{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:37Z","timestamp":1788415957378,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Doll therapy is a person-centered intervention for behavioral and psychological symptoms of dementia, but evidence from Chinese nursing homes and information about implementation, medication use, and ethical acceptability remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an exploratory pilot and feasibility mixed-methods cluster-randomized clinical trial in six nursing homes in Zhengzhou, China. Homes were randomized 1:1 to a staff-mediated doll-therapy care package plus routine care or routine care alone. Residents with dementia were assessed at baseline, 6\u202fweeks, and 12\u202fweeks. Registered primary outcomes were class-specific standardized daily psychotropic doses; NPI-12 was the main proximal clinical outcome. Feasibility, fidelity, safety, and interviews with intervention-home staff and family caregivers were also evaluated. Marginal models used nursing home as the top-level cluster and the Mancl-DeRouen small-sample variance correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 185 residents screened, 142 were enrolled, and 130 (91.5%) completed 12-week follow-up. Sixty-eight of 71 intervention participants (95.8%) attended at least 6 of 8 sessions; mean fidelity was 94.1%. The intervention-control difference in NPI-12 change was \u22123.61 points at 6\u202fweeks (95% confidence interval [CI], \u22125.86 to \u22121.36) and \u22124.40 at 12\u202fweeks (95% CI, \u22126.50 to \u22122.30). The Barthel difference was 3.96 points at 6\u202fweeks (95% CI, 1.06 to 6.86) and 3.07 at 12\u202fweeks (95% CI, \u22122.33 to 8.47). All medication-dose intervals showed no difference. Six possible or probable related events were mild or moderate; no serious event was related. Interviews with 15 staff and 9 family caregivers indicated engagement for some residents, absent or adverse responses for others, and the importance of training, non-deceptive introductions, prompt respect for refusal, and operational ownership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The care package was feasible and produced a preliminary behavioral signal, but medication effects were imprecise, and functional improvement was not sustained. A larger cluster trial with an attention-control condition is required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>ClinicalTrials.gov<\/jats:uri>\n                      , NCT06506487;\n                      <jats:ext-link>https:\/\/clinicaltrials.gov\/study\/NCT06506487<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1935007","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:15:03Z","timestamp":1788412503000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Staff-mediated doll therapy in Chinese residential dementia care: an exploratory pilot and feasibility mixed-methods cluster randomized clinical trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhenti","family":"Cui","sequence":"first","affiliation":[{"name":"School of Medicine, Sias University","place":["Zhengzhou, Henan, China"]},{"name":"Department of Social and Preventive Medicine, Universiti Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongrong","family":"Guan","sequence":"additional","affiliation":[{"name":"School of Art and Design, Zhengzhou University of Industrial Technology","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianrui","family":"Xue","sequence":"additional","affiliation":[{"name":"School of Medicine, Sias University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongchang","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Medicine, Sias University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maw Pin","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mas Ayu","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Universiti Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingdong","family":"Cao","sequence":"additional","affiliation":[{"name":"School of Medicine, Sias University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.jalz.2012.11.007","article-title":"The global prevalence of 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