Abstract
Background
Globally, by 2050 it is expected that over 150 million people will be diagnosed with dementia (GBD 2019 Dementia Forecasting Collaborators, 2022). Dementia is a degenerative condition and to date any benefits from pharmacological treatments to delay the onset of dementia have been minimal (O'Brien et al., 2017), limited to Alzheimer’s disease, and involve exposing patients to significant risks, such as amyloid-related imaging abnormalities (Espay et al., 2024; Kepp et al., 2023; Sims et al., 2023). There is growing evidence that reablement and rehabilitation programs are beneficial for people with dementia and can delay functional decline (Laver et al., 2020b). In the dementia care context, there is yet to be consensus around the terminology used to describe these programs. In Australia for example, different research groups have used either ‘reablement’, ‘restorative care’ or ‘rehabilitation’ to describe similar approaches to maintaining and improving independence in people living with dementia (Clemson et al., 2021; Jeon et al., 2019; Laver et al., 2020b). The term ‘reablement’ has been used in the present work as this aligns with the recently released Australian National Dementia Action Plan (Australian Government, 2024). The authors note however, that internationally, there appears to be a trend towards using the term ‘rehabilitation’ (Alzheimer’s Disease International [ADI] et al., 2025; World Health Organization [WHO], 2023).
An internationally accepted definition of reablement is “a person-centred, holistic approach that aims to enhance an individual’s physical and/or other functioning, to improve or maintain their independence in meaningful activities of daily living at their place of residence and to reduce their need for long-term services” (Metzelthin et al., 2022; pg11). There are a range of service models that could be leveraged to deliver reablement, depending on available resources. For example, community aged care teams, memory clinics, community outpatient teams, and private allied health providers (Suárez-González et al., 2024). Reablement is ideally delivered by a trained interdisciplinary team and consists of multiple consultations including a comprehensive assessment followed by development of individualised goal-oriented support plans and regular reassessments (Metzelthin et al., 2022). Due to their specialised expertise, a range of allied health professionals may be involved in dementia reablement, including, but not limited to, occupational therapists, physiotherapists, speech pathologists, psychologists, and social workers (ADI et al., 2025; WHO, 2023). Individually administered reablement programs delivered in a person’s home environment are more likely to be successful (Jeon et al., 2021). Reablement programs have potential to address a broad range of client-centred goals to maximise social and everyday living participation, including mobility, cognitive and social functioning, leisure and activities of daily living (ADLs) (Poulos et al., 2017). While the WHO and the most recent Lancet Standing Commission on Dementia recommend that people with dementia are offered reablement programs as part of usual care (Livingston et al., 2024; WHO, 2023), access to these programs remains limited (Layton et al., 2024; Lee et al., 2024a; WHO, 2017). There is a gap between research that has identified benefits of reablement programs and implementation into health or social care practice for people living with dementia (Koh et al., 2024). Indeed, a recent international position paper with a focus on embracing dementia reablement as an essential support approach has highlighted the need for more research on the implementation of dementia reablement (Metzelthin et al., 2024).
The WHO ‘Global action plan on the public health response to dementia 2017-2025’ emphasised the importance of using implementation research to enhance care for people living with dementia and their family caregivers (World Health Organization, 2017). Implementation research is about identifying contextual barriers and facilitators that may impact on uptake of an intervention, and developing a range of implementation strategies to address the identified barriers and facilitators to enhance intervention uptake (Bauer & Kirchner, 2020). As implementation of evidence-based treatments into clinical practice can be influenced by multiple factors, the use of a framework provides a consistent approach to knowledge development by identifying the various determinants that may influence implementation outcomes (Damschroder et al., 2022; Nilsen, 2015). The Consolidated Framework for Implementation Research (CFIR) is a widely used implementation science framework that provides a list of multi-contextual constructs to guide the preparation for and evaluation of implementation efforts (see Figure 1) (Damschroder et al., 2009). The CFIR has been used within the dementia care context to evaluate the implementation of allied health programs such as physical activity programs (Cardona et al., 2023), primary healthcare programs (Morgan et al., 2019), and community-based programs for informal caregivers of people living with dementia (Zhu et al., 2023). Within the context of reablement for people living with dementia, use of the CFIR can enable a greater understanding around the types of barriers and facilitators to implementation and this information can be used to develop tailored strategies to promote uptake into practice. Illustration of the Consolidated Framework for Implementation Research (CFIR) applied to the implementation of reablement for community-dwelling people living with dementia. The CFIR constructs are grouped into five domains: (1) Innovation; (2) Inner setting; (3) Outer setting; (4) Individuals; and (5) Implementation process
The primary objective of this scoping review is to identify barriers and facilitators around the implementation of reablement programs for community-dwelling people living with dementia. Secondary objectives are to explore: (1) what implementation strategies have been used to support uptake and delivery of reablement programs into community-based dementia care; and (2) stakeholder-specific factors associated with implementing dementia reablement programs.
Methods
Study Design
Scoping review methodology was selected as it permits a broad review of relevant literature inclusive of varying study designs. The review methodology was informed by a combination of frameworks (Arksey & O'Malley, 2005; Colquhoun et al., 2014; Peters et al., 2021) and the review is reported in line with the reporting guidelines ‘Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews’ (PRISMA-ScR) (Tricco et al., 2018). The protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/C3HR7).
Search Strategy
A university librarian advised on the development of the search strategy – the full strategy and terms used can be found in Appendix 1. PubMed, Web of Science, APA PsycINFO, Embase and CINAHL databases were searched using a targeted search strategy covering three domains (dementia AND reablement AND implementation) with a combination of MESH terms and key words. Grey literature was also searched using Google Scholar with the first 100 citations considered. Search criteria were limited to publications published in English and the search was conducted on the 25th of July 2024 and updated on 26th of May 2025 and again on 3rd February 2026 with no lower bound on the time range applied.
Screening and Article Selection
Both qualitative and quantitative publications were included where implementation was discussed in relation to a reablement program (including any allied health programs with reablement and rehabilitative goals) for community-dwelling people living with dementia. Detailed inclusion/exclusion criteria are listed in Appendix 2. As the term reablement is inconsistently used, papers were included if the program described matched the international definition of reablement (Metzelthin et al., 2022) even if different terminology was used. In line with the dementia reablement models discussed in the 2025 World Alzheimer’s Report (ADI et al., 2025), included papers required reablement programs to be delivered in the community by allied health professionals (e.g. occupational therapists, physiotherapists, speech pathologists, psychologists) either independently or in collaboration with nursing professionals, and both multidisciplinary and single-discipline programs were included (WHO, 2023). In terms of implementation, studies were included where reablement programs had been implemented, or where planning for implementation had been undertaken, for example, focus groups or pre-implementation surveys with discussion around anticipated barriers, facilitators, and implementation strategies. The implementation inclusion criteria were adapted from the Standards for Reporting Implementation Studies (StaRI) checklist (Pinnock et al., 2017). No limit was placed on country of publication, but included papers were limited to those published in English language. Publications were excluded where details of the process, preparation or evaluation of implementation were not included in the methods or results sections, where there was a focus on pharmacological treatments or on participant intervention outcomes (with no implementation outcomes), where there was no clear allied health involvement in delivery of the intervention, and where there were mixed study populations (e.g. older people with a range of health conditions or people with mild cognitive impairment).
Covidence software (Covidence Systematic Review Software, 2024) was used for data management; once all databases had been searched, duplicates were removed. An initial relevancy screen of all unique records was then conducted to identify and remove those with titles/abstracts clearly unrelated to the study objective (i.e., did not focus on implementation or knowledge translation, did not assess an outcome related to dementia, did not include settings of community care, did not focus on reablement related programs). For the primary database search (July 2024) and first search update (May 2025), two authors (SH, SD) independently reviewed the titles, abstracts, and subsequently, the relevant full texts from the search using an eligibility form developed for the review. Any disagreements which arose in the inclusion or exclusion of a study were resolved through discussion and consensus with a third author (CO). For the final search update (February 2026), titles and abstracts were screened by the first author only (SH), with relevant full-text articles subsequently reviewed independently by the first (SH) and last authors (CO). Any uncertainties regarding eligibility at the full-text stage were resolved through discussion and consensus.
Data Extraction
Using a data extraction form developed for the review, data from the included articles were extracted by one author (SH), with a second author (SD) independently extracting data from 10% of the articles to facilitate inter-rater reliability, with an overall agreement of 72%. Coding data from implementation studies is complex (Merle et al., 2023), for example, teasing out the difference between whether a factor is a facilitator or an implementation strategy is nuanced, and sometimes there is overlap between these two dimensions (Nilsen & Bernhardsson, 2019). The authors defined barriers and facilitators as determinants or contextual factors that impact on the implementation process (Schmitt et al., 2025), and implementation strategies as the techniques or methods used to improve the implementation of an intervention program (Balis & Houghtaling, 2023). However, at times there was overlap where a feature could be rated as both a facilitator determinant and an implementation strategy, in which case the item was scored across both domains, for example, leadership engagement, which functioned as a facilitator while also being actively mobilised to promote adoption. Any discrepancies were resolved through careful review and in-depth discussion between the authors, prior to full data extraction. Extracted data included: authors, country, year of publication, title, journal, aims/objectives, reablement intervention, setting (e.g. home, group-based program), stakeholders (e.g. people with dementia, family caregivers, allied health professionals, program managers etc.), stakeholder-specific factors, study type (e.g. implementation study, pragmatic trial, implementation preparation study e.g. focus groups), implementation barriers, implementation facilitators, implementation strategies used, implementation outcomes.
Data Analysis
The quality of the evidence gathered was evaluated using the Critical Appraisal Skills Programme (CASP) checklists for qualitative studies, descriptive and cross-sectional studies and randomised control trials (Critical Appraisal Skills Programme, 2023). The CASP checklist was independently completed for each included study by two authors (SH, JC) with 100% agreement between authors for the 10% cross over.
Qualitative thematic analysis was used to analyse and synthesise the extracted data. For the primary outcomes of the scoping review, data were analysed deductively, using the CFIR (Damschroder et al., 2022) to provide a structured framework ensuring comprehensive consideration around the potential barriers and facilitators to implementing reablement for people with dementia. For the secondary outcomes exploring implementation strategies and stakeholder-specific factors, inductive thematic analysis was applied, whereby data were coded with an iterative process of theme development to explore reablement programs, implementation strategies, and stakeholder-specific factors associated with implementing reablement programs for community-dwelling people living with dementia. The CFIR implementation process domain was used to contextualise the analysis around the implementation strategies; identified implementation strategies were then mapped to the Expert Recommendations for Implementing Change (ERIC) framework and domains (Powell et al., 2015; Waltz et al., 2015). Mapping was based on the purpose, content, and delivery of each identified strategy, which was then compared against the standardised definitions contained within the ERIC framework. NVivo software (Lumivero, 2023) version 14 was used to analyse the data. Final codes and themes were discussed with the broader research team and finalised through consensus.
Results
A total of 7160 references from databases and citation searching were retrieved (Figure 2). Following the removal of duplicates, 4244 titles and abstracts were screened with 4078 excluded. Of the 166 papers included for full text screening, four were unable to be retrieved. One hundred and twelve papers were excluded through full text screening for various reasons listed within Figure 2, including 23 that were classified as grey literature e.g. conference abstracts, guest editorials etc. Failure to discuss implementation was the most common reason for exclusion. The final 50 papers were included in the scoping review, including 5 that were classified as grey literature (all conference abstracts). Appendix 3 provides a detailed summary of included publications. Results of search: PRISMA flow chart
The 50 included papers consisted of publications from around the world including 19 from Australia (Bennett et al., 2023; Bennett et al., 2020; Campbell et al., 2025; Cations et al., 2020; Cations et al., 2019; Clemson et al., 2021; Culph et al., 2021; Culph et al., 2020; D'Cunha et al., 2023; D’Cunha et al., 2025; Gannon et al., 2025; Jeon et al., 2019; Laver et al., 2020a; Lee et al., 2024b; O'Connor, Clemson, et al., 2019; O'Connor et al., 2020; O'Connor et al., 2022; Rahja et al., 2020; Suttanon et al., 2012), 12 from the United States of America (USA) (Dawson et al., 2020; Faieta et al., 2024; Fredriksen-Goldsen et al., 2019; Gitlin et al., 2024; Kellett et al., 2023; Koeuth et al., 2024; Logsdon et al., 2005; Primetica et al., 2015; Ries & Carroll, 2022; Teri et al., 2012, 2020; Warren et al., 2025), nine from the United Kingdom (UK) (Adams et al., 2023; Clare et al., 2019, 2023; Di Bona et al., 2017; Hynes et al., 2016; Kinsella et al., 2017; Morgan-Trimmer et al., 2021; Tucker et al., 2024; Wenborn et al., 2023), four from the Netherlands (Döpp et al., 2013; Döpp et al., 2015; Van’t Leven et al., 2012; Vernooij-Dassen, 2011), two from Germany (Ross et al., 2024; Steinbeisser et al., 2020) and one each from Italy (Lanzoni et al., 2023), Norway (Mjørud et al., 2025), Canada (Dal Bello-Haas et al., 2014), and France (Corvol et al., 2018). Included papers were published between 2011 and 2025 with the majority (n = 31; 64.6%) published from 2020 onwards, from high income countries. Regarding the focus of included publications, 22 were prospective studies evaluating the implementation of an intervention, 20 were focussed on preparing for implementation, two were cost-benefit analyses, one was a pragmatic trial, and five included discussions around considerations for implementing reablement programs for community-dwelling people with dementia.
The CASP checklist for qualitative research, randomised controlled trials and descriptive or cross-sectional studies (Critical Appraisal Skills Programme, 2023) was completed for each of the included publications (Appendix 4). Of the qualitative studies (n = 36), a lack of consideration of the relationship between researcher and participants was the criterion most frequently not met (n = 27). There was also uncertainty as to whether the recruitment strategy was appropriate to the aims of the research (n = 12), whether ethical issues had been considered (n = 8), or if the data analysis was sufficiently rigorous (n = 4). Seven qualitative studies had no identifiable risk of bias. Of the quantitative studies, the only criterion not met for the randomised control trials (n = 4) was in relation to participant and investigator blinding, which may not be applicable to a reablement context. The criteria for the economic evaluations (n = 2) were all met. The descriptive or cross-sectional studies (n = 8) were most at risk of bias, in part due to multiple being conference papers which lacked methodological detail. The criterion most frequently not met across the descriptive or cross-sectional studies was whether the sample size was sufficient to minimise the play of chance.
What Community-Based Reablement Programs for People With Dementia have been Implemented Into Health or Social Care Services
Overview of Reablement Programs Reported in the Included Papers
NB: the paper by Koeuth et al. (2024) discussed both TAP and COPE, therefore this paper is counted twice in the above table to appropriately reflect the papers that discussed each intervention.
Overall, the majority of programs were dyadic, with a range of allied health disciplines involved in delivery. In addition to the formally named programs (n = 36), a number (n = 14) were broadly described, for example, occupational therapy programs (Cations et al., 2019; Corvol et al., 2018; Vernooij-Dassen, 2011), exercise and activity programs (Dal Bello-Haas et al., 2014; Dawson et al., 2020; Laver et al., 2020a; Lee et al., 2024b; Suttanon et al., 2012), and broadly defined reablement, rehabilitation or non-pharmacological programs (Campbell et al., 2025; Cations et al., 2020; Faieta et al., 2024; O'Connor et al., 2020; O'Connor et al., 2022; Ross et al., 2024).
Barriers and Facilitators to Implementing Reablement for People With Dementia
Identified Barriers and Facilitators Mapped to the CFIR Domains
CFIR: Consolidated Framework for Implementation Research (Damschroder et al., 2022).
Individuals: Reablement Program Deliverers, Team Members and Leaders
A common barrier discussed among health professionals in the COTiD and more broadly defined reablement programs was a lack of confidence delivering reablement programs due to inexperience with the intervention (Döpp et al., 2013; Van’t Leven et al., 2012; Vernooij-Dassen, 2011). A lack of knowledge across the community aged care sector of the role of allied health professionals both generally and in relation to reablement for people living with dementia specifically added to these challenges by influencing low health professional buy-in and referral rates (O'Connor et al., 2020; Van’t Leven et al., 2012; Vernooij-Dassen, 2011). In some publications, health professionals were uncertain of the efficacy or fit of reablement, or they perceived clients to have a lack of capacity to engage with extra information (Cations et al., 2020; Döpp et al., 2015). In contrast, greater program deliverer confidence in their capabilities to deliver reablement was a facilitator to the implementation of various programs, contributing to higher levels of staff program acceptability (Clemson et al., 2021; Döpp et al., 2013; Lee et al., 2024b). In parallel, perceived benefits for clients and client acceptability of the program positively influenced the confidence of those delivering multiple reablement programs including GREAT, PrAISED and COPE (Adams et al., 2023; Clemson et al., 2021; Mjørud et al., 2025). Health professionals delivering TAP also commented that delivering reablement expanded their repertoire of clinical strategies (Warren et al., 2025). Support for and promotion of reablement from service managers was a frequently identified implementation facilitator. Managers supported implementation across various programs through providing strong leadership for staff, allocating resources and time for program implementation, championing reablement within the organisation and advocating to higher executives about reablement (Bennett et al., 2023; Cations et al., 2020; Culph et al., 2021; O'Connor et al., 2020; Warren et al., 2025).
Individuals: Reablement Program Recipients
In multiple studies, such as those delivering COPE, RDAD, and SPICE, the availability of a caregiver to be present was a prerequisite to meet eligibility criteria to receive reablement (Clemson et al., 2021; D'Cunha et al., 2023; Logsdon et al., 2005). However, the lack of availability, capacity and engagement of family caregivers was frequently highlighted as a barrier to implementation across programs and countries, such as Norway, USA, UK, and Australia (Bennett et al., 2020; Campbell et al., 2025; Mjørud et al., 2025; Morgan-Trimmer et al., 2021; Suttanon et al., 2012; Warren et al., 2025; Wenborn et al., 2023). One study delivering COTiD reported that the implementation of a new reablement program within the context of high levels of caregiver burden contributed to participant drop-outs (Döpp et al., 2015). Low client motivation and variable moods were reported as challenges to engaging recipients with dementia and sustaining reablement programs in some cases (Clemson et al., 2021; Lee et al., 2024b). Caregivers highlighted the role of health professionals delivering the COTiD program to motivate clients as they valued their ability to provide motivation to complete activities that caregivers felt they may not be able encourage clients to engage in (Hynes et al., 2016). Other client-specific barriers included competing clinical health needs of the clients, geographical location (regional, rural etc.), dementia stigma and fatalism (Adams et al., 2023; Corvol et al., 2018; O'Connor et al., 2020). Building rapport between health professionals and clients was a major identified facilitator for delivering GREAT and TAP, to engage clients in the process, identify relevant goals and strategies, and tailor reablement to their needs and preferences (Bennett et al., 2020; Mjørud et al., 2025; Morgan-Trimmer et al., 2021). This relationship further facilitated the implementation of PrAISED as incorporating the interests of recipients positively influenced program engagement and motivation (Adams et al., 2023).
Inner Setting: Within the Reablement Service Provider
Time constraints and workforce capacity limitations due to a lack of available staff were reported as significant barriers across many of the included programs (e.g. GREAT, PrAISED, TAP) to achieving reablement program fidelity during implementation as they led to insufficient time with clients to complete the program as intended (Bennett et al., 2023; Clare et al., 2023; Mjørud et al., 2025; Tucker et al., 2024). Time constraints also impacted the client’s ability to absorb and understand the program information in the time provided (Clare et al., 2019). Confusion regarding professional role responsibilities within the team, a lack of interdisciplinary relationships or professional role models and changes in management also impacted implementation across various programs (e.g. COPE, COTiD, PrAISED) (Culph et al., 2020; Döpp et al., 2013; Tucker et al., 2024). Organisations with prevalent nihilistic views about dementia and health professionals unaware of the benefits of reablement programs contributed to difficulties securing resources and referrals for GREAT and COPE programs (Clare et al., 2023; Culph et al., 2021). Facilitators within organisations included coming together, sharing knowledge, providing team support and building relational connections to support adherence to the program and combat staff turnover and changes to workloads (Adams et al., 2023; Primetica et al., 2015). Having a team approach to delivering COPE and GREAT provided health professionals with a support system, fostering motivation and accountability (Culph et al., 2020; Mjørud et al., 2025), and the appointment of a champion within the organisation to guide the implementation process was also discussed in the implementation of I-HARP (Jeon et al., 2019). The open layout of physical workspaces further facilitated communication as team members were able to discuss implementation with each other more easily (Cations et al., 2020; Culph et al., 2020).
Outer Setting: Factors External to the Reablement Service Providers
The most prevalent barriers mentioned in the outer setting were around funding mechanisms and navigating the community aged care sector to access reablement programs. Despite the reported cost-effectiveness of reablement programs in settings such as Australia and Germany on the community level (Gannon et al., 2025; Steinbeisser et al., 2020), on an individual level, multiple publications discussed uncertainty around the affordability of the program and the need to plan models of care to facilitate access to reablement programs while reducing client financial burden (Bennett et al., 2023; D’Cunha et al., 2025; O'Connor et al., 2020; Rahja et al., 2020; Ross et al., 2024; Teri et al., 2020; Warren et al., 2025). In Australia, these challenges were further complicated by competition between community-based service providers for people with dementia where some did not support the provision of psychosocial programs, and others were unsure whether clients would have sufficient funding to access reablement (Bennett et al., 2020, 2023; Clemson et al., 2021). A barrier identified by one German study was the lack of transport options for recipients to reach services, which contributed to the reliance on family caregiver availability and capacity (Ross et al., 2024). In Australian government-funded programs, there was concern as to whether funding packages would cover reablement costs, or whether clients may be made to choose between reablement programs or other services (Bennett et al., 2023; Lee et al., 2024b). While in the UK, financing was also discussed as a barrier, with debate around whether programs should be publicly or privately funded (Tucker et al., 2024).
Competing policies were highlighted as an influencing factor for implementation. For example, where policies were perceived to prioritise cohorts such as young people with disabilities, this impacted on the capacity of allied health professionals to deliver reablement services for people living with dementia (Clemson et al., 2021; Ross et al., 2024). Lack of public awareness in Australia and the USA regarding the benefits of reablement for dementia was suggested as a barrier to implementation, impacted by limited efforts to engage communities prior to and during implementation (Bennett et al., 2023; Culph et al., 2021; Faieta et al., 2024). Additionally in the UK and Australia, stigma around accessing dementia support services and limited awareness of available services were identified as barriers to engaging eligible recipients in the community (O'Connor et al., 2020; Tucker et al., 2024). Interorganisational collaboration and the formation of partnerships with other stakeholders such as researchers and community agencies were facilitators used to increase the adoption, penetration and sustainable delivery of reablement (Fredriksen-Goldsen et al., 2019; O'Connor et al., 2020; Teri et al., 2020; Teri et al., 2012). Additionally, leveraging external resources such as online dementia training also supported those delivering reablement during implementation in the Australian context (O'Connor et al., 2020).
Innovation Domain: Delivering Reablement Programs
Although the implemented reablement programs differed in design across the publications, challenges in setting, prioritising and remembering client goals were commonly discussed. Program timeframes were raised as a contributing factor across different programs, with concerns raised about not having sufficient rapport-building time to develop, set and achieve client goals, or around feasibility of achieving client goals within limited available timeframes (Adams et al., 2023; Cations et al., 2020). Additionally, more impaired clients were reported to experience challenges engaging with the goal setting process or remembering goals, with some goals being abandoned entirely (Clare et al., 2019). Differences between client and caregiver goals were highlighted as posing a further layer of complexity to program implementation in various programs (Clare et al., 2019; Vernooij-Dassen, 2011). Insufficient/inappropriate training and the need for a practical guideline or protocol for delivering reablement was mentioned across countries (e.g. Australia, Netherlands, Norway, UK, USA) as there was confusion amongst program deliverers as to what equated to guideline adherence, especially when programs were adapted during implementation (D'Cunha et al., 2023; Faieta et al., 2024; Mjørud et al., 2025; Van’t Leven et al., 2012; Warren et al., 2025; Wenborn et al., 2023). There were concerns about maintaining program fidelity while adapting to fit local contexts due to unclear guidelines about what aspects of the programs such as RDAD could and could not be adapted (Teri et al., 2012).
In some cases, there was a lag between training and implementation which impacted program deliverers’ confidence delivering reablement (Clare et al., 2023; Clemson et al., 2021; Lee et al., 2024b). In one UK study, COVID-related lags between training and program implementation led to reduced practitioner confidence that their organisation could sustain program delivery (Clare et al., 2023). Furthermore, there was a greater risk of training knowledge being lost in organisations where there was high staff turnover (Culph et al., 2021). Allied health professionals delivering COTiD indicated a desire for further training to support implementation and program deliverer confidence as some found the training too basic or felt the need for additional training (Wenborn et al., 2023). In another COTiD study, fewer than 15% of occupational therapists felt competent delivering reablement, while more than half reportedly missed the presence of a role model, and having occupational therapists on the team who were not specifically trained in reablement was reported to further hinder implementation (Döpp et al., 2013).
Health professionals’ perception of a strong evidence-base for the GREAT, SPICE and PrAISED programs was a facilitating factor, increasing their confidence in the intervention and influencing uptake, acceptability and adoption (Clare et al., 2023; D'Cunha et al., 2023; Mjørud et al., 2025; Teri et al., 2012). Promoting awareness of the evidence-base for reablement was also highlighted as an implementation facilitator for gaining support from doctors and managers (Van’t Leven et al., 2012). During COPE program implementation, managers used the evidence-based ‘stamp’ to promote buy-in and support from other stakeholders (Culph et al., 2021). Additionally, COPE program training in Australia and the USA was valued by program deliverers, enabling them to engage with the reablement approach and communicate benefits to recipients (Culph et al., 2020; Kellett et al., 2023). Training also helped to develop health professionals’ program knowledge and build confidence delivering COTiD and GREAT programs (Mjørud et al., 2025; Wenborn et al., 2023).
Implementation Strategies
Identified Implementation Strategies Mapped to the ERIC Strategy Compilation
Strategies for Service Providers and Clinicians
Implementing reablement programs and maintaining program fidelity required a team approach and sufficient planning prior to implementation. The importance of ongoing communication was highlighted across all members of the implementation team from care support workers, allied health practitioners, to referring doctors in both Australian and UK settings (Adams et al., 2023; Clare et al., 2023; Lee et al., 2024b). Collaborating as a team with shared mission alignment helped staff to overcome implementation challenges when implementing RDAD in the USA (Teri et al., 2012). In the context of the COPE and GREAT programs, quality workplace team relationships and environments including motivated managers and committed staff facilitated engagement in activities such as reorganising caseloads, promoting organisational awareness of the intervention, and sharing case examples (Clare et al., 2023; Culph et al., 2020).
Practical Strategies
Fidelity monitoring through peer support and checklists was implemented within COPE programs to facilitate program planning and to support staff program knowledge (Clemson et al., 2021; Gitlin et al., 2024). Monitoring program fidelity in the RDAD program also supported those delivering the program as it identified inconsistencies in reablement delivery, highlighted opportunities to add training, and contributed to staff understanding of how caregivers and clients were progressing with the intervention (Primetica et al., 2015). Ensuring other colleagues are informed about the program, the development of referral pathways and understand where reablement fits within practice also facilitated referrals and program funding for COPE (Clemson et al., 2021; Culph et al., 2021). Flexibility within reablement programs allowed program deliverers to adapt the timing, delivery approach and language to fit client needs and abilities, thus enhancing program acceptability and sustainability (Clare et al., 2023; O'Connor et al., 2020). In a Norwegian study implementing GREAT, an easy to follow ‘homework schedule’ was created for the person with dementia to work towards their goals and it was suggested that this tool be offered as part of all reablement programs (Mjørud et al., 2025). In a UK study evaluating GREAT implementation, adaptations to the timing of delivering different program material as well as simplifying the language in the program handbook enhanced client understanding around program details (Morgan-Trimmer et al., 2021). Similarly, modifications were made to make language and terminology around reablement and dementia more positive in Australian reablement program handbooks and in practice in a USA-based COPE study (Kellett et al., 2023; O'Connor et al., 2022). For example, activity ‘prescriptions’ was changed to activity ‘strategies’ as a result of negative connotations with the term identified by caregivers (Kellett et al., 2023).
Strategies to Support Engagement With People Living With Dementia and Their Supporters
Supporting caregivers and providing them with practical individualised strategies was seen as beneficial for engaging caregivers and maintaining their support for COPE, I-HARP, SPICE, and TAP programs (Clemson et al., 2021; D’Cunha et al., 2025; Jeon et al., 2019; Kinsella et al., 2017). A useful strategy discussed to address potential limitations around family caregiver capacity (Bennett et al., 2020) was broadening the program support network such as engaging with other family members including children and paid care support workers (Logsdon et al., 2005; Morgan-Trimmer et al., 2021; O'Connor, Clemson, et al., 2019). Explaining the evidence-based nature of reablement programs and providing education about dementia also facilitated caregiver engagement in various programs (Clare et al., 2019; O'Connor, Clemson, et al., 2019). Program deliverers should also be positive and reassuring, reminding people with dementia about previously enjoying the activities to motivate and engage them in sessions if they aren’t feeling like participating (D'Cunha et al., 2023; Jeon et al., 2019).
Stakeholder-Specific Factors Associated With Implementing Dementia Reablement Programs
Of the publications that included stakeholder-specific factors on the implementation of reablement programs (n = 38), 33 included perspectives from allied health professionals, 16 from informal caregivers, 15 from people living with dementia, 11 from those in manager roles, one from policy stakeholders, and one from general practitioners.
Allied health professionals valued GREAT and COPE reablement programs for people with dementia across all stages of disease progression and would readily recommend them (Clare et al., 2023; Kellett et al., 2023). Some occupational therapists reported that delivering COPE led to them feel more sensitive to caregiver needs and they were able to transfer this responsiveness to needs in other areas of their practice (Kellett et al., 2023). Many occupational therapists reported strong mission alignment of VALID and TAP with occupational therapy and how implementing reablement allowed them to maximise their role (Di Bona et al., 2017; Warren et al., 2025). In some cases, implementing VALID was also reported to feel less time pressured than much of their other work (Di Bona et al., 2017).
Managers also had positive attitudes towards implementing reablement due to its perceived usefulness (Döpp et al., 2013). Managers described the organisational benefit of providing an additional service to clients (Bennett et al., 2023), and valued the opportunity to grow and improve geriatric programs through offering reablement (Warren et al., 2025). Managers also noted the alignment of reablement with supporting family caregivers and reported that implementing reablement did not significantly add to their workload, with any additional time considered worthwhile (Kellett et al., 2023).
Caregivers appreciated how reablement promoted the abilities of the person with dementia and led to greater caregiver acceptance of the disease (Corvol et al., 2018). Reablement sessions also facilitated caregiver knowledge around supporting people with dementia through the provision of educational materials, and caregivers valued the opportunity to ask questions (Clare et al., 2019). Caregivers participating in TAP also noted benefits from reablement for both themselves and the person with dementia when engaging in meaningful activities together (O'Connor, Clemson, et al., 2019). Reablement was suggested to improve caregiver and client relationships in GREAT and SPICE programs as it led to a greater understanding of and patience supporting the person with dementia and not blaming the person with dementia or themselves (D'Cunha et al., 2023; Morgan-Trimmer et al., 2021). The opportunity to connect with other caregivers to share experiences and advice was also discussed to be beneficial (D'Cunha et al., 2023).
People with dementia were motivated by the individualised nature of reablement (Adams et al., 2023), perceived benefits of reablement for themselves and also for minimising caregiver burden (Suttanon et al., 2012), as well as enjoyment of the program and the formation of relationships and social interactions (Campbell et al., 2025; Corvol et al., 2018; O'Connor, Clemson, et al., 2019; Ries & Carroll, 2022). In a USA study evaluating an exercise program (OEP), the enjoyment and social interaction was suggested to be a greater motivation than reducing risk of falls (Ries & Carroll, 2022). This was also reflected in a Canadian exercise study where reablement was delivered in a group setting; clients appreciated connecting socially with others in similar situations, contributing to reduction in stigma (Dal Bello-Haas et al., 2014).
Overall, stakeholders viewed reablement as an important approach to supporting people living with dementia, with benefits extending across key stakeholders involved in implementation efforts. For the people coordinating services for people living with dementia, reablement was seen as vital in preventing further use of health and social care resources by helping individuals with dementia to remain in their homes and avoid higher levels of care (Tucker et al., 2024).
Discussion
This review synthesises and summarises the literature related to implementing reablement programs for community-dwelling people living with dementia. While a range of reablement programs have been implemented throughout the world, outcomes from this review have illustrated some consistent themes around the barriers and facilitators to implementing community-based dementia reablement programs. Mapping outcomes to the CFIR facilitated a consistent approach to analyse, present findings and identify stakeholder and setting-specific factors which influenced implementation. Key barriers included: limited reablement and dementia knowledge and awareness, lack of health professional confidence and challenges around maintaining intervention fidelity, workforce capacity within service providers, policy pressures, and limited informal caregiver capacity. Key facilitators included: health professional confidence and motivation from perceived reablement benefits, teams working together with good communication, interorganisational collaboration, promoting awareness of the evidence-base for dementia reablement, rapport-building with clients, and supporting caregivers. Overall, the findings of this review point to the need for consideration of a range of strategies to support implementation of dementia reablement, which are broadly described below.
Building Knowledge and Challenging Stigma
Insufficient knowledge and understanding around dementia reablement (spanning across the individual level, the inner setting, and the outer setting) was found in this review to be a pervasive barrier to implementation. This highlights a pressing need for greater knowledge and understanding throughout the community around the importance of reablement for people living with dementia. These findings parallel recent literature highlighting the contribution of stigma and lack of knowledge to limitations in accessing dementia reablement (Cations et al., 2020; Hall et al., 2023; Quick et al., 2022, 2024). A lack of community knowledge around reablement has been suggested to hinder referral rates and client access to reablement (Laver et al., 2020b; Layton et al., 2024). In one study, some clients with mild dementia declined to participate in the study as they didn’t see the need for the program as they perceived themselves to be ‘doing fine’ (Jeon et al., 2025). For health professionals, dementia knowledge in parallel with reablement knowledge is essential for providing effective programs for people with dementia (Hall et al., 2023; Quick et al., 2024). Yet a lack of dementia training at undergraduate level for medical and allied health professionals likely contributes to ongoing nihilistic attitudes about the ability of people with dementia to benefit from reablement (Cations et al., 2020; Quick et al., 2022). Increasing public awareness of dementia reablement and promoting its benefits, while ensuring programs are financially accessible is critical.
Moving forward, a range of top-down and bottom-up strategies could address issues around inadequate reablement and dementia knowledge. Policy changes that adequately address funding mechanisms and support care pathways that prioritise reablement for people living with dementia are necessary (Metzelthin et al., 2024). In parallel, it is vital that dementia training is incorporated into allied health and medical course content, with a focus on reablement. For practicing health practitioners and general practitioners, continued professional development and education can increase referral rates and support greater fidelity during reablement delivery (Gitlin et al., 2010; Layton et al., 2024; Lee et al., 2024a; Lindelöf et al., 2023).
Indeed, freely available educational resources exist and should be leveraged to support health professionals to upskill and gain confidence in understanding dementia and delivering reablement programs (Dementia Training Australia, 2025, Wicking Dementia Research and Education Centre, 2026; O’Connor et al., 2019; O’Connor & Poulos, 2021; Poulos et al., 2019). Finally, community campaigns are needed to empower clients and family to request reablement when planning their care. Educating family caregivers and facilitating their involvement from diagnosis is important for sustaining participation in meaningful daily activities for people with dementia (Poulos et al., 2017).
Communication and Collaboration Across Stakeholders
Similar to reablement and dementia knowledge, the need for effective communication and collaboration was identified in this review to span across the individual level, the inner setting, and the outer setting, extending from health professionals communicating with clients and informal caregivers, internal communications within service provider teams (including with management), and inter-organisational collaboration and communication. Caregiver involvement was a prerequisite for the inclusion of participants in many of the reablement programs in the included papers. While caregiver involvement in program delivery and understanding around the principles of reablement have been suggested to positively influence program success (Jeon et al., 2020), there is potential that people living alone with dementia may miss out on these life-enhancing interventions. Encouragingly, recent evidence highlights the potential to effectively engage people with dementia who live alone in non-pharmacological interventions such as reablement (Clare et al., 2024; Polack et al., 2025), it is therefore important that support is provided as needed (e.g. involving allied health assistants or care support workers) so that all people with dementia have the opportunity to participate in reablement. While care support workers and allied health assistants were not included as stakeholders in the current review, they can play an important role in supporting a dementia reablement program, with support from a multidisciplinary team (Possin et al., 2025). Future work should look more deliberately at these vital team members who often spend more time with the person living with dementia than do the allied health professionals.
Findings from this scoping review around the importance of rapport-building with clients and families echoes previous research highlighting that strategies to enhance goal setting processes are largely based on relationship building and communication with clients and families (Jogie et al., 2021; Lindelöf et al., 2023). In line with this scoping review, previous research has identified specific strategies to support collaborative goal setting between health professionals and clients, including: involving both the client and caregiver in goal formulation, collaborating with caregivers for goal development, focussing on one goal at a time, building client confidence, and establishing rapport prior to goal setting to understand client perspectives, strengths, and interests (Jogie et al., 2021; Lindelöf et al., 2023).
In the present review, the concept of collaboration and shared goals continued within the inner setting between health professionals to promote motivation and facilitate positive outcomes, enabling teams to adapt reablement programs as necessary. In the outer setting between organisations, shared motivations and goals towards a reablement approach were suggested in our review to facilitate collaborative implementation efforts, however, this contrasts with previous research suggesting that this might be limited by local economic factors and the market-driven landscape of the healthcare system (Stephan et al., 2015). The political landscape is also an important consideration, with public health services often chronically underfunded (Dobson, 2024). There is a need to design a model of care that is informed by human rights, public health and social equity principles to bridge the gap between health and aged care services in order to broadly implement dementia reablement (Low et al., 2021). On a more local level, to address gaps in communication and collaboration, strategies have been suggested such as establishing local learning collaboratives that prioritise team member engagement (Day et al., 2022), or a consistent contact such as a case manager to facilitate cross-service collaboration and support client service navigation (Layton et al., 2024; Low et al., 2023; Stephan et al., 2015). However, despite the reported benefits of long-term case managers, in practice, access to case managers or designated social workers is often only provided in the short-term (Low et al., 2023).
Pre-Implementation Planning and System Readiness for Reablement Delivery
To maximise the likelihood of successful implementation, pre-implementation planning, including developing a tailored implementation plan, is critical (Alley et al., 2023). Despite the importance of developing an implementation plan, this step is often overlooked when implementing an intervention (Gagliardi et al., 2011); a finding that was reflected in the current review. A systematic scoping review conducted around dissemination and implementation of dementia care practices, found that pre-implementation assessment of the implementation environment, barriers and facilitators was uncommon, and there was a lack of detail around how the included studies reported on the identification and coding of implementation strategies (Lourida et al., 2017). To address these issues, appropriate implementation planning and preparation is vital, to assess and address organisational capacity and needs, prior to implementing reablement (Ambugo et al., 2022). Including regular review meetings within the team and with leadership, prior to and during the implementation process, with specific consideration around the restructure of services and referral strategies to sustain program implementation is important to support successful implementation (Clemson et al., 2021; Döpp et al., 2013; Teri et al., 2020).
When planning for implementation, consideration of what allied health and dementia-specific services are locally available, understanding local policy priorities and how to access existing resources is important (Adams et al., 2023; Tucker et al., 2024). While reablement programs have been reported to be cost-effective at the system level (Gannon et al., 2025; Steinbeisser et al., 2020), the financial and administrative burden often falls on individual clients and practitioners. This suggests a disconnect between policy-level cost-benefit assumptions and the practical realities of implementation and access. Additionally, service provision for people with dementia is frequently fragmented, including post-diagnostic services (Ng & Ward, 2019), with access and availability varying significantly by geographic location, thereby limiting affordable care options in rural and regional areas (Layton et al., 2024; Ross et al., 2024). To address issues relating to sustainability or equity of access, approaches such as telehealth have been successfully implemented for people with dementia accessing cognitive rehabilitation (Cotelli et al., 2019), occupational therapy (Rhodus et al., 2023) and speech therapy (Schaffer & Henry, 2023). In scaling up telehealth approaches, consideration around technological knowledge and access, and self-efficacy in older adults will be required (Wilson et al., 2021).
Gaps in Strategy Use and Opportunities for Strengthening Implementation
A range of implementation strategies were employed across the included studies, with strategies around engagement and adapting to context well-represented. However, mapping to the ERIC strategy compilation (Powell et al., 2015) identified that a number of ERIC strategies were not reported. This highlights potential for future studies to trial new strategies to support implementation sustainability and scale-up. Notably absent from the present review were policy and system-level strategies, which may suggest there is limited consideration or understanding around how to address these external broad challenges. Interpersonal and leadership-based strategies such as identifying and preparing champions, recruiting and training for leadership and using advisory boards or implementation advisers, were also largely underused, although there is limited evidence to suggest their effectiveness in driving internal capacity and culture change (Gilfoyle et al., 2023; Lee et al., 2025; Santos et al., 2022). Interestingly, a range of the strategies for supporting health professionals to implement reablement identified in the present review align with those suggested in a mixed methods study reporting on strategies to support implementation of an independence promoting dementia intervention, for example, providing a session summary document, video examples, time to practice and continued implementation support (Walton et al., 2020).
Strengths and Limitations
Strengths of this study include the application of a comprehensive literature search involving five databases with the inclusion of grey literature, reference list searching, and the involvement of multiple experienced multi-disciplinary reviewers. Despite these strengths, there are some limitations. The included publications used inconsistent and varied approaches to assessing and discussing implementation which limited the comparability of findings across publications. Similarly, publications used a range of descriptors for reablement programs. The search strategy was developed in consultation with a university librarian to prioritise free-text terms supplemented with MeSH headings for core clinical concepts to maximise sensitivity. However, it is possible that omission of some search terms, such as ‘process evaluation’, mean that some relevant publications may have been missed from the review. Although grey literature was included in our search strategy, none met inclusion criteria. This underscores the limited availability of non-peer-reviewed evidence in this field and may bias findings toward published studies. Future work should continue exploring grey literature to capture emerging or locally implemented interventions. The complexity of these reablement and implementation concepts may have contributed to the lower-than-average level of inter-rater agreement during preliminary data extraction, primarily due to differences in interpretation of nuanced implementation and intervention details. However, careful review and in-depth discussion between reviewers facilitated accuracy and consistency for the full data extraction. Overall, there was a lack of policymakers or high-level leaders engaged as stakeholders in the included publications, contributing to a gap in understanding strategies to address the system level challenges faced by service providers in implementing reablement. Future research should seek to apply consistent and theoretically underpinned implementation approaches that consider the needs of all stakeholders, from end users to policymakers.
Conclusion
This scoping review highlighted a range of barriers and facilitators to implementing reablement for community-dwelling people with dementia and illustrated strategies to address some of the identified challenges. Outcomes emphasise the importance of building strong relationships among stakeholders, enhancing staff and caregiver knowledge of reablement, and tailoring programs to client abilities while leveraging funding to maintain program sustainability. To enhance adoption and sustainability, implementation efforts should include pre-implementation planning to facilitate interdisciplinary collaboration and managerial support as well as consideration of local contexts and strategies to minimise caregiver burden. More consistent methods for reporting implementation in future research are needed. Further research should consistently evaluate the implementation of reablement programs for community dwelling people with dementia across diverse settings, to bridge the gap between evidence and practice and contribute to accessible reablement programs for all people living with dementia.
Supplemental Material
Supplemental Material - Implementing Reablement Programs for People Living With Dementia: A Scoping Review of Barriers, Facilitators and Strategies
Supplemental Material for Implementing Reablement Programs for People Living With Dementia: A Scoping Review of Barriers, Facilitators and Strategies by Sasha A. Houlden, Jennifer Culph, Sally Day, Lindy Clemson, Christopher J. Poulos, Yun-Hee Jeon, Kaarin J. Anstey, Susan Kurrle, Justin N. Scanlan, Claire Spargo, Kate Laver, Claire M. C. O’Connor in Dementia.
Footnotes
Acknowledgments
The authors would like to thank the University of New South Wales librarians for their support in developing the search strategy for this scoping review.
Ethical Considerations
As this was a scoping review, ethical approval was not required. However, the review is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR; Tricco et al., 2018), and the protocol was registered on Open Science Framework (
).
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: CMOC is supported by a Dementia Centre for Research Collaboration Post-doctoral Fellowship and this project was supported by an Aged Care Research & Industry Innovation Australia (ARIIA) Grant, funded by the Australian Government Department of Health, Disability and Ageing. KJA is funded by an ARC Laureate Fellowship FL190100011.
Declaration of Conflicting Interests
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
These may be made available upon reasonable request to the authors.
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