Layers of Influence: Important Contextual Factors in Directing Dementia Care Programs

Abstract

Researchers have documented the powerful influence of the physical and social environment on persons with dementia; however, most intervention studies fail to include contextual assessments when exploring outcomes. As part of a larger study assessing a horticultural therapy (HT) intervention, the authors explored the contextual and procedural factors that impacted results. Guided by the theory of environmental press, interviews were conducted with five of the study’s activity facilitators who worked in seven dementia care programs possessing varied social and physical environments. Findings indicated that the theory of environmental press should be expanded beyond the person with dementia and applied to program facilitators. A hierarchical relationship became evident; for program participants to achieve congruence between their competence and their environment, the facilitator must first achieve such a fit. Facilitators with fewer competencies were more vulnerable to the shortcomings of their environments; supportive environments can minimize deficits in competence.