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@ARTICLE{Palm:163479,
      author       = {Palm, Rebecca and Fahsold, Anne and Roes, Martina and
                      Holle, Bernhard},
      title        = {{C}ontext, mechanisms and outcomes of dementia special care
                      units: {A}n initial programme theory based on realist
                      methodology.},
      journal      = {PLOS ONE},
      volume       = {16},
      number       = {11},
      issn         = {1932-6203},
      address      = {San Francisco, California, US},
      publisher    = {PLOS},
      reportid     = {DZNE-2022-00239},
      pages        = {e0259496},
      year         = {2021},
      note         = {(CC BY)},
      abstract     = {Dementia special care units represent a widely implemented
                      care model in nursing homes. Their benefits must be
                      thoroughly evaluated given the risk of exclusion and stigma.
                      The aim of this study is to present an initial programme
                      theory that follows the principles of realist methodology.
                      The theory development was guided by the question of the
                      mechanisms at play in the context of dementia special care
                      units to produce or influence outcomes of interest in people
                      with dementia.The initial programme theory is based on
                      qualitative interviews with dementia special care
                      stakeholders in Germany and a realist review of complex
                      interventions in dementia special care units. The interviews
                      were analysed using content analysis techniques. For the
                      realist review, a systematic literature search was conducted
                      in four scientific databases; studies were appraised for
                      quality and relevance. All data were analysed independently
                      by two researchers. A realist informed logic model was
                      developed, and context-mechanism-outcome (CMO)
                      configurations were described.We reviewed 16 empirical
                      studies and interviewed 16 stakeholders. In the interviews,
                      contextual factors at the system, organisation and
                      individual levels that influence the provision of care in
                      dementia special care units were discussed. The interviewees
                      described the following four interventions typical of
                      dementia special care units: adaptation to the environment,
                      family and public involvement, provision of activities and
                      behaviour management. With exception of family and public
                      involvement, these interventions were the focus of the
                      reviewed studies. The outcomes of interest of stakeholders
                      include responsive behaviour and quality of life, which were
                      also investigated in the empirical studies. By combining
                      data from interviews and a realist review, we framed three
                      CMO configurations relevant to environment, activity, and
                      behaviour management.As important contextual factors of
                      dementia special care units, we discuss the transparency of
                      policies to regulate dementia care, segregation and
                      admission policies, purposeful recruitment and education of
                      staff and a good fit between residents and their
                      environment.},
      keywords     = {Adaptation, Physiological / Behavior Therapy / Databases,
                      Factual / Dementia / Humans / Nursing Homes: statistics $\&$
                      numerical data / Quality of Life},
      cin          = {AG Holle / AG Halek / AG Roes},
      ddc          = {610},
      cid          = {I:(DE-2719)1610002 / I:(DE-2719)1610001 /
                      I:(DE-2719)1610003},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34784375},
      pmc          = {pmc:PMC8594822},
      doi          = {10.1371/journal.pone.0259496},
      url          = {https://pub.dzne.de/record/163479},
}