Positive Approach to Care (PAC): a realist evaluation study

There is a need to increase the number of evidence-based psychosocial interventions to improve the care of those living with dementia. As the abilities of a person living with dementia change in cognitive and functional areas, their ability to, for example, eat or change their clothing diminishes, and these tasks require support from a caregiver. This doctoral project, funded by a philanthropic donation, will rigorously assess the use of a model of care - Positive Approaches to Care (PAC) in UK dementia care settings. 

 A key facet of PAC is Hand-under-Hand® (HuH; Snow, 2012). Developed by occupational therapist Teepa Snow in the US (see https://teepasnow.com/), this technique aims to assist people in all areas of engagement, especially with activities of daily living, with the caregiver’s hand performing the activity, which the person living with dementia’s hand rests on top of the caregiver’s palm-to-palm. HuH is theorized to elicit fewer problems with people living with dementia in which their brain is unable to process the movement (Amellia, Aselage, 2012; Batchelor-Murphy et al. 2015; Batchelor-Murphy et al. 2015).

Realist evaluation will be used to assess the use of PAC in care homes. The project will identify contexts, mechanisms and outcomes that support PAC. Mixed methods will be used to evaluate dementia knowledge and perception, carer burden and sense of competence, and experience of PAC. This project will develop an initial programme theory (IPT) using a realist synthesis of literature. The IPT will then be tested in care environments where PAC is used, followed by development of a programme theory using stakeholder consultation. The theory developed will be used to inform future development and implementation of PAC in dementia care. 

Realist evaluation has been used to evaluate complex health and social care interventions (Pawson, 2013; Salter, Kotari, 2014), including in dementia care environments.

Open to candidates who pay UK/home rate fees. See UKCISA for further information.

You will need to meet the minimum entry requirements for our PhD programme. The project is suitable for someone with a psychology, neuroscience, nursing, occupational therapy or other allied health background. The applicant must have project-relevant experience of working with older people, including those living with dementia. Experience of working in social care or health settings will be valuable. The project will use mixed methods therefore skills in both quantitative and qualitative methods are valuable. Additional training will be provided as part of the University of Surrey’s doctoral programme and via the Doctoral College.

Clinical Intervention and Practice research group