Abstract
OBJECTIVES: To gather insights from people living with dementia, unpaid carers and professionals to co-design and refine a dementia-inclusive adaptation of the SAFER-Mental Health discharge care bundle, SAFER-Dem, that addresses challenges in the discharge process from mental health inpatient settings. A secondary objective was to assess how stakeholders interact with and understand the revised materials, focusing on usability and the perceived effectiveness of the dementia-inclusive adaptations. DESIGN: Qualitative co-design study involving sequential workshops and 'think-aloud' usability interviews, guided by participatory design and cognitive interviewing methods. SETTING: Mental health inpatient settings in the UK. PARTICIPANTS: 17 stakeholders (nine people with lived experience as a person living with dementia or carer and eight healthcare professionals) took part in four co-design workshops. 12 additional stakeholders (four people living with dementia, four unpaid carers and four professionals) participated in 'think-aloud' interviews. Participants were recruited via NHS Trust networks, advisory groups and social media. RESULTS: Participants highlighted widespread dissatisfaction with current discharge procedures, especially communication failures and environmental barriers. Changes to SAFER-Dem included simplified materials, flexible timing of delivery, realistic imagery and additional aids such as scenario cards and talking mats. Three main usability themes emerged: appropriateness, practical changes and usability. CONCLUSIONS: The SAFER-Dem care bundle was well received by stakeholders, showing promise for improving discharge quality for people living with dementia. Participants identified areas for improvement to enhance accessibility and effectiveness. Findings suggest that with further evaluation, SAFER-Dem could become a valuable tool in supporting dementia-inclusive discharge practices. Research and co-design with people living with dementia have been instrumental in understanding experiences during discharge.