Partnership With the Community to Improve the Well-being of People With Mild Cognitive Impairment (MCI)/Early Dementia and Their Caregivers With Music Intervention: an Effectiveness-Implementation Cluster Randomized Clinical Hybrid Trial
Phase: NA
Conditions: Dementia
Sponsor: The Hong Kong Polytechnic University

 
 
Study official title: Partnership with the Community to 
Improve the Well-being of People with Mild Cognitive 
Impairment (MCI)/Early Dementia and their Caregivers 
with Music Intervention: an Effectiveness-
Implementation Cluster Randomized Clinical Hybrid 
Trial 
 
 
Principal Investigator: Daphne Cheung 
Co-Principal investigator: Claudia Lai 
Co-Investigators: Lily Ho, Daniel Lai 
Version: 1.0 
Date: 14-March-2018 
 

Partnership with the Community to Improve the Well-being of People with Mild Cognitive Impairment 
(MCI)/Early Dementia and their Caregivers with Music Intervention: an Effectiveness-Implementation Cluster 
Randomized Clinical Hybrid Trial 
Daphne Cheung (PI), Claudia Lai (Co-PI), Lily Ho, Daniel Lai 
BACKGROUND 
Dementia is a neurodegenerative disorder and it can adversely affect patient’s cognitive, behavioural, social and emotional 
functioning. Its prevalence will increase continuously because of the increase in aging population and it is predicted that 
around 333,000 people in Hong Kong (equivalent to 11% population aged 60 or above) will suffer from dementia in year 
2039 (Legislative Council of the Hong Kong SAR, 2017; Prince et al., 2013; Yu et al., 2012). The gradual functional 
decline, communication difficulties, the behavioural symptoms associated with cognitive impairment, may affect the 
relationships with the family members and the wellbeing (Wadham, Simpson, Rust, & Murray, 2016). A latest Cochrane 
Review commented that music-based intervention may be helpful to improve emotional wellbeing and quality of life 
according to some limited evidences, as well as depressive symptoms, although future studies with larger sample sizes and 
more rigorous research design are suggested (van der Steen et al., 2017). 
In 2014 – 2016, our team has modified a music-with-movement intervention designed for nursing home residents with 
moderate dementia (Cheung, Lai, Wong, & Leung, 2018), into a protocol specified for caregiver-delivered home-based 
intervention to promote  the psychosocial wellbeing of people with early dementia in Hong Kong (Lai, Lai, Ho, Wong, & 
Cheung, 2016). We found that the dyadic music-with-movement intervention yielded significant reduction on anxiety 
levels of people with early dementia as compared to control group (Lai et al., 2016). Similar, Särkämö and colleagues 
(2017) also found that caregiver-implemented music intervention group have reduced depression of people with early 
dementia and reduced caregiver burden. With the strong evidence that music intervention is useful in improving the 
wellbeing of people with early dementia and their family caregiver, it is essential to disseminate the culture-appropriated 
and validated intervention for promoting health and evaluate its effectiveness in real-practice setting by implementation 
research. 
This research is anchored by a conceptual framework of leisure and subjective wellbeing (Newman, Tay, & Diener, 
2014). This framework explained that through participating in activities outside the obligated works (either paid or 
unpaid) that is subjectively regarded as leisure, would lead to an improvement of well-being through five psychological 
mechanisms, namely detachment-relaxation, autonomy, mastery, meaning and affiliation (Newman et al., 2014) (see 
figure 1). Caregivers and care-recipients are found relaxed after participating in music intervention because they are 
temporary detached from the everyday caregiving chaos (Roland & Chappell, 2015). Participating in an intervention 
designed by the participants themselves would increase their sense of autonomy and mastery (Ryan, Patrick, Deci, & 
Williams, 2008). During the dyadic music intervention, the caregivers and people with MCI/early dementia would design 
their activities within the music-with-movement framework after instruction of music therapist that allow them to exercise 
their choices based on their music preference. Through the interaction in the dyadic intervention, it has been found that 
through participating in dyadic music intervention, people with dementia and their caregivers have improved in 
relationship and social inclusiveness (Osman, Tischler, & Schneider, 2016; Roland & Chappell, 2015). Caregivers would 
feel their competence or mastery in the skills when leading music intervention (Van't Leven et al., 2013). Staff and 
caregivers reported that activities that address the psychological needs, provide enjoyment, value individuality, reinforce a 
sense of identity and belonging are meaningful to people with dementia (Harmer & Orrell, 2008; Sixsmith & Gibson, 
2007). Therefore, we hypothesized that dyadic music-with-movement intervention would improve the subjective 
wellbeing of both the people with MCI/early dementia and their caregiver, if there are relevant implementation strategies 
to increase the ease of uptake of the intervention. For example, stress of caregivers could be relieved by successful music 
intervention. 
Fig.1 Conceptual Framework 

 
When the aim is to maximize the uptake of the intervention in the real-life settings as a routine, we have to examine the 
influence of contextual factors on implementation. Hence, this study have three main objectives: 
1. To test the effectiveness of the dyadic music-with-movement intervention on wellbeing of people with MCI/early 
dementia, and of their caregivers in real-life settings;  
2. To conduct a process evaluation of the effectiveness-implementation study by gathering information on the 
implementation process; and 
3. To validate and extend the applicability of “Leisure & Wellbeing” conceptual framework to the dyads. 
In this project, one of the implementation strategies to maximize the uptake of the music intervention by the dyads, is to 
train a team volunteers to support the caregivers and people with MCI/early dementia, which is a unique group of 
population. There is a general lack of knowledge and inappropriate attitude towards dementia or Alzheimer’s disease 
worldwide (Cahill, Pierce, Werner, Darley, & Bobersky, 2015; McParland, Devine, Innes, & Gayle, 2012; Woo, 2013). In 
Hong Kong, it was reported that university students majoring in medicine, nursing, occupational therapy and social work 
showed inadequate knowledge towards this group of patients (Kwok, Lam, Yip, & Ho, 2011). By providing training for 
volunteers to support participating dyads, it would be able to provide a better understanding on dementia and create a 
supportive community for dementia. Therefore, we will explore the changes in the following outcomes of the volunteers: 
4. To examine the change of knowledge and attitudes towards dementia of the volunteers before and after 
participating in the project; and 
5. To examine the change of satisfaction and motivation to volunteering before and after participating in the project. 
METHODS 
This is a 3-month multicenter, cluster randomized controlled effectiveness-implementation hybrid trial with follow-up at 
month 6, involving 75 dyads from 5 community social services organizations in Hong Kong (Flow chart in Fig. 2). The 
mixed method design comprises the quantitative assessment with validated outcome measures and qualitative evaluation 
of the implementation strategies effectiveness by interviews of the dyads. 
The design of effectiveness-implementation hybrid approach allows us to assess the effectiveness of both an intervention 
and the implementation strategies (Curran, Bauer, Mittman, Pyne, & Stetler, 2012). Cluster RCT design allows us to 
evaluate the effectiveness of the intervention on the dyadic outcomes of people with MCI/early dementia and their 
caregivers, which will be assessed with validated instruments at different time-points. The successfulness of the 
implementation strategies as process evaluation, will be appraised with both quantitative and qualitative assessments on 
all stakeholders of this project (i.e. staff, volunteers, caregivers, and people with MCI/cognitive impairment).  
Fig. 2 Flow chart of the study 

 
 
Settings and target population 
Organizations providing social services to people with MCI/early dementia, and/or the families with people with 
MCI/early dementia in Hong Kong will be included. We will recruit the organizations by purposive sampling method 
through personal networks. These organizations are providing social services to either the older adults or family 
caregivers in Hong Kong. Each organization will be regarded as a cluster. Selection criteria of target population is as 
below: 
Inclusion criteria: 
- 
People with MCI/early dementia (Global Deterioration Scale Grade 3 or 4 respectively) who are living at home; 
aged 60 or above; in a stable medical condition; and able to communicate in Cantonese; and 

- 
Family caregiver who is willing to participate the training and deliver the trained intervention at home three times 
per week. 
Exclusion criteria: 
- 
Either people with MCI/early dementia or their family caregivers with critical medical or psychiatric illnesses; 
and 
- 
Either people with MCI/early dementia or their family caregivers received music intervention within six months 
upon recruitment. 
Sample size 
There was a significant interaction effect (time x group) was found on anxiety level of PWeD, with the effect size of 
Cohen’s d = 0.361 (Lai et al., 2016). With reference to the effect size, power = 0.8, α = 0.05, number of measurement (T0, 
T1), and the attrition rate of 16.7% (Lai et al., 2016), and assumed the cluster design effect ICC = 0.01, the total sample 
size required = 86. The Foundation, which supports this project is only willing to support 75 families, which may be the 
limitation in this study.  
The conventional focus group size ranges from 5 – 12 participants (Krueger & Casey, 2015). Regarding to the sample size 
of the staff members, volunteers, caregivers and people with MCI/early dementia to be interviewed, the details are 
tabulated as below: 
 
Number 
Approach 
Venue 
Staff 
2 from each 
organization 
Two focus group interviews will be held 
for treatment group and control group 
separately post-intervention. 
@ PolyU 
Volunteers 
8 from each 
organization 
5 focus group interviews will be held 
separately. Each group consists of 8 
volunteers serving for the same 
organization. 
@ Corresponding 
centres 
Caregivers & 
People with 
MCI/early 
dementia 
4 dyads from each 
organization 
5 focus group interviews will be held 
separately. Each group consists of 4 
dyads recruited by the same 
organization. 
@ Corresponding 
centres. 
 
Randomization  
Organization are cluster randomized to intervention group or wait-list controlled group. The implementation strategies 
may be optimized during the process. Hence, the participating center staff and participating dyads cannot be completely 
blinded to group allocation, although cluster-randomized control design is more preferable to reduce the potential 
contamination between groups. However, the trained assessors will be blinded to the group allocation. 
Before randomization, all participating centers will be informed about the study design, the aims and the content of the 
intervention. Each center will be randomized to intervention or control group using the random number generated by a 
computer. Participating dyads will follow the group allocation of their corresponding centers. 
Dyadic music-with-movement music intervention 
A validated 12-week MWM intervention will be adopted in this project. The MWM intervention will be delivered by the 
CG at home three times a week for 20 – 30 minutes each time. With input from organization project coordinators, the 
intervention protocol is modified by including four sessions of MWM taken place in the corresponding centre (at Week 1, 
3, 7 and 12), and sending trained volunteers (instead of staff members) to visit the family for three times throughout the 
intervention period (at Week 2, 5, and 9), for enhancing the sustainability and fidelity. After 12-week intervention, i.e. 
starting of 12-week minimal support phase, trained volunteers will visit these families monthly. 

During the intervention, CG and people with MCI/early dementia will listen to their preferred music and move their body 
parts. CG will also be the facilitator to encourage his/her family members to engage in the music activities. The activities 
may include dancing, playing with musical instruments, etc. (See Appendix A for details) 
Control condition 
The control group will receive care as usual, during the trial. The usual care includes social support to either the CG or the 
people with MCI/early dementia to motivate control group to continue participating, they will receive the same 
intervention, training and support from volunteer after the data collection at month 3.  
Training of centre staff (trainer) and volunteer (ambassador) 
Volunteers will be trained as the assistants of centre staff to visit the home of the participating families. The training 
package for the staff and volunteers is modified based on our last project (Lai 2015) by trimming 2 sessions to cater the 
busy work of staff in order to increase their commitment. The project team will teach the staffs and volunteers about the 
techniques in music-with-movement intervention for people with MCI/early dementia, as well as being a trainer of 
caregivers to deliver the intervention at home. The training programme for staff is 8 hours in total (2 hours x 4 sessions), 
while there are additional 2 hours for volunteers to introduce the basic knowledge of cognitive impairment before training 
with staff.  
Training of CG 
Caregivers will be trained for 8 hours (2 hours x 4 sessions). The training package is slightly modified from the protocol 
of the last project but trimming down from 6 sessions. Without affecting the dosage of the training, an e-book (developed 
from the last project), which contains most of the necessary skills will be introduced. 
Implementation strategies 
The implementation strategies are developed based on the experience of our previous randomized controlled trial. The 
strategies are developed according to the feedback from the CGs and the staff members of the participating centers of 
previous studies. Our strategies focus on empowering and partnership with local community service centers to adopt the 
intervention in their practice, and empowering and supporting the family caregivers to deliver the intervention at home. 
The details about the implementation strategies, please refer to Appendix B. 
Data collection 
Demographic characteristics and music preference at baseline 
The following demographic and music preference will be collected at baseline.  
 
People with 
MCI/early 
dementia 
CG 
Volunteer 
Staff 
Age 
√ 
√ 
√ 
√ 
Gender 
√ 
√ 
√ 
√ 
Education 
√ 
√ 
√ 
√ 
Living arrangement 
√ 
√ 
 
 
Marital status 
√ 
√ 
 
 
Relationship with the person 
with MCI/early dementia 
 
√ 
 
 
Medical history 
√ 
√ 
 
 
(Past / Current) Occupation 
√ 
√ 
√ 
√ 
Caregiving experience 
 
√ 
 
 
Use of antipsychotic drugs 
√ 
√ 
 
 
Cognitive functions (MoCA) 
√ 
 
 
 
Music preference 
√ 
√ 
 
 
Years of working experience 
in dementia care 
 
 
√ 
√ 

 
Effectiveness measure (quantitative) 
The outcome measures will be measured at baseline (T0), at 3-month post randomization (T1), and at 6-month post 
randomization (T2; in the treatment group only because of funding limitation). For details, please see Appendix C. 
1. On people with MCI/early dementia 
 
Rating Anxiety in Dementia (RAID) (Shankar, Walker, Frost, & Orrell, 1999) (Chinese version -- 
Cheung, Lai, Leung, 2017) 
 
Cornell scale for depression in dementia (CSDD) (Alexopoulos, Abrams, Young, & Shamoian, 1988a, 
1988b) (Chinese version -- (Lin & Wang, 2008)) 
2. On CG 
 
Perceived Stress Scale 10 (PSS-10) (Cohen, Kamarck, & Mermelstein, 1983) (Chinese version --(Leung, 
Lam, & Chan, 2010)) 
 
Positive Aspects of Caregiving measure (Tarlow et al., 2004) (Chinese version -- (Lou, Lau, & Cheung, 
2015)) 
 
Heart Rate Variability measuring with Polar OH1 optical heart rate monitor armband (on caregivers with 
high stress at baseline only, i.e. PSS total score over 24) 
3. Dyadic relationship 
 
Quality of the Caregiver-Care Recipient Relationship (Lawrence, Tennstedt, & Assmann, 1998) 
4. On volunteers 
 
Volunteer Satisfaction Index (VSI) (Galindo-Kuhn & Guzley, 2002) (Chinese version -- (Wong, Chui, & 
Kwok, 2011)) 
 
Volunteer Functions Inventory (VFI) (Clary et al., 1998) (Chinese version -- (Wu, Lo, & Liu, 2009)) 
 
Dementia Attitudes Scale (DAS) (O'Connor & McFadden, 2010) (Chinese version -- (Xia, 2014)) 
 
Alzheimer’s Disease Knowledge Scale (Carpenter, Balsis, Otilingam, Hanson, & Gatz, 2009) (Chinese 
version --(Xia, 2014)) 
There are 3 time points for data collections, baseline (T0), immediate post-intervention (T1) and 3-month post-
intervention (T2). For dyads randomized into intervention arm, assessments will be performed in all 3 time points. For 
dyads randomized into control arm, assessments will only performed at T0 and T1, i.e. no data would be collected among 
dyads randomized into control arm after the end of 12-week usual care. 
Process evaluation Indicators of effective implementation strategies (mixed-method) 
Upon the completion of the intervention, each stakeholders of this project will be interviewed about the implementation 
strategies in the following aspects: 
Implementation outcomes 
Target groups 
Method of data collection 
1. Fidelity 
Caregiver 
Self-report competency 
Focus group interview of 
volunteers 
2. Dose 
Dyad 
Log book 
3. Acceptability 
Dyad, staff and organization 
Focus group interviews of dyads 
and staffs 
4. Adoption 
Staff intention to adopt as 
routine intervention 
Organization 
Focus group interviews of staff 
5. Appropriateness 
Perceived relevance of the 
intervention 
Organization 
Focus group interviews of staff 
6. Feasibility 
Dyads, organization 
Focus group interviews of dyads 
and staff 
7. Sustainability 
Dyads, organization 
3 months post-intervention 
assessment 

The semi-structure interview questions can be seen in Appendix D. 
Conceptual model validation (qualitative) 
To strengthen our understandings on how “Leisure and Wellbeing” conceptual framework able to explain the 
improvement of wellbeing of the dyad, semi-structured interviews will be conducted with five focus groups of dyads 
regarding the MWM music interventions after completion of the intervention. The research team will facilitate the group 
discussions by sequencing questions from the general to the specific (Kruger and Casey, 2015). The sequencing will be 
guided by the bottom up approach of the “Leisure and Wellbeing” conceptual framework, which divide the interviews 
into different domains: 
1. Opening domain: Experiences of music intervention as structural activities outside obligated work time and 
subjective engagement to leisure 
2. Domain I: Detachment-recovery 
3. Domain II: Autonomy 
4. Domain III: Mastery 
5. Domain IV: Meaning 
6. Domain V: Affiliation 
7. Concluding domain: Satisfaction and wellbeing 
The semi-structure interview questions can be seen in Appendix D. 
Data management and analyses 
A project coordinator will be responsible to assist the principal investigator to oversee the implementation of the 
programme and manage the data collected by trained research assistants. Each person with MCI/early dementia 
participant will be assigned an identity code. All the questionnaires or the database would not consist of the name of the 
participants. Instead, an identifier will be assigned to each participants. Data will be stored in a computer locked with 
password. Raw data in paper form will be stored in a locked cabinet in a research office with 24 hours security 
monitoring. Only the research team can access the information. All the data will be permanently discarded three years 
after the completion of the trial.  
Demographics and clinical characteristics between intervention and control group will be compared at baseline using Chi-
square test for categorical variables, and independent t-test for continuous data if they are normally distributed, or Mann-
Whitney U-test of the data are not normally distributed.  
In addition to PSS-10 collected among caregivers, heart rate variability (HRV) can provide physiological evidence on 
changes in stress. Stress can modulate both sympathetic and parasympathetic cardiac control, i.e. HRV varies with stress 
level and it can be used as indicator of stress (Berntson & Cacioppo, 2004). High frequency (HF) HRV is regulated by 
parasympathetic control while low frequency (LF) HRV is regulated by both sympathetic and parasympathetic action 
(McDuff, Gontarek, & Picard, 2014). Nowadays HRV can be estimated by measurement of pulse rate variability using 
photoplethysmograms function implanted in smartphone or smartwatch (Peng, Zhou, Lin, & Zhang, 2015). Artefacts of 
HRV data will be corrected by Kubios HRV Premium 3.0 (Biosignal Analysis and Medical Imaging Group, Kuopio, 
Finland) before statistical analysis (Darragh, Booth, Koschwanez, Sollers, & Broadbent, 2013; Tarvainen, Niskanen, 
Lipponen, Ranta-Aho, & Karjalainen, 2014) because measurement of HRV by PPG  is affected by environment and 
motion more easily than conventional ECG method hence motion artefacts are produced more easily by PPG-measured 
HRV signals (Kranjec, Beguš, Geršak, & Drnovšek, 2014). 
There are several different parameters extracted from HRV signals. LF parameters of HRV would be analyzed since 
previous review reported that LF parameters are more prone to be affected by stress (Reyes del Paso, Langewitz, Mulder, 
Roon, & Duschek, 2013). Therefore mean and SD of RR intervals, ratio between LF and HF band powers, powers and 
peaks of VLF, LF and HF would be analyzed (Tarvainen et al., 2014). These parameters will be analyzed in the way 
similar to other continuous variables (Repeated ANCOVA).   
For the quantitative analysis, modified intention-to-treat analysis approach will be adopted for evaluating the clinical 
effectiveness of the intervention, i.e. subjects in intervention arm without receiving first session of music intervention will 

be excluded from analysis (Montedori et al., 2011). Missing data will be imputated before the analysis. Repeated 
ANCOVA will be used to evaluate the change of the outcome variables over time. The intraclass correlation coefficient 
will be calculated to assess the proportion of the total variance in data between included clusters.  
The interviews will be audio-recorded and transcribed verbatim. Directed content analysis will be employed to analyze the 
focus group interview data to examine the implementation outcomes. For model validation, transcribed verbatim will be 
analyzed under the approach of directed content analysis (Hsieh & Shannon, 2005) under the pre-determined “Leisure & 
Wellbeing” conceptual framework. The goal of directed content analysis is to validate or extend conceptually a theoretical 
framework. This contributes to our objective to investigate how the “Leisure & Wellbeing” conceptual framework is 
applicable to the MCI dyad. By reading the transcriptions line-by-line, the research team will highlight the text that on 
first impression appears to represent the constructs in the “Leisure & Wellbeing” conceptual framework. The research 
team will further identify key concepts as initial coding categories using the “Leisure & Wellbeing” conceptual 
framework. Aftermath, operational definition for each category will be determined using the same conceptual framework. 
Throughout the whole analysis, team members will review on the developed codes and categories. The relationships 
between generated categories and sub-categories will be further explored in order to explain the improved wellbeing of 
the dyad. Whenever there are data that cannot be coded under the framework, these data will be determined if they 
represent a new category which is not included in the framework. This allows the research team to capture any 
phenomenon which may not be explained by the conceptual framework and to offer additional explanation the effect of 
MWM on the wellbeing of the dyad. This is deemed important to capture the particularities of MCI dyad and assists in the 
translation of a general conceptual framework to be utilized by MCI dyad. 
Ethical consideration 
This study will be registered in clinicaltrials.gov. Ethical approval from the University and corresponding organizations 
will be sought. Information sheet will be given to the staff members and volunteers who will be involved in this study, 
caregivers and PWeD or people with MCI. Verbal and written informed consent will be obtained from the staff, 
volunteers, caregivers and PWeD or MCI participants after explaining the purpose and procedures of the research. 
Continuous verbal consent will be obtained from the participating PWeD or people with MCI when the research assistant 
conduct data collection on them. Caregivers, volunteers and centre staffs are advised not to implement the music 
intervention to the PWeD or people with MCI if they refused.  
Center social worker will support the staff, volunteers, caregivers and PWeD or people with MCI when there is emotional 
upset arise during the trial. However, based on our previous experience, the intervention is safe and the possibility of 
inducing any emotional distress on the participants is low.  
Video will be captured during the music intervention delivering at home on selected participants for future knowledge 
transfer purpose. The video will be edited as a micro-film to be broadcasted to promote the supportive culture of 
caregivers and volunteers for PWeD or people with MCI. Verbal and written consent will be sought from volunteers 
involved, caregivers, and PWeD or people with MCI before video capture. Rejection of video shooting did not mean 
refusal of accepting the intervention. Only those with consent will be shot in the video. 
SIGNIFICANCE OF THE STUDY 
This study will advance the existing knowledge and provide insights about the implementation strategies in supporting the 
MWM intervention. The findings will also help to develop educational workshops to promote the application of the 
intervention in the community. 
One of the study aims is to through partnership with the local community centres and involving the volunteers, it is hoped 
that the intervention can be spread to other centres, other centre users with dementia or their social networks so as to 
benefit more people. This study can also provide evidence of feasibility of implementing music intervention among 
PWeD or people with MCI who are not living in nursing home in Hong Kong and Chinese society. 
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Appendix A: Intervention Protocol 
Programme feature 
Music-with-movement intervention 
Eligibility 
People with MCI/early dementia 
Inclusion criteria: 
i. 
Aged 60 or above 
ii. 
Cognitively impaired, defined by Global Deterioration 
Scale 3 or 4 
iii. 
Community-dwelling 
iv. 
With stable medical condition 
v. 
Able to communicate in Cantonese 
vi. 
have a family caregiver who was willing to take part in 
the study 
Exclusion criteria: 
i. 
Suffering from any critical medical or psychiatric 
illnesses 
ii. 
Unable to hear even using hearing aids 
iii. 
Unable to sit independently for around 30 minutes 
iv. 
Received music intervention within six months 
v. 
Participate in any clinical trial within 6 months prior to 
the start of study 
 
Caregiver (CG) 
Inclusion criteria: 
i. 
Primary caregiver of the PWeD 
ii. 
Related to the PWeD and not a paid live-in care attendant 
Exclusion criteria: 
i. 
Suffering from any critical medical or psychiatric 
illnesses 
ii. 
Received music intervention within six months prior to 
the start of study 
Core components 
Caregiver will co-design the activities that require them to move their 
body parts with preferred music. The movement may involve gross- and 
fine-muscle. 
Dose 
Recommended to 1 – 3 times per week, for at least 12 weeks, for 30 – 45 
minutes each time. 
Providers 
Trained caregivers will encourage the people with MCI/early dementia to 
participate in this dyadic intervention.  
Sites 
Home and Centre 
Tailoring 
Caregivers are encouraged to discuss with their family member with 
MCI/early dementia about their music preference and activity preference. 
Strategies to improve 
fidelity 
1. Volunteer support; and 
2. Peer support during the centre-based music activities 
 
 
 

Appendix B: Implementation Strategies 
1. To address the objective 1 (PWeD and CG), 
Teach families who have relatives with dementia how to deliver the Intervention. Empower them with skills training 
and continual support offered by centre staff and trained volunteers, with the aim that they will become more likely to 
sustain its use even after the completion of this Project. 
i. 
Centre staff and volunteers will provide training to caregivers to deliver the Intervention. The training will be 
supervised by the project team and music therapist for quality improvement. With the Project Team’s past 
experience, it is important to empower the family caregivers in delivering the Intervention at home, particular 
in the early stage. Therefore, the 12-week intervention programme is designed with both centre-based and 
home-based sessions in a 6-month Intervention, while the 13th – 26th weeks will be maintenance period. 
Centre staff and trained volunteer will provide onsite support to caregivers regularly too. The support in 13th – 
26th weeks will be minimal but it will be assessable when centre staff or caregivers consider as necessary. 
 
Week 
Mode of delivery 
Volunteers home visit 
1 
Centre-based intervention 
 
2 
Home 
√ 
3 
Centre-based intervention 
 
4 
Home 
 
5 
Home 
√ 
6 
Home 
 
7 
Centre-based intervention 
 
8 
Home 
 
9 
Home 
√ 
10 
Home 
 
11 
Home 
 
12 
Centre 
 
13 – 26 
Home 
√ (though it is the maintenance phase 
and to be monitored by the research 
team, allowance will be given) 
 
ii. 
To foster a closer peer support among the family caregivers in each centre, and for better management by the 
centre, 7-8 families will be recruited at each cycle. Centre staff can also provide prompt support to them when 
caregivers have difficulties.  
iii. 
The caregiver participants will set up support group (can be face-to-face or virtual) to share their caregiving 
experience and their experience in using music intervention, other than the monthly reinforcement sessions at 
the Centre. 
iv. 
The regular meetings may also include other topics such as behavior symptoms management, social services 
for caregivers and people with dementia in order to maintain the interest of the family caregivers to continue 
participation. 

v. 
Caregivers are encouraged to seek help from centre staff and volunteers when they encounter difficulties or 
problem related to the intervention programme. 
vi. 
The adherence of the protocol by the caregivers will be co-monitored by the volunteer, centre staffs, and the 
project manager.  
To foster the sense of the ownership of the caregivers to this skill, $100 will be charged to each dyad as the tuition fee. 
The charges will be used to cover the expenses in purchasing related music instrument. The music instrument to be used 
in the intervention will be kept by the participants to encourage them to continue the intervention. 
 
2. To address the objective 2 (Community centre), 
Develop certain forms of contractual agreement with NGOs in order to collaborate on:  
(a) structuring a system for capacity building of the centre staff; and  
(b) developing the means to sustain the interest and capacity of families who are members of the 
participating centres. 
i. 
The participating centre will be offered training and accredited as “Music Intervention Centre for People with 
Dementia and Caregiver” if more than 50% of their activity staffs (e.g. social workers, activity assistants) are 
trained and assessed to be competent (will be elaborated more); consistently maintain a team of 15 trained 
older volunteers; and committed to recruit at least 7-8 dyads of PWD and caregivers every three months. 
Regular remediate training sessions will be offered if there is staff turnover among the participating centres. 
As the accreditation will need to be renewed every year, if the number of trained staffs and volunteers is 
lower than the recommended, the Project Team and the centre will discuss the matter to find a mutually 
acceptable solution. 
ii. 
A centre will be asked to support and maintain a team of volunteers in order to support the families, and 
organize centre-based intervention session. This strategy is proposed in order to enhance the sustainability of 
this programme and can be continued after the project ended.  
iii. 
A closing ceremony will be launched to acknowledge the contribution of the participating centres. A 
plaque/certificate will be issues of recognition for display too.  
 
3. To address the objective 2 (Staff members), 
Teach centre staff how to deliver the music-with-movement intervention programme (hereafter refer to as the 
Intervention) and enhanced their abilities to also be teachers of the Intervention, i.e., to teach families how to deliver 
the Intervention at home as well. 
i. 
A training programme will be conducted by a music therapist and the Project team, to the staff members of 
the participating centres. The training programme would include lectures, skill training, return demonstration 
and discussion. The training package include five training sessions and assessment. For quality assurance, all 
participating staff members will take part in an assessment to ascertain that the techniques in teaching family 
caregivers to provide the Intervention and deliver it at home have been mastered. It is assumed that two cycles 
of training programmes will be offered to cater five participating centres. 
ii. 
Staff members will be supported during the project period, but the support will be gradually faded out across 
two implementation cycles. Monthly meetings at the beginning of the project will be arranged for collecting 
feedback, and solving problems during the implementing the project. After the first round of implementation, 
quarterly or ad-hoc meetings will be arranged to provide continuous support.  
iii. 
To acknowledge the participation and competency of individual staff members, they will be certified as 
“Music Intervention Facilitator” after training and assessment. As the staff members are required to trained 

the caregivers and volunteers, their competency will be reviewed during the training by the registered music 
therapist. Suggestions for improvement will be given. 
 
4. To address the objective 3 and 4 (volunteers), 
Build up a mobile voluntary support team with the necessary skills required to enable the caregiver to adopt and 
sustain the Intervention at home. 
i. 
High caliber and motivated volunteers will be recruited from the Institute of Active Ageing, PolyU. The 
project team will match them up with the participating centres according to the living place. The participating 
centres are welcomed to recruit their volunteers by themselves according to a set of criteria in order to uphold 
the quality.  
ii. 
15 volunteers from each centre will receive training (at centre & at participants’ home) to support 7-8 families 
in each round and if they attain to certain ability (evaluated by music therapist), they will be accredited as 
“Music Intervention Ambassador”. This strategy is also served as a recognition to the contribution and 
competency of the volunteers, and promote the sense of ownership of this project among them. 
iii. 
Upon completion of services, volunteers will receive a certificate of appreciation and will be presented in the 
closing ceremony.  
iv. 
Two volunteers will be assigned to assist a family which would empower their confidence. 
v. 
To improve the coherence and communication among volunteers which can also serve as quality assurance 
and peer support, a What’s Apps group will be created to encourage frequent communication among 
themselves and with the project team. The What’s Apps group will be managed by the project assistant and 
centre-in-charge. 
vi. 
Allowance ($60 / half day visit) will be offered to volunteers to cover their travel expenses and as a token of 
thanks. 
vii. 
We would expect the volunteers to support the family for six months. In addition to the initial training, four 
regularly meetings will be organized throughout the six months (2 meetings will be organized by the 
individual centres, and other 2 meetings will be organized by the project team, that would include all 
volunteers from different centres to come together). These meetings can serve three purposes: (1) solve the 
problems of volunteers when they are helping the family at home; (2) increase the sense of coherence among 
themselves (i.e. peer social support); and (3) provide information in dementia care related topics (i.e. 
advanced training) to maintain their interest to support this project continuously.  
viii. 
Volunteers will be invited to provide written feedback (by filling in a simple form, with open- and close-end 
questions) after each visit, and send to the centre for record. That would help the centre to trace their 
contribution as well as providing prompt advice.  
 
5. To address the objective 5 (supportive culture), 
Create a supportive culture for people with dementia and their families, through learning about and engaging in 
meaningful interactions during the intervention programme. 
i. 
With the consent of the dyadic participants and volunteers, video recording will be done during the 
intervention programme (at home and at centre). The micro film will be produced to highlight the positive 
interactions between dyads and the dyads with volunteers, which will be broadcasted in the closing ceremony 
for reducing the stigmatization of dementia in general public and promoting the supportive culture.   

ii. 
Observations will be made and reports will be documented throughout the project to examine for signs of a 
changing pattern of relationship and communication between the dyads, as well as between centre volunteers 
and dyads, over time. 
iii. 
Observations will be made and reports will be documented to reflect on how the centres support their 
volunteers and families over time. 
iv. 
A public seminar will be held to disseminate the results of the projects and the related knowledge about 
home-based caregiver delivered music intervention. 
v. 
A professional workshop will be arranged to other health and social care professional.