Brain Health Service pilot: evaluation - final report

5. Discussion

In this chapter, we reflect on the findings and respond to the key evaluation questions.

What are the demographics of people accessing the service?

The model’s clinical practice guidelines highlighted that significant effort should be made to ensure that the serive is accessible to people from under respresented groups. Community engagement activities demonstrate the efforts made to reach sections of the population and rause awareness of the new service.

Overall, while the service demonstrates reasonable gender balance and effective engagement with older age groups, there are opportunities to improve equity by enhancing outreach efforts to younger populations to encourage them focus on brain health before middle age and individuals from BME backgrounds.

In the absence of recording full postcode data for individuals accessing the service, it was not possible to considered the socioeconomic profile of those accessing the Service and so there is no commentary on the deprived backgrounds of individuals. The Brain Health Clinic was resourced to provide services for Aberdeen City residents, which effectively created a two-tier system for NHS Grampian residents living in Aberdeenshire and beyond.

• Key facilitators: central location of the service within Aberdeen, enabling easy access for city residents, effective local marketing and outreach strategies within Aberdeen City.
• Key barriers: limited service engagement to younger demographics and ethnic minorities and data not collected on deprivation, geographic limitations in extending clinical services beyond Aberdeen City

What is the motivation for people accessing the service?

Individuals accessed the service for diverse reasons, primarily driven by personal or family health concerns related to dementia, cognitive decline, memory issues, and lifestyle risk factors including hypertension, diabetes, anxiety, and stress. A small proportion of individuals sought preventive guidance to maintain cognitive health, reflecting increasing public awareness about the importance of early intervention.

• Key facilitators: public interest in preventive healthcare and dementia awareness, accessibility of self-referral enabling proactive engagement, absence of other services addressing MCI
• Key barriers: limited public understanding of the full scope of the service offerings, stigma or misconceptions around dementia potentially discouraging early engagement.

What is the success of efforts to highlight the service and subsequent clinic, including a reach analysis within the Aberdeen area?

The service was promoted through comprehensive marketing approaches, including targeted media coverage, social media campaigns, public events, and distribution of educational materials. This was reinforced by significant community-based awareness raising activities through dedicated public health practitioner time to engage targeted groups. Users primarily learned about the service through promotional materials, events, and word-of-mouth referrals. Despite these extensive efforts, feedback highlighted the ongoing need for increased visibility, especially given the distinct preventative role of the service as separate from traditional dementia diagnostic clinics, emphasising a need for clearer communication and sustained public health outreach.

• Key facilitators: diverse and multi-channel promotional strategies, effective use of local community events to raise awareness.
• Key barriers: insufficient awareness among wider stakeholder groups and potential users, need for sustained and extensive public health campaigns clearly distinguishing the preventative nature of the service from dementia diagnostic clinics.

What is the understanding of how people have found engagement across the various stages - what were their expectations and to what extent were these met?

Overall, service users reported highly positive experiences, often surpassing initial expectations. Users specifically appreciated the welcoming, stigma-free environment, the compassion and empathy of staff, and the efficiency of the referral and assessment processes. Stakeholders indicated that offering more follow-up activities at Stage 1 could improve engagement, adherence, and positive behavioural outcomes, reinforcing the importance of ongoing support rather than isolated interventions.

• Key facilitators: empathetic and approachable staff, creating trust and reassurance, quick access to comprehensive, tailored clinical assessments, personalised follow-up interactions promoting ongoing engagement.
• Key barriers: limited initial awareness or clarity of the service scope among some users.

What are the initial responses to personalised action plans, adherence to these, and whether people feel they benefit from these?

Personalised action plans emerged as an important component for encouraging behavioural changes among users. These action plans ranged significantly in their structure and detail, tailored specifically to individual user needs—from simple verbal advice to comprehensive lifestyle and behavioural guidance. Users highlighted the effectiveness of tailored recommendations around physical activity, dietary adjustments, cognitive engagement, and reduced alcohol consumption. Stakeholders noted that seeing tangible, positive behavioural changes reinforced the value of continuous, personalised follow-up.

• Key facilitators: person-centred, flexible approach to developing action plans, continued follow-up and support reinforcing sustained behavioural change, visible outcomes reinforcing the effectiveness and value of ongoing support.
• Key barriers: inconsistency in the format and documentation of action plans potentially limiting user clarity, lack of structured follow-up for some users.

What are the initial findings around overall brain health awareness, and whether the Service has increased this in the Aberdeen area versus nationally?

Whilst it was not possible to compare the increased awareness of brain health in Aberdeen to other parts of the country, engagement with the Service has increased users’ awareness and understanding of brain health and dementia prevention. Although some users already had baseline knowledge, the majority reported either an enhancement of their existing understanding or that they had acquired new actionable information regarding modifiable risk factors.

• Key facilitators: detailed, personalised educational conversations during appointments, availability of informative resources and leaflets
• Key barriers: variability in users’ baseline knowledge, requiring more tailored communication strategies, need for wider public health messaging to reinforce broader awareness.

What are the interactions with other services ahead of and post referral?

The service successfully established interactions with external healthcare and support services, offering comprehensive clinical and non-clinical referrals. However, stakeholders highlighted the urgent need for clearer referral pathways and stronger integration with the existing NHS Grampian system particularly neurology, psychiatry and primary care services. The limited data sharing and integration of patient records posed challenges to continuity of care and efficiency.

• Key facilitators: positive collaboration between NHS Grampian and Alzheimer Scotland, informal relationships with clinical area supporting flexible referrals.
• Key barriers: lack of clear, formalised referral pathways into certain clinical specialties, limited data sharing capabilities across the Service team due to information governance restrictions, challenges related to effective integration with relevant clinical services

What is the understanding of whether interaction with the service has improved (a) their understanding and (b) their likelihood to positively alter behaviour for their brain health?

Interactions with the service notably improved users’ understanding of brain health and encouraged them to take proactive steps towards maintaining cognitive health. Users frequently reported tangible behavioural changes in diet, exercise, alcohol consumption, and cognitive engagement, directly influenced by their supportive discussions, action plans and clinical assessments. The evidence from service user interviews showed that this positive behaviour change was being sustained.

• Key facilitators: personalised, meaningful advice linked directly to users' health concerns, supportive follow-up processes maintaining user motivation.
• Key barriers: limited structured follow-up for some users potentially reducing sustained behaviour change