Translating dementia care to public health: implementation analysis of a community center for people with dementia and family caregivers in Chile

Background As part of the National Plan of dementia in Chile, community centers for people with dementia have been developed (1). This program delivers support to the person living dementia and their family, integrating social and clinical aspects through a multicomponent interprofessional intervention, and has been highlighted as an innovative approach to dementia care (2‐4). There is limited knowledge on implementation aspects influencing its functioning as a public health initiative. This work seeks to analyze implementation outcomes of the first community center, called Kintun, in Santiago, Chile, 2013‐2022. Method A qualitative study was conducted following a realistic approach (multiple data collection strategies and informants to analyze complex interventions). Key informants of program implementation were identified to participate in interviews or focus group, at different levels (macro‐level of centralized policy, meso‐level of intervention deliverers and coordinator, and micro‐level of user family caregivers). Table 1 summarizes informants, multiple data collection strategies, and implementation outcomes addressed. Interviews and focus group were audio‐recorded and transcribed. Deductive thematic analysis was used with predetermined codes describing implementation outcomes according to the Active Implementation Frameworks (Blanchard et al, 2017) and implementation outcomes by Proctor et al (2011). Result The Kintun program is on a full implementation stage. At a macro‐level, the program has not experienced significant administrative transformations, where fidelity is tensioned due to lack of updated centralized technical orientations. In contrast, at a meso‐level, program components have been locally modified or adapted. Several implementation drivers are identified, such as engagement with the local service network, tailoring according to context, and more recently, the COVID‐19 pandemic, and new policies (explicit health guarantee). The program is highly pertinent for all levels, however, the inception of new health policies challenges its place in the healthcare network. Conclusion In the implementation of the first community center for people with dementia in Chile, at a policy macro‐level the program has been continuous and stable. Modifications and adaptations occurred at a meso‐level of implementation, informing of discrepancies in intervention fidelity. Due to the high influence of meso‐level on intervention implementation, it is necessar