Implementation of the Community Occupational Therapy in Dementia program in Italy (COTiD-IT): qualitative survey to identify barriers and facilitators in implementation

Background: Community Occupational Therapy in Dementia in Italy (COTID−IT) is a feasible and effective treatment that aims improving the quality of life and well−being of people with dementia and caregivers. The implementation of the program in the national context has not been studied yet. Aim: The objective of this study is to identify barriers and facilitators in the Italian implementation of the program. Methods: We designed a quantitative cross-sectional survey. A questionnaire was developed to collect descriptive data regarding the respondents, the perceived barriers and facilitators regarding the application of COTiD and possible actions to promote the implementation process. Results: The questionnaire was sent to all 90 Italian OTs trained in the use of COTiD−IT from 2013 to 2020. 50 people responded (61%). Barriers to the implementation of the COTID−IT included lack of knowledge about Occupational Therapy and the COTID−IT program by other health professionals. In addition, the scarcity of economic funds invested in home rehabilitation is experienced as another significant barrier. Facilitators were found to be the presence of an interprofessional team interested in the COTID−IT program and occupational therapy and the fact that COTID−IT is supported by scientific evidence. The creation of national and regional inter professional education and support groups, the availability of online resources are seen as opportunities to better implement the COTID−IT program. Conclusions: Implementation of psychosocial interventions is complex. OTs in Italy should be increasingly included within health policies and care programs of people with dementia to promote the use of COTID−IT. Further studies are needed to detail the policy and methodological actions that OTs should take in the future to disseminate and consolidate this intervention.