Exploring and Evaluating the Impact of 'Refresh and Reconnect!' (ReCognition)

January 28, 2025 updated by: Rahul Malhotra, Duke-NUS Graduate Medical School

Exploring and Evaluating the Impact of 'Refresh and Reconnect!': A Museum-based Heritage Programme for Older Persons With Cognitive Impairment

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:

  1. To what extent, and how does participation in the "Refresh and Reconnect!" programme impact health and well-being of PWCIs?
  2. To what extent, and how does participation in the programme affect the study participants' understanding and perception of the museum as a potential place to enhance one's health and well-being? [Note: Study Participants include all who are participating in the study such as PWCIs and those who are implementing (e.g. museum staff), facilitating (e.g. artists) and assisting (e.g. volunteers) with the R&R! Programme]
  3. What are the contexts and mechanisms that influence the implementation of the programme?

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Singapore
      • Singapore, Singapore, 178897
        • National Museum of Singapore
        • Contact:
        • Sub-Investigator:
          • Senior Manager (Curatorial & Programmes)
        • Sub-Investigator:
          • Senior Manager (Programmes)
        • Sub-Investigator:
          • Assistant Manager (Curatorial and Programmes)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Fulfils the programme recruitment criteria and registers for the programme through National Museum of Singapore's collaborating partners; AND
  • Provides consent for participation in the study personally; AND
  • Willing and able to participate in interviews independently, without proxy; AND
  • Scores between 22 to 27 on the MoCA (or 22 to 26 for participants with less than 10 years of education; or 22 to 25 for participants who are unable to provide information on the number of years of formal education completed). These thresholds follow the recommendation of MoCA use in determining mild cognitive impairment and mild dementia in Singapore and draw from studies concerning mental capacity and consent for persons living with cognitive impairment

Exclusion Criteria:

  • Whose cognitive impairment status cannot be confirmed by the administered screener; OR
  • Do not give consent to participate in the study; OR
  • Scores below 22 on the MoCA, or above 27 (or 26 for participants with less than 10 years of education; or 25 for participants who are unable to provide information on the number of years of formal education completed)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group
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.
Other: Heritage art programme
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).
Other Names:
  • "Refresh and Reconnect!"

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in Quality of life at the end of the 6-week intervention
Time Frame: From enrolment to the end of intervention at 6 weeks
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
Time Frame: From enrolment to the end of intervention at 6 weeks
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 anxiety and depression at the end of the 6-week intervention
Time Frame: From enrolment to the end of intervention at 6 weeks
Anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale (HADS). It is a self-reported rating scale of 14 items on a 4-point Likert scale (range 0-3), with 7 items each for anxiety and depression. The total score is the sum of the 14 items, and for each subscale the score is the sum of the respective seven items (ranging from 0-21). Scores of 11 or more on either subscale are a significant 'case' of psychological morbidity, while scores of 8-10 represents 'borderline' and 0-7 'normal'.
From enrolment to the end of intervention at 6 weeks
Change from baseline in loneliness at the end of the 6-week intervention
Time Frame: From enrolment to the end of intervention at 6 weeks
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
Time Frame: From enrolment to the end of intervention at 6 weeks
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
Time Frame: From enrolment to the end of intervention at 6 weeks
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
Time Frame: From enrolment to the end of intervention at 6 weeks
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
Time Frame: From enrolment to the end of intervention at 6 weeks
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

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes to subjective well-being after each session of the 6-week intervention
Time Frame: From enrolment to the end of intervention at 6 weeks
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.
From enrolment to the end of intervention at 6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Duke-NUS Graduate Medical School

Collaborators

National Heritage Board, Singapore
National Museum Singapore, Singapore

Investigators

  • Principal Investigator: Rahul Malhotra, MD, MPH, Duke-NUS Graduate Medical School
  • Principal Investigator: Ad Maulod, PhD, MSc, Duke-NUS Graduate Medical School

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

February 3, 2025

Primary Completion (Estimated)

January 1, 2026

Study Completion (Estimated)

July 1, 2026

Study Registration Dates

First Submitted

January 28, 2025

First Submitted That Met QC Criteria

January 28, 2025

First Posted (Actual)

March 25, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

January 28, 2025

Last Verified

January 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NUS-IRB-2024-259

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The investigator team will decide on sharing of individual participant data on a case-to-case basis, when such requests are made.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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