| Summary: | There is growing interest in the research literature towards relationships in the context of dementia care. This thesis focuses upon the relationship between spouses when one has a diagnosis of dementia, called here the ‘care-dyad’. Group interventions that may benefit both spouses amidst the inherent challenges of the diagnosis are explored. This thesis is divided into two chapters. Chapter one presents a systematic review of the available evidence for group interventions that have been designed for both spouses, where one spouse has a diagnosis of dementia. The review synthesises the evidence from available research, highlighting the limited efficacy of group interventions and suggests a need for more empirical testing to understand the processes that occur within dyadic interventions. Limitations of the empirical evidence suggest a lack of theoretical underpinning of the interventions tested and the inconsistent use of outcome measures that have been recommended for dementia research. Findings demonstrating few significant benefits to care dyads and some negative consequences to carers raises significant ethical considerations when empirically evaluating such interventions within practice settings. Therefore, in considering dyadic group intervention research within dementia, the possible benefits and costs to the participants must be weighed up (Woods et al, 2012). Of note, previous studies have limitations, in which this study aimed to build upon. As such, Chapter 2 evaluates the efficacy of a dyadic post-diagnostic group intervention that is delivered within routine older adult health care services. The study described in Chapter 2, builds upon previous limitations in three ways. First, this study uses an entirely spousal sample, as previous dyadic intervention study samples included people with dementia and their carers, including spouses and family members. This is important as the needs, roles and emotional reactions to family members with dementia differs between spouses and adult children (Braun et al., 2009). Second, a number of outcome measures have been recommended by expert consensus for use with dementia studies, however, previous studies have not consistently used these outcome measures. As such, this study uses recommended outcome measures for use in dementia research. Third, this post-diagnostic group draws upon the couplehood literature and equity theory, which is novel in comparison with previous studies, which have not described their theoretical framework, a limitation previously highlighted by Braun et al. (2009). Preliminary unpublished qualitative data evaluating this post diagnostic group, previous to this study, has demonstrated that participants report benefits in improving their ability to cope and their knowledge of dementia, as well as considering the intervention to be both appropriate and satisfying. Previous participants have not expressed negative consequences of the intervention and furthermore, retention rates for the intervention have traditionally been high, which supports the supposition that the intervention appears acceptable for participants. This post-diagnostic group however, had not been studied using validated quantitative measures. Given that the present study aimed to build upon previous limitations described above, and that participants have previously reported positive qualitative experiences of this post-diagnostic group, the decision was made to explore the potential efficacy and effectiveness of this intervention using standardised quantitative measures. The second chapter presents an empirical study of whether a post-diagnostic dyadic group intervention, which is theoretically informed by the ‘couplehood’ literature, increases relationship quality for spousal dyads, where one spouse has a diagnosis of dementia. The findings are explored and discussed within a theoretical context. The chapters in this thesis have been formatted to the guidelines set out by Dementia, the international journal of social research and practice, which adheres to SAGE style and APA referencing. The guidance provided by Dementia has been summarised in Appendix 7.
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