A systems approach to implementing digital tools for earlier Alzheimer detection in Scottish primary care services

Hamilton, Sarah Jayne

Thesis

A systems approach to implementing digital tools for earlier Alzheimer detection in Scottish primary care services

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Creator

Hamilton, Sarah Jayne

Rights statement

Strathclyde Thesis Copyright

Awarding institution

University of Strathclyde

Date of award

2026

Thesis identifier

T18000

Person Identifier (Local)

202458587

Qualification Level

Masters (Postgraduate)

Qualification Name

Master of Philosophy (MPhil)

Department, School or Faculty

Department of Design, Manufacturing and Engineering Management

Abstract

The early detection of dementia is a clinical and system priority. Technology has the potential to achieve earlier detection, however, may fail to be successfully implemented. This thesis examines how a novel digital cognitive assessment might be embedded into routine primary care workflows to support the earlier detection of Alzheimer disease (AD), using the tablet-based Four Mountains Test (4MT) as a case study. Rather than evaluating diagnostic accuracy, this research investigates the conditions shaping detection and the practical requirements for integrating a new assessment into general practice. Guided by systems thinking principles and the Engineering Better Care (EBC) framework, qualitative research generated actionable knowledge from three perspectives: (1) patient and carer journey mapping to trace lived experience and pathways to diagnosis; (2) clinician process mapping, semi-structured interviews, sketching tasks and workshops; and (3) usability testing of the 4MT prototype with GPs, followed by iterative adaptation. Data were transcribed, coded and analysed thematically to surface barriers, enablers and points of fit. Findings show dementia detection as an emergent, distributed process shaped by community actors, relational advocacy and constraints including short appointment times and variable access to memory services. Clinicians described diagnostic practice as multiple strands with brief cognitive tests, functional assessments, collateral histories and clinical judgement, rather than relying on any single instrument. Existing typically paper-based assessment tools (e.g. MMSE, MoCA) were perceived as limited in sensitivity, time demanding or culturally narrow. Testing the 4MT with GPs revealed cautious optimism: its design was seen as promising, but practical concerns required modification. In response, the prototype was adapted, producing a clinician-endorsed version ready for patient use. This thesis contributes empirically by documenting distributed detection practices, practically by producing clinician-informed adaptations and implementation recommendations, and methodologically by demonstrating a systems approach to digital health implementation. It concludes that applying a systems approach can support practical integration of tools like the 4MT in Scottish primary care, with outputs grounded in frontline workflows and informing future patient testing and evaluations.

Advisor / supervisor