came out around like 2003. And since then, it’s been tested in many different countries. And now it’s offered in, I think more than 34 countries. It is the only non-drug treatment recommended by the UK national guidelines.

Esther Hui:

How does CST exactly work? It’s a bit unclear unfortunately. We don’t really know exactly what are the active ingredients of CST. Research still needs to be done there. But we do from past studies that it simulates executive function and brain areas that relates to language and also memory processing.

Esther Hui:

CSC was also designed based on theories and concepts like reality orientation, reminiscence therapy, use it or lose it bio-psychosocial model and multisensory simulation. That’s a lot of different theories and concepts, but I think what my supervisor did, she developed the original CST, is she looked at what was working in the past and kind of picked different pieces of it and came up with like CST. We have some idea of how it works, but not exactly.

Dr Anna Volkmer:

Yeah. That’s Professor Aimee Spector, isn’t it?

Esther Hui:

Professor Aimee Spector. Yeah, sorry.

Dr Anna Volkmer:

No, no. She was my second supervisor on my PhD actually.

Esther Hui:

Great. I didn’t know that. Awesome.

Dr Anna Volkmer:

I’ve talked to her a lot about how it works and I remember saying I’d love to do a conversation analysis study, like video recording the CST therapy sessions to see what people are actually saying.

Esther Hui:

Yeah, this is a little bit off tangent, but this is not part of my PhD, but when you are looking at fidelity as well. So I made a fidelity measure for CST as well as ICST. So we’re recording all the sessions and looking at how people are… What are they saying exactly and then trying to analyze that.

Dr Anna Volkmer:

That’s interesting. You’re recording them, transcribing them and kind of looking at the key components but not necessarily using conversation analysis. Perhaps this is the conversation we should have [inaudible 00:11:06].

Esther Hui:

Yeah. Yeah. I have a fidelity measure. So I’m checking off specific things, but maybe not the same type of analysis.

Dr Anna Volkmer:

No, no. I’ve done both fidelity measures. This sounds like a whole nother podcast, I think. Because I think it’s such a hot topic, isn’t it? [inaudible 00:11:32] Methodology onto itself, but I can imagine maybe if you’ve got those lovely recordings, I can imagine that would be a great resource for lots of different research studies to analyze what’s going on in those therapy sessions.

Dr Anna Volkmer:

It’s so exciting and so important because it’s delivered. So if it’s being delivered, it would be really helpful for us to know what the active ingredients are because not only the pandemic, but certainly I’ve been in situations clinically or known of colleagues where they want to deliver these interventions and they can’t always deliver them to the letter.

Dr Anna Volkmer:

The pandemic is a good example of that. I wonder how the pandemic… What do you two know of how the pandemic has affected the delivery of CST and has that kind of inspired you to do your virtual because you are working on these virtual versions of CST aren’t you? Emily, maybe we should come to you first.

Emily Fisher:

Yeah, definitely. So I can talk about the impact of the pandemic on our CST international study in Brazil, India and Tanzania. The study started in September 2018 and got off to a flying start with stakeholder engagement and the development of implementation plans so that we could try and embed CST into routine practice or check if that’s possible.

Emily Fisher:

Then 2020 came along, familiar story across lots of research projects. We had to pause participant contact. I think initially thinking a few weeks, a few months sort of cautiously optimistic at the time, but as time went on, it became clear that it wasn’t going to be possible to restart face to face groups.

Emily Fisher:

There was a separate piece of work going at the university of Hong Kong, developing a virtual CST protocol. Protocol for delivering CST over Zoom. This hadn’t been done before and we were wondering is this going to be possible? We had a vision of what CST was in our head, which is groups of people in a room throwing balls to each other, painting things. We thought how will this work over Zoom?

Emily Fisher:

But the team at Hong Kong and a group of trainee clinical psychologists at UCL have tested or they’re in the process of testing virtual CST in a randomized control trial and this was the… It was the protocol for this virtual intervention that we have used to be able to continue delivering virtual CST through the CST international study which has allowed us to maintain participant contact and continue to collect data.

Emily Fisher:

Also, I think it just really key is to provide where interventions and participant contact and services have been paused or put on hold. It has felt really positive to be able to offer this virtual intervention at a time when people are isolated. That has felt like a really, really good thing.

Dr Anna Volkmer:

Yeah. Positive influence. First of all, though, had you signed up to a job Emily where you thought you’d get to go to India or Brazil?

Emily Fisher:

Exactly.

Dr Anna Volkmer:

No.

Emily Fisher:

Exactly.

Dr Anna Volkmer:

[crosstalk 00:15:15] Point.

Emily Fisher:

Yeah. So I go on a lovely virtual world tour through Zoom. But yeah, no international travel as of yet.

Dr Anna Volkmer:

I can imagine people coming up. Hopefully or think, well, yeah. I say hopefully all things being well. It’s interesting though that there was already a virtual version being developed over in Hong Kong. Yeah. It sounds like there was and actually it makes sense, doesn’t it? There really potentially already was a need for a virtual version of CST. Is that fair?

Esther Hui:

Yeah, I think so. I think the virtual CSE project in Hong Kong was actually planned way before the pandemic, because I guess there are people who lack transport provision. There are people that have limited mobility and all the health issues that prevent them to get to like a CST group or like in-person one. They were ahead of the curve in planning this like I think way before the pandemic. I think when the pandemic hit, it just like made sense that this research, it’s really helpful and yeah. I actually collaborated with them for my PhD project, which has been very helpful.

Dr Anna Volkmer:

That’s brilliant. So you’ve been able to collaborate with an existing group?

Esther Hui:

Yeah. Because I was developing it in Hong Kong as well as the UK at the same time. Having the Hong Kong team working on it a little bit before I did, it was very helpful because they kind of helpful in terms of cultural adaptation as well as the virtual aspect of it.

Dr Anna Volkmer:

So yeah. Yeah. You didn’t have to reinvent the wheel. Although there’s already a protocol isn’t there for delivering CST. Did you have to redesign the actual protocol in order to deliver it for the virtual world?

Esther Hui:

Yeah. Well for my particular project is I have to redo it because it’s individual. So the sessions, the themes are different from the group version.

Dr Anna Volkmer:

That makes sense.

Esther Hui:

But maybe Emily can comment on the group [inaudible 00:17:39].

Emily Fisher:

Yeah, definitely. Yeah, for the group CST, there is already quite a comprehensive protocol and different manuals that people follow. But yeah, obviously you couldn’t follow that to the T for a virtual CST.

Emily Fisher:

The team at UCL and in Hong Kong university carried out stakeholder engagement and field testing, so they speak to people with Dementia who had been in virtual CST groups and people who delivered virtual CST along with some service managers from the charity sector, just to get an idea of what kind of adaptations would be needed and what kind of support would be needed to run virtual CST groups.

Emily Fisher:

Yeah, the output of that is some… We’ve published some provisional guidance for running virtual CST groups on the international CST center website. But hopefully by the time the podcast is out, we’ll also have a paper published, which outlines the stakeholder engagement and field testing work. And then also has a full protocol to follow for virtual CST.

Dr Anna Volkmer:

So that’s for the groups, but you are also… Esther, your work is around individual CST. Is that right?

Esther Hui:

Yeah. So individual CST. Do you want me to talk about individual CS?

Dr Anna Volkmer:

Yeah. I’d love to hear about the individual. It’s quite different. Emily painted this picture and this has been my experience of delivering it, this picture of people sitting in a group, answering questions, quizzes, throwing balls to one another. Whereas individual, it must be quite different.

Esther Hui:

Yeah. It’s very different. I think in like a typical in-person CSE group, there’ll be around maybe eight people in a group. So it’s quite a number of people. I think in a virtual version, they probably have like four to six. So individual is definitely different, but I think there was a need for individual even before the pandemic. Because there are people who just cannot join groups due to sensory impairments like hearing loss or things like that, as well as people who just cannot travel because I think with the original in person individual CST, the facilitator would go to the person’s home and then deliver, which is very helpful if the person is in more moderate stages of dementia because then they might not be able to participate in a group like people with mild dementia.

Esther Hui:

Yeah. We thought that it’s hard for people to engage. Even for me, to engage in the video conferencing-like platform, it’s much easier to have meetings in person. And on top of that, people with dementia may not be the most familiar with technology. Some might find video conferencing a little bit confusing and distracting. Some might think like they’re looking at a TV and why’s the TV talking to them. It can get a bit overwhelming as well as confusing.

Esther Hui:

So we thought that some people might be able to engage better on a one to one basis, especially if they are more moderate. The original version of individual CST that’s in person was delivered by carers. It was also like 75 sessions long, so a lot longer. But recently, I think in 2019 or 2020 a shorter version that’s 14 session came out that was the psychologist actually delivered this version that it had positive effects on people’s cognitive function.

Esther Hui:

I adapted my virtual version based on this newer version of ICST and… I would say that it’s more similar to the group-based CST that has like stronger evidence or cognitive function and also quality of life. It’s still called ICT though, but it’s like a shorter version as well as the virtual version. Yeah.

Dr Anna Volkmer:

Is that also delivered by the carers or delivered?

Esther Hui:

No.

Dr Anna Volkmer:

No. Okay.

Esther Hui:

Delivered by psychologists. I think that’s actually a key difference because I think interaction are just like really different if it’s delivered by somebody who is family or someone that you’re close to. I think past, ICST studies from the original trial, they had a problem with adherence.

Esther Hui:

I think when you schedule an appointment with somebody, you’re probably more likely to show up than if you schedule an appointment with sadly a family member or carer or-

Dr Anna Volkmer:

[inaudible 00:23:02]. Yeah. Makes a lot more sense. If my other half would start telling me how to do therapy tasks, I’d probably not be as receptive if I’m honest.

Esther Hui:

Yeah. Yeah. But I think one good thing about still having the carer deliver it, is makes it a lot more accessible because then you don’t need somebody who is trained to deliver something, which could be potentially a manpower issue. Which is part of the reason probably… This is not probably based on evidence, but it could be why ICSD is less cost effective aside from the group aspects of CST. But I think by making it virtual, you’re cutting down time, you’re cutting down potential costs as well which is quite beneficial, I think.

Dr Anna Volkmer:

Absolutely.

Esther Hui:

Especially for those who can’t join groups.

Dr Anna Volkmer:

Yeah. And there are always going to be people who can’t or don’t want to. If the difference is nothing or this, that’s also still presumably on a certain level has some cost effectiveness element to it. It would be really useful to do some cost effectiveness evaluation, I presume.

Dr Anna Volkmer:

But yeah, I’m always [inaudible 00:24:21] people. And they say to me, “I’ve never been a group person. I’m not a joiner. Don’t even ask me to join.” And that’s why I always forget that because I’m a big joiner, which I love a group. I love a group. So we’ve already started talking about some of the results and findings of your research and that’s what I actually wanted to ask you about next.

Dr Anna Volkmer:

Is it worth it? What are the results of your studies? Who wants to go first? Perhaps Emily, do you want to go first?

Emily Fisher:

Yeah, I definitely can. In terms of the findings from CST international, one of the things to highlight here is it’s an implementation study rather than an efficacy study. We are collecting pre and post intervention outcome data in terms of cognition, quality of life. But that’s just kind of one aspect of the study. So we’re also focusing on kind of acceptability, ability to recruit participants, if it’s possible to kind of embed CST into a service and change policies around service provision.

Emily Fisher:

Very initial findings are that virtual CST appears to be feasible and acceptable to both participants and facilitators. Because that’s one of the key things to consider if the facilitators enjoy it and find it worthwhile and it’s not too time consuming. I would add a caveat that it is really important to consider that we’ve not actually been able to roll out virtual sessions in every study site through CST international. So one of the sites in India and one of the sites in Tanzania, it just hasn’t been possible. There isn’t the technology infrastructure to deliver virtual sessions.

Emily Fisher:

They have been able to deliver face to face CST sessions there with kind of COVID restrictions and safety considerations in place. But I think that’s… Virtual CST isn’t this kind of fit catch-all intervention that will fix problems related to COVID restrictions or future geography or travel problems and ability issues. That’s definitely something that we’ll be looking into more in terms of kind of the patterns of exclusion and looking at whether this might differ socioeconomic status or particularly a characteristic.

Dr Anna Volkmer:

Yeah. Like candidacy characteristics. That makes sense. I like that phrase. It’s not catch-all. We don’t have a magic wand for behavior interventions, do we? It has to be much more individualized. I see that completely. Esther, would you like to tell us a little bit about the results of your research now too?

Esther Hui:

I think it’s definitely possible and we’re delivering ICSC virtually. I was saying this, I was developing the intervention for Hong Kong as well as the UK. My Hong Kong study was a small mixed method case series. I think mixed methods means there’s a qualitative as well as a quantitative component to it. So we’re collecting both types of data. The UK study is a feasibility randomized control trial.

Esther Hui:

Both of these studies are very small. So I can’t really draw any firm conclusions on like treatment efficacy and things like that. But we found from the Hong Kong study, that’s completed already, that delivering virtually works because we didn’t know if it was going to work in Hong Kong before, especially with older adults, some older adults, are a bit hesitant to use technology. So I actually was pretty hesitant when I took this project. I actually switched projects because this wasn’t my original PhD project. I had to switch because of COVID.

Esther Hui:

Yeah. A lot of people in Hong Kong through the qualitative data, we found that they prefer the remote options because a lot of the carers were actually adult children of the people with dementia. So they have to work during the day. Some of the comments were like, “It’s really hard to like bring them to a care home because I have to work. And when I come back to work, it’s already really late.”

Esther Hui:

So having that remote option, especially I think at the time they were working from home, it was really easy for them to just like switch on the computer and then receive therapy.

Esther Hui:

For the UK study is still ongoing and I’m blinded. So I can only speak from the therapy sessions that I delivered. It seems to be going pretty well. I’m quite optimistic about it. We know that it’s feasible. I hope. It seems like it is feasible I should say and acceptable. But I’m blinded to other participants. I don’t know yet, but the Hong Kong study will come out soon. So it’s under review right now. That study, I can say is feasible, acceptable and also culturally appropriate.

Dr Anna Volkmer:

One of the things that really impresses me most about this work is the collaboration internationally with Hong Kong. But going back to that conversation about opinion-based questions. I remember when I was at the conference in Hong Kong, I was chatting to somebody and they were saying in some discreet cultural groups, it’s really not appropriate to ask people opinion-based questions. I wonder actually, how and whether you’ve had to adapt the intervention for different cultural needs at all.

Esther Hui:

Yeah. I definitely had to adapt the Hong Kong [inaudible 00:31:01] culturally as well. But I think the good thing about my project is a lot of the work has been done already with the CST. Like Hong Kong, they already have a manual out so I can… While like ICST is a bit different, a lot of the content is similar. I collaborated with them and then I used a lot of the information.

Esther Hui:

But with individuals because everyone is so different, I had to add quite a bit more cultural adaptations on top of what was existing. But the good thing about CST, it does offer a very flexible template that’s feasible for different cultures. So general content and structure of the therapy remained the same. Most of the changes I made were the content, like part of the content, I guess, like to make things a little bit more familiar and more familiar for the participant.

Esther Hui:

An example of this is I rephrased some sample questions. Who would you invite if you were to host a party. I changed it to, “Who would you invite if you were to host a dinner banquet?” Okay. Yeah. Yeah. Because older adults in Hong Kong don’t tend to have parties. They have large meals with people. But coming back to your question about opinion-based, I think as a whole, maybe Hong Kong and Chinese tend to be a little bit more reserved, but they do have opinions.

Esther Hui:

And the good thing about one to one is that they kind of have to answer. I think in the group, you can kind of dodge answering. And I think that was one of the comments on the CST Hong Kong study in the past. Like they said that some people were reserved and they were less to speak, but I think good thing about one to one is the facilitator can really encourage them to. Which works well actually for this culture.

Esther Hui:

I like the whole Chinese culture, I guess. We actually have a cultural adaptation guidance published from CSC International. I think the first step is engaging local stakeholders. I did that with mine too. I talked to a lot of stakeholders and collaborators to find out if things were going to be feasible and also culturally appropriate. That has been super helpful. Yeah. Emily, do you want to add to how CSC was culturally adapted?

Emily Fisher:

Yeah. Yeah, of course. There’s some guidance. I think it came out in 2014. So it’s kind of a template for adapting CST to different cultures. As Esther said at the start of the podcast, I think CST is now delivered in about 34 countries. The guidance is doing it’s job. People are able to follow this guidance and culturally adapt CST. It’s more than just translating, like you said, this kind lots of considerations take into account.

Emily Fisher:

There’s stakeholder engagement and then also thinking about theories and cultural knowledge. So kind of looking into the electric chair and looking at other interventions and then there’s a process of reviewing and testing and finalizing the protocol for the adapted intervention.

Emily Fisher:

Yeah. Sorry. [crosstalk 00:34:54]. This is a process that took place across Brazil, India and Tanzania before CST International. Then when the study started, there were the protocols kind of ready to go for people to start kind of testing through the implementation study.

Dr Anna Volkmer:

Sorry, I always get really excited [inaudible 00:35:12] people in podcast. But I was getting excited because you described those guidelines about adapting CST to different cultures, but I know that they’ve also been used to adapt other interventions as a kind of guideline for other behavior interventions. Certainly we’ve been using them-

Esther Hui:

Great. Wow.

Dr Anna Volkmer:

Yeah, yeah. Absolutely. Because it’s a useful guide. NCST is one of the first interventions that has made that bigger leap into… It’s so relevant across the world internationally. So it’s really valuable for other interventions to be able to follow suit and again, not have to reinvent the wheel. We’re using it to adapt some of our interventions for Brazil.

Esther Hui:

Amazing.

Emily Fisher:

Yeah. Yeah.

Dr Anna Volkmer:

[crosstalk 00:36:01] And the local people in Brazil are finding it really, really helpful to have that guidance there, which is really exciting.

Esther Hui:

Yeah.

Dr Anna Volkmer:

Yeah. My last question though, however, I mean, we’ve talked about tech already. I want to come back to tech. Tech feels like a really or technology feels like a really important topic, actually both clinically and in the research world during the pandemic. Because we keep talking about converting everything to being remote, to being online, to being virtual, but it’s not always that easy and I just wondered, we were all laughing. It really isn’t, is it? I just wondered whether you had any strategies where you’ve had to support people as part… Have you had to build that into your protocol, this idea of actually doing some preamble, some pre-work with participants to make them feel more confident?

Esther Hui:

When I screened a participant, before even screening, I would send them like guidelines on how to use Zoom and also I would spend some time on the phone actually teaching them how to use Zoom as well. But I think because my sample is quite small, I did exclude people who didn’t have access to a computer or a tablet or mobile phone or basically video conferencing in the UK.

Esther Hui:

But in Hong Kong, we were able to provide that for them if they didn’t have a tablet. So we would bring the tablet to the person’s home. But yeah, I definitely had to spend some time making Chinese and English versions of guidelines with pictures, so they understand how to use Zoom and to my surprise, it seemed okay. We had quite a large range of participants too. Like in Hong Kong, we had people in cage homes.

Esther Hui:

I don’t know if you know what homes are. The people from, I guess, a lower socio-economical status, so their homes are like a box. So they don’t have everything as in like super, super small space and they didn’t have a tablet and we had to bring the tablet. But somehow because they internet connection even in that kind of environment, it worked. It was okay.

Esther Hui:

And we have like people from the opposite end of the spectrum, like as well as participants. It’s really encouraging to see that this intervention can work or can be delivered I guess, to different types of people. Even with the technology.

Esther Hui:

Most people do have a carer though. In Hong Kong, most of them had carers helping them, whereas in the UK, somewhere living alone and participated okay on their own. I just had a participant finish like 14 sessions, didn’t miss one. But I also built in reminders in the program that I would send automatic emails one working day before each session so they won’t forget. And I also called them if… It’s quite a bit of work, but I think Zoom is quite easy to use. That’s a video conference application we used.

Dr Anna Volkmer:

I suspect that we are all developing lots of how to use Zoom guides across lots of different research studies. We should probably all share all our different resources. I suspect all of us, researchers, are spending time recreating the same things. We should probably share those, shouldn’t we? It sounds really obvious, but yeah probably, we probably haven’t thought of that, now have we?

Esther Hui:

I think it’s on our website actually. Well, not my version yet. I probably should do something about my version, but I think there’s a group version that’s slightly different on the CST website.

Dr Anna Volkmer:

Maybe we could point listeners to that because I think that could be a really useful resource for any researchers [inaudible 00:40:30] having to reinvent their own.

Esther Hui:

Yeah.

Dr Anna Volkmer:

[inaudible 00:40:34] Really helpful. Well, thank you both. I think that about wraps it up for today. Thank you to our guests, Esther and Emily. It’s been such an interesting discussion and it’s really highlighted many of the barriers that there are in developing complex interventions, but also the ways to get around some of these issues also.

Dr Anna Volkmer:

So for anyone listening who didn’t know about cognitive stimulation therapy or CST, now you do. We have profiles on all today’s panelists on our website including details of their Twitter accounts. So please do take a look and finally, please remember to like, subscribe in which ever app you’re listening in and remember to visit the Dementia Researcher website, where we publish new content every day from careers and science blogs, job listings, funding calls and event, and so much more. And perhaps some of my own blogs too. But anyway, have a great day. And thank you for listening.

Voice Over:

Brought to you by dementiaresearcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society. Supporting early career dementia researchers across the world.

END