Enhancing engagement in meaningful occupation in a dementia town: A qualitative evaluation of MOED - The meaningful occupational engagement intervention for people with dementia.

Introduction: Engagement in meaningful everyday life occupations is linked to well-being. However, people with dementia are often deprived of engagement. As a response, a Danish Dementia Town was established with the intention of transforming care services to improve opportunities for meaningful engagement. The evidence-based The meaningful occupational engagement intervention for people with dementia (MOED) intervention was developed and implemented in dementia town to enhance meaningful occupational engagement. The purpose of this paper is to evaluate the content, impact and implementation process of MOED.

Method: To evaluate MOED, we applied a program theory-based qualitative approach, building on participant observations and informal conversations with people with dementia ( = 7) and staff ( = 9). Data were analysed from a hermeneutic approach to gain an in-depth understanding of how MOED influenced meaningful occupational engagement and to evaluate the implementation process.

Findings: The main theme 'Engagement in meaningful occupations - a conditional and fragile process' emerged along with three subthemes: 'Creating an everyday space of meaning: Conditions of the intervention', 'Occupational engagement as an opportunity to blossom: Impact of the intervention' and 'Professional identity, culture and reflections: Contextual barriers to changes to working practice'. Together, the subthemes illustrate how engagement in meaningful occupations arose. However, opportunities to engage in meaningful occupations were fragile, as they depended on various factors within the context.

Conclusion: Engagement in meaningful occupations emerged when MOED was applied in accordance with the program theory, as it seemed to create spaces where people with dementia could engage in meaningful occupations and they could blossom over time. However, MOED was only partially implemented in accordance with the developed program theory, as several contextual barriers influenced the sustainability of the intervention. MOED showed potential to support improvement in dementia care activity programmes to enhance opportunities to engage in meaningful occupations in everyday life for people living with dementia.