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| Name | Class |
|---|---|
| National Museum of Singapore | UNKNOWN |
| National Heritage Board, Singapore | UNKNOWN |
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Dementia and mild cognitive impairment are a rising concern for the ageing population in Singapore, leading to diminished quality of life and health outcomes. Arts-based interventions in a museum setting have been shown to improve cognitive health and well-being for Persons with Cognitive Impairment (PWCIs), however little is known about the relationship of heritage-based interventions on the health and well-being of PWCIs.
This mixed-methods study evaluates the 6-week "Refresh and Reconnect!" programme (R&R!), a museum-based heritage programme including guided artist-led activities and tours of the National Museum of Singapore.
(i) In the quantitative study (n = 64-120 PWCIs, comprising with mild cognitive impairment (MCI) or mild dementia), assessments will be conducted at 2 time points (pre-programme, post-programme) to evaluate change in cognitive, social, and mental well-being.
ii) In the qualitative study, ethnographic observations of the R&R! programme; ethnographic interviews with staff (n= max 3), & artists (n= max 6); and in-depth interviews with PWCIs (n=16) will be used to elicit the underlying context-mechanisms-outcomes which enable R&R! success. Programme volunteers will also be engaged through casual or informal conversations as part of the ethnographic observations.
The study will provide valuable insights for the development of effective, non-pharmacological interventions for PWCIs. The primary objectives of the study are to (a) compare the change (before and after programme participation) in the health and well-being of PWCIs participating in the programme, and (b) assess the change (before and after programme participation) in the perception of the museum, 'heritage' and learning among PWCIs participating in the programme. The secondary aims are to understand the factors, contexts, and mechanisms that influence the implementation of the museum-based intervention and its effects, including the place-based effects of the curated museum Reunion space for PWCIs.
Achieving the objectives will help answer the following research questions:
These findings are of significant public health importance for Singapore, potentially informing policy decisions, resource allocation, and healthcare strategies to better support PWCIs, ultimately improving their quality of life. Findings of the study may also contribute to similar heritage-based programmes in future, contributing to the understanding of key elements of programme success, and for whom these programmes are effective for.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Group | Experimental | Persons with cognitive impairment will undergo a 6-week heritage-based intervention programme conducted by the National Museum of Singapore, which includes guided gallery tours led by the museum's Care Facilitator volunteers and artist-led hands-on activities based on various art forms. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Heritage art programme | Other | The 6-week 'Refresh and Reconnect!' programme includes guided gallery tours led by the museum's Care Facilitator volunteers and artist-led hands-on activities based on various art forms (e.g. artist-led dance, art, or drama workshops). |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in Quality of life at the end of the 6-week intervention | Quality of life (QoL) will be assessed using the Control, Autonomy, Self-Realization, and Pleasure-11-SG (CASP-11-SG) scale. CASP-11-SG has been validated in Singapore. It has 11 items covering two domains: Control-Autonomy, and Self-realization-Pleasure (Table 1). Items are scored on a four-point response scale [Often (score = 3), Sometimes, Not Often, Never (score = 0)] based on how often the participant feels the way described in the item. Negatively worded items are reverse-coded. A higher total score (range: 0-33) indicates higher QoL. Control-Autonomy subscale (range: 0-18) and Self-realization-Pleasure subscale (range: 0-15) scores are also calculated. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in Health-related Quality of life at the end of the 6-week intervention | Health-related Quality of life (HRQoL) will be assessed using the EuroQol- 5 Dimension (EQ-5D) questionnaire. The EQ-5D comprises five questions on mobility, self-care, pain, usual activities, and psychological status with five possible answers for each item (1=no problem, 2=slight problem, 3=moderate problem, 4=severe problem, 5=unable to do). Overall, a total score of 5 indicates the best health state, whereas higher scores indicate more severe or frequent problems. In addition, there is a visual analogue of the scale to indicate general health status, with a score of 100 indicating the best health status. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in depression at the end of the 6-week intervention | Depression will be assessed using the CES-D-11 (Center for Epidemiologic Studies Depression Scale - 11 item version). It is a self-reported rating scale of 11 items on a 3-point Likert scale (range 0-2), with response options for "None/Rarely" (0), "Sometimes" (1), and "Often" (2) based on experiences over the past week. The total score is the sum of the 11 items, ranging from 0 to 22. Reverse Scoring: Positively worded items (e.g., "I felt happy," "I enjoyed life") are reverse scored before summing the total score. For these items, the scoring is: Often (0), Sometimes (1), None/Rarely (2). Scores of ≥9 indicate significant depressive symptoms, 5-8 suggest borderline depressive symptoms, and 0-4 fall within the normal range. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes to subjective well-being after each session of the 6-week intervention | Museum-based subjective well-being will be assessed by University College London (UCL) Museum Wellbeing Measures toolkit. The toolkit includes a 12-item Generic Wellbeing Questionnaire (GWQ) and Positive Wellbeing Measures Umbrella, designed specifically for museum projects. The GWQ uses statements that refer to an emotion or life quality that participants might have experienced during the museum activity, such as 'I felt confident'. These are rated from 1 ('None of the time') to 5 ('All of the time'). The Positive Wellbeing Umbrella consist of a hexagonal shape with six sections of different colours. Each of the six sections has a word next to it related to a wellbeing mood or emotion and responses are ranged from one (I don't feel) to five (I feel extremely). Participants are required to rate the extent they feel the wellbeing word at that moment in time by circling the appropriate number. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rahul Malhotra, MD, MPH | Duke-NUS Graduate Medical School | Principal Investigator |
| Ad Maulod, PhD, MSc | Duke-NUS Graduate Medical School | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Museum of Singapore | Singapore | 178897 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33460037 | Background | Zietlow KE, Oyeyemi DM, Cook SE, Hardy M, McDonald SR, Lagoo-Deenadayalan S, Heflin MT, Whitson HE. RESEARCHCognition and Capacity to Consent for Elective Surgery. J Am Geriatr Soc. 2020 Nov;68(11):2694-2696. doi: 10.1111/jgs.16786. Epub 2020 Aug 17. No abstract available. | |
| 38358084 | Background | Yang M, Samper-Ternent R, Volpi E, Green AN, Lichtenstein M, Araujo K, Borek P, Charpentier P, Dziura J, Gill TM, Galloway R, Greene EJ, Lenoir K, Peduzzi P, Meng C, Reese J, Shelton A, Skokos EA, Summapund J, Unger E, Reuben DB, Williamson JD, Stevens AB. The dementia care study (D-CARE): Recruitment strategies and demographic characteristics of participants in a pragmatic randomized trial of dementia care. Alzheimers Dement. 2024 Apr;20(4):2575-2588. doi: 10.1002/alz.13698. Epub 2024 Feb 15. |
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The investigator team will decide on sharing of individual participant data on a case-to-case basis, when such requests are made.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jan 20, 2025 | Jan 27, 2025 | Prot_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jan 20, 2025 | Jan 27, 2025 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D060825 | Cognitive Dysfunction |
| ID | Term |
|---|---|
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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This is an exploratory study that adopts a quasi-experimental (single-arm, before-after) and mixed-methods quantitative and qualitative design.
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| From enrolment to the end of intervention at 6 weeks |
| Change from baseline in anxiety at the end of the 6-week intervention | Anxiety will be assessed using the GAD-7 (Generalized Anxiety Disorder-7) Scale. It is a self-reported rating scale consisting of 7 items on a 4-point Likert scale (range 0-3), with response options for "Not at all" (0), "Several days" (1), "More than half the days" (2), and "Nearly every day" (3), based on experiences over the past two weeks. The total score is the sum of the 7 items, ranging from 0 to 21. Higher scores indicate greater anxiety severity. Interpretation: Scores of 0-4 indicate minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety. A total score of ≥10 is typically used as the threshold for identifying probable generalized anxiety disorder. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in loneliness at the end of the 6-week intervention | Loneliness will be assessed using The Three-Item Loneliness Scale. Each item of the scale has a five-point Likert response option: "Always" (scored as 4) "Fairly Often" (3), "Occasionally" (2), "Rarely" (1), and "Never" (scored as 0). The scores for each individual question can be added together to give a possible range of scores from 0 to 12. Higher scores indicate greater degrees of loneliness. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in social isolation at the end of the 6-week intervention | Lubbens Social Network Scale 6-item (LSNS-6) is a social engagement scale that consists of six items. The score for each item ranges from 0 to 5, with 0 indicating none and 5 indicating nine or more. The total score is calculated by finding the sum of all items, and ranges from 0 to 30. A higher score indicates more social engagement. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in ageing perceptions at the end of the 6-week intervention | The Brief Ageing Perceptions Questionnaire (Brief-APQ) measure comprise Likert scale items that represent seven ageing perception domains. Participants rate their agreement with a series of statements - for example "I am always aware of my age" or "As I get older I can take part in fewer activities" with a five-point response scale with the options: Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree. | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in motivations to learn at the end of the 6-week intervention | Motivations to learn will be assessed using the Readiness-to-learn Scale from the background questionnaire of the Programme for the International Assessment of Adult Competencies (PIAAC). This scale assesses participants' motivations to learn, and the learning strategies they adopt to solve challenges in learning. The response categories for this item range from not at all (1), to a very high extent (5). | From enrolment to the end of intervention at 6 weeks |
| Change from baseline in Montreal Cognitive Assessment score at the end of the 6-week intervention | Cognitive performance will be assessed using the Montreal Cognitive assessment (MoCA). MoCA assessment parameters are visuospatial/ executive, naming ability, vigilance, verbal fluency, delayed recall, and abstractions. The maximum MoCA score is 30 points. MCI (Mild Cognitive Impairment) is indicated by a score of less than 27 for those with 10 or more years of education or a score of less than 26 for those with less than 10 years of education (following the recommendation of MoCA use in Singapore). | From enrolment to the end of intervention at 6 weeks |
| From enrolment to the end of intervention at 6 weeks |
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