Implementing the MATILDA intervention to enhance community participation for older adults with intellectual disability: A feasibility randomised controlled trial and RE-AIM guided process evaluation

Aim: The primary aim of this study was to assess the feasibility, acceptability, and procedures of conducting a randomised controlled trial and to determine whether the prespecified progression criteria for advancing to a full trial were met. Secondary outcomes explored the clinical outcomes, process evaluation and health economics. Methods: This was a two-arm, randomised feasibility study with 1:1 allocation conducted in the UK. The intervention lasted 6-months. Clinical outcome variables (quality of life, anxiety, loneliness) were collated at baseline, 6- and 12-months post intervention. The RE-AIM framework (Acceptability, Reach, Effectiveness, Adoption, Implementation and Maintenance) was used to undertake the process evaluation. A health economic evaluation was also explored. Results: We recruited 57 participants of our target population of 64 (89%), 28 participants were randomly allocated to MATILDA and 29 to an active control group. Two participants died and one withdrew from the intervention arm prior to commencement of the intervention. We were able to match all 25 participants to a community group, most with a mentor(s). With regards reach and implementation, most older adults with an intellectual disability were still attending their community groups at 6-months (N = 18, 72%) and at 12-months (N = 17, 68%). There was a slight decrease in the anxiety scores for the participants in Matilda over the 6- and 12-months follow-up periods compared to the control group. MATILDA was found to be clearly acceptable and adoptable by the community groups and mentors. There were some challenges identifying and recruiting community groups and getting mentors to complete their questionnaires. Discussion: MATILDA appears to be a promising community-based intervention to support older adults with an intellectual disability that promotes social inclusion, quality of life, and wellbeing. This study advances our empirical knowledge in understanding the contextual factors, mechanisms and outcomes in developing and delivering a community intervention for this population.