Filipino Multicomponent Intervention to Maintain Cognitive Performance among High‐Risk Populations (FINOMAIN): Challenges in design and delivery of complex interventions
Authors: Dominguez Jacqueline C , De Guzman Ma Fe Payno , Guevarra Anne Cristine Deocariza , Yu Justine Megan F , Sales Ma Paz Lugay , Orense Consuelo Luber , Montalvo Maryanne Jenelle Yabut , Decena Jaypee , Natividad Boots P , Citron Raphael Louis B , Galvez Francy Joy , Marra Kate , Phung Thien Kieu Thi 
Published: December 2020

Background

Cognitive impairment in older adults is multifactorial and chronic hence, a complex intervention that can be integrated in community programs is a major consideration for it to impact society. Designing complex intervention is challenging intensified with lack of research and resources to support its development. In this paper, we aim to delve on experiences of Filipino investigators in designing and overcoming challenges of complex interventions for elderly with mild cognitive impairment (MCI).

Methods

As part of study process evaluation, we gathered qualitative evaluation regarding the development of Filipino Multicomponent Intervention to Maintain Cognitive Performance among High‐Risk Populations (FINOMAIN) study. This is currently on‐going cluster‐randomized controlled pilot trial designed to assess multicomponent intervention combining ballroom dance INDAK (Improving Neurocogniton through Dance and Kinesthetics), nutrition counseling and vascular risks management among community‐dwelling Filipino elderly with MCI. Semi‐structured interviews among eleven investigators with multidisciplinary expertise was conducted to examine their experiences, challenges encountered and cultural factors influencing design and delivery of this complex intervention. Data were coded, organized into themes and subjected to content analysis.

Results

Primary difficulty of designing INDAK as core intervention of FINOMAIN study is finalizing dance modules and designing intervention delivery into standard manner while allowing some degree of flexibilities considering capacity of Filipino elderly with MCI. Filipino guidelines for vascular risks management were followed while nutrition counseling design was based on “Pinggang Pinoy” which visualized what an ideal “Filipino plate” should look like and modelled required amount of nutrition. Despite existing guidelines, challenges in standardizing delivery of intervention were affected by participant‐related factors such as compliance, economic resources, access to care, lifestyle, motivation, and biological response of participants. Culture such as interconnectedness of participants and community power structure can both be restrictive and promotive in encouraging participation to intervention. Challenges were resolved by having team consensus, training of interventionists, close collaborations with local governments and strong involvement of families and caregivers for promotion of intervention compliance.

Conclusion

FINOMAIN is the first multicomponent intervention in the Philippines that can provide model for cost‐effective intervention to reduce dementia risk in low‐resource settings with similar culture and public health challenges.