title: Understanding the impact of visual arts interventions for people living with dementia: a realist review protocol.
abstract: BACKGROUND
  Arts-based activities are being increasingly suggested as a valuable activity for people living with dementia in terms of countering the negative aspects of their condition. The potential for such programmes to improve a broad range of psychosocial outcomes is suggested in some studies. However, there is largely an absence of rigorous methodology to demonstrate the benefits, and research results are mixed. Practice variability in terms of the content, contexts and implementation of such interventions raises challenges in terms of identifying an optimal arts programme model that could be adopted by other service providers. Understanding how interventions may have the best chance at broad implementation success and uptake is limited.
  
  
  METHODS
  A realist review will be undertaken. This aims to understand how visual arts interventions influence outcomes in people living with dementia. The review will explore how the context, that is the circumstances which enable or constrain, affect outcomes through the activation of mechanisms. An early scoping search and a stakeholder survey formulated the preliminary programme theory. A systematic literature search across a broad range of disciplines (arts, humanities, social sciences, health) will be undertaken to identify journal articles and grey literature. Data will be extracted in relation to the programme theory, contextual factors, mechanisms and outcomes and their configurations, background information about the study design and participant characteristics, detail about the quantity ('dose') of an intervention, theoretical perspectives proposed by the authors of the paper and further theorising by the reviewer. Thematic connections/patterns will be sought across the extracted data, identifying patterns amongst contextual factors, the mechanisms they trigger and the associated outcomes.
  
  
  CONCLUSIONS
  Along with stakeholder engagement and validation, this review will help inform the development of an optimal, replicable arts intervention for people with dementia as part of our broader research programme, titled 'Dementia and Imagination' (funded by the Arts and Humanities Research Council). Forthcoming work under this programme of research will test this theoretically informed intervention in three different geographical areas of the UK. The production of freely available practice guidance is a key aspect of dissemination.
  
  
  BACKGROUND
  PROSPERO registration number CRD42014008702.
authors.affiliation: Dementia Services Development Centre, Bangor University, Ardudwy, Holyhead Road, Bangor, Gwynedd LL57 2DG, Wales. g.windle@bangor.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Windle
authors.forename: Samantha
authors.initials: S
authors.lastname: Gregory
authors.forename: Andrew
authors.initials: A
authors.lastname: Newman
authors.forename: Anna
authors.initials: A
authors.lastname: Goulding
authors.forename: Dave
authors.initials: D
authors.lastname: O'Brien
authors.forename: Clive
authors.initials: C
authors.lastname: Parkinson
mesh_terms: D006801:Humans; D001155:Art Therapy; D003704:Dementia / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012107:Research Design; D012196:Review Literature as Topic