Beyond the project: Building a strategic theory of change to address dementia care, treatment and support gaps across seven middle-income countries

Erica Breuer*, Adelina Comas-Herrera, Emily Freeman, Emiliano Albanese, Suvarna Alladi, Rochelle Amour, Sara Evans-Lacko, Cleusa P. Ferri, Ishtar Govia, Claudia Iveth Astudillo García, Martin Knapp, Michael Lefevre, Mariana López-Ortega, Crick Lund, Christine Musyimi, David Ndetei, Deborah Oliveira, Tiffany Palmer, Meera Pattabiraman, Tara Puspitarini SaniDubglas Taylor, Eileen Taylor, Imelda Theresia, Priya Treesa Thomas, Yuda Turana, Wendy Weidner, Marguerite Schneider

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capacity and evidence on dementia care and services in Brazil, Indonesia, India, Jamaica, Kenya, Mexico and South Africa. This article presents the Theory of Change (ToC) approach we used to co-design our research project and to develop a strategic direction for dementia care, treatment and support, with stakeholders. ToC makes explicit the process underlying how a programme will achieve its impact. We developed ToCs in each country and across the STRiDE project with researchers, practitioners, people living with dementia, carers and policymakers at different levels of government. This involved (1) an initial ToC workshop with all project partners (43 participants); (2) ToC workshops in each STRiDE country (22–49 participants in each); (3) comparison between country-specific and overall project ToCs; (4) review of ToCs in light of WHO dementia guidelines and action plan and (5) a final review. Our experiences suggest ToC is an effective way to generate a shared vision for dementia care, treatment and support among diverse stakeholders. However, the project contribution should be clearly delineated and use additional strategies to ensure appropriate participation from people living with dementia and their carers in the ToC process.

Original languageEnglish
Pages (from-to)114-135
Number of pages22
Issue number1
Publication statusPublished - Jan 2022


  • health planning
  • low- and middle-income countries
  • theory of change


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