Describing and Measuring the “Switch-on” Effect in People Who Participate in Cognitive Stimulation Therapy
This study explored the “switch-on” effect, a recently identified outcome experienced by some participants of cognitive stimulation therapy (CST). CST is an evidence-based group intervention for improving cognitive function in people with mild to moderate dementia. The aim of the study was to attain a more comprehensive understanding of “switch-on”, a satisfying and little-known benefit of CST, by focusing on three research questions: • What is the nature of the “switch-on” effect as described by people attending CST and their family or caregivers? • At what time-points during and after the group is the “switch-on” effect reported? • Are the changes described as the “switch-on” effect measurable using the Volitional Questionnaire? A convergent parallel mixed methods design merging qualitative descriptive methodology and the single-subject A-B design was used for the inquiry. Qualitative data were collected via semi-structured face-to-face interviews with four community-dwelling CST attendees with dementia and their family member or caregiver before, during and after CST. Measurements using the Volitional Questionnaire (VQ), an observational measure of volition, were obtained with patient participants concomitantly. The interview data were analysed using NVivo-assisted thematic analysis, and the VQ measurement results were examined through descriptive statistics and visual analysis. Thematic qualitative analysis of the interview data indicated that the “switch-on” effect was multi-dimensional in nature, with increased engagement in occupation and expanded scope in Doing, Feeling, Relating, and Thinking and Reflecting. The occurrence of the effect described by patient and family participants involved a noticeable onset of “switch-on” changes within the first three weeks of CST. The changes continued to consolidate towards the completion of the seven-week programme in both CST and home environments. Descriptive analysis of the VQ data across the three time-points revealed concurrent improvement, mainly on the Achievement sub-scale, in three of the patient participants, although the instrument was deemed to not effectively capture the “switch-on” changes due to its ceiling effect. This study generated a detailed description of the “switch-on” effect, a cluster of interrelated beneficial changes following participation in CST, as reported by the four patient participants and their family caregivers. It also contributed a range of newly discovered positive outcomes of CST as part of “switch-on”. These included intentional occupational adjustment at home in Doing; improved acceptance of living with dementia and improved appreciation and consideration towards family caregivers in Feeling; the subcultural dimension described as “fellowship” and “comradeship” within the CST group and improved spousal relationships at home in Relating; and extended thought patterns that oriented more towards sociality and the future rather than focusing on themselves and the past in Thinking and Reflecting. The mixed methods findings of the study further suggested the positive impact of the intervention on patient participant’s volition and volitional processes, a source of changes that has not been explored in past CST studies and is worth more investigation in future research.