Barriers and facilitators to implementing DREAMS:START intervention for sleep disturbance in dementia within the NHS: A pre-implementation study

Background: Sleep disturbances are common in people living with dementia and negatively affect them and their family carers. Non-pharmacological interventions like DREAMS:START (Dementia Related Manual for Sleep: Strategies for Relatives) offer potential benefits but are not yet implemented widely in NHS practice. Aims: To explore the barriers and facilitators to implementing DREAMS:START in UK NHS dementia services, from the perspective of healthcare professionals and intervention facilitators, using qualitative interviews. Method: We interviewed 19 NHS staff – (n=10) staff with no prior DREAMS:START experience and (n=9) DREAMS:START facilitators using semi-structured interviews and analysed data using reflexive thematic analysis, organized according to the Consolidated Framework for Implementation Research (CFIR). Ethical approval was granted by the London- Camden and Kings Cross Research Ethics Committee (Reference: 20/LO/0894). Results: Five key themes emerged: 1) perceived need for interventions targeting sleep in dementia; 2) importance of evidence and cost-effectiveness; 3) influence of service manager attitudes and support; 4) inter-professional interconnectedness and training; and 5) staff capacity and attitudes toward change. Participants highlighted the need for flexible, personalised delivery, robust evidence, training, supervision, and local champions to facilitate adoption. Conclusions: Implementation of DREAMS:START in NHS services is feasible but organisational barriers need addressing to enhance staff capacity, and promote evidence-based, cost-effective practices. Findings from this study will inform strategies for scaling up the intervention to improve sleep outcomes for people with dementia and their carers.