IMPACT: Innovations using mhealth for people with dementia and co-morbidity and their carers Health systems in low- and middle-income countries are ill-equipped to cope with rapidly aging populations. Dementia is a particular problem in Peru and challenges the health system on many fronts. People with dementia often have other health problems as well (co-morbidities) which go untreated, cause suffering and cost money. There is little social care infrastructure and care is provided almost entirely by over-stretched family members.

Our goal is to strengthen the health system in Peru to meet the challenges of dementia by using technology and trained community health workers to bring expert diagnosis, treatment and support right to where it is needed – to the homes of patients and carers. To achieve this, we will run four linked lines of work to:

1) assess whether the healthcare system can care for more people with dementia
2) improve the diagnosis of dementia
3) improve the care of people with dementia and their carers
4) evaluate the costs of dementia to society

Health systems readiness: We will interview people with dementia, carers, health professionals and government officials. We will find out about current dementia care in Peru and what is needed to improve it

Diagnosis: Dementia is hard to diagnose in people who live far from health centres or have little formal education. We will make an ‘app’ to help community health workers diagnose people with dementia. We will test how well this app works in 3200 people across four distinct regions of this diverse country.

Care: Although there is no cure for dementia, support and advice, group-based activities and physical exercise all help people to live well with dementia. But this type of care is not readily available in Peru. A project in the USA has developed a way of providing this care with smartphones. Because most Peruvians have smartphones, we can use them to develop a similar service, testing whether providing this care is feasible in Peru.

Costs: We will measure the cost of dementia and comorbidities in Peru. The health system needs to know how much dementia care will cost, so that it can introduce cost-effective plans for better care.

We will work with dementia charities in Peru and around the world to keep our research focused on patients. We will collaborate with the Peruvian Ministry of Health to develop a National Plan for Dementia. We focus on Peru in order to understand the context in depth but are confident that our findings will be applicable much more widely in Latin America. The aim of IMPACT is to strengthen health systems in Peru, using dementia as a tracer condition, through sustainable, integrated, community-delivered, technology-enabled innovations. Specific research objectives, embedded in our five Work Packages are:

1. Evaluate health system readiness to diagnose, treat and support people with dementia and their carers
a. To understand the needs of and resources available for people with dementia and their carers
b. To assess the readiness of the Peruvian health system to implement innovative tools for the diagnosis of dementia, and an intervention for people with dementia and their carers
c. To adapt and scale-up the health system readiness tools for use across Latin America

2. Develop and implement an mHealth-enabled system for diagnosis of dementia
a. Design and develop an mHealth, task-shifting diagnostic system for dementia and co-morbidities
b. Assess the accuracy and acceptability of the diagnostic system in four regions of Peru
c. Integrate the dementia diagnostic system in primary health care across the four study regions.

3. Determine the feasibility of an intervention to support people with dementia and their carers
a. Adapt an existing intervention from the USA aimed at improving health-related quality of life for people with dementia and their carers in Peru
b. Assess the feasibility of delivering this intervention in Peru and its acceptability to people with dementia and their carers
c. Identify appropriate ways to measure health-related quality of life and multimorbidity outcomes in people with dementia and their carers

4. Assess the economic burden of dementia in Peru and estimate the costs of rolling out the diagnosis tool at a national level
a. Estimate the economic burden of dementia in Peru from a societal perspective and the additional costs of comorbidities
b. Assess the health-related quality of life of people with dementia and their carers and its variation with additional comorbidities
c. Determine the cost to the health system of implementing the diagnostic screen for dementia

5. Optimise internal and external communications to deliver health systems improvements in Peru
a. Manage resources to deliver the project to plan, within time and budget, including risk management and quality control procedures
b. Ensure effective communication and work dynamics with attention to interactions between work packages
c. Engage with communities, healthcare workers, policy makers and other stakeholders