Culturally adapting the In-Touch guide: A multi-country process for a palliative care intervention for people with advanced dementia living in care homes

Background: The purpose of the In-Touch project is to integrate and evaluate two non-pharmacological palliative care interventions for people with advanced dementia living in care homes: Namaste Care, which focuses on sensory activities to enhance quality of life, and the Family Decision Support Tool, designed to assist family members in making informed decisions. Given the project's multinational scope, cultural adaptation was essential to ensure the guide's relevance across diverse European care contexts. Aim/Research question or hypothesis: To culturally adapt the intervention guide. Methods: A structured adaptation process was guided by an international team of experts, including representatives of people with lived experience and project members. Feedback was gathered through group interviews in seven countries (UK, Ireland, Czechia, Poland, Portugal, Italy, and the Netherlands), involving three participant groups: (a) care home staff experienced with the intervention components; (b) care home staff unfamiliar with the intervention components; (c) family carers of people with advanced dementia. Participants evaluated the guide’s clarity, cultural appropriateness, and feasibility. The data were thematically analysed to identify key areas for cultural adaptation and practical improvements. Results: Key themes identified included suggestions for simplifying the guide to improve usability and ensuring that the language is accessible to all staff levels. Flexibility in activities was a recurring theme, with recommendations for adjustments in session length, structure, and available spaces to fit care home routines. Greater clarity on volunteer and family roles was also requested. The international team refined the manual based on this feedback, enhancing cultural relevance, usability, and practicality. Discussion: This collaborative adaptation process resulted in a culturally sensitive In-Touch guide, ready to facilitate broader implementation in a cluster randomised controlled trial across Europe.