| 118 At times having multiple pages in the participant handouts posed both physical and cognitive challenges for participants. However, with researcher support, it was possible to re-orientate those who lost their place. Interviewer: ‘You may go to the last page.’ Participant: ‘Huh, huh am I getting nervous.’ Interviewer: ‘Well, there’s no need for that…Uhm you may turn to page uh 5 for now.’ Participant: [Browses to page 5] ‘Aah they are stuck together.’ The Netherlands, Participant 5 Participant: ‘Now even you ask me the questions…my weakness is sometimes I go off on a tangent and forget what you want me to do.’ Interviewer: ‘Yes. Well...hopefully those pictures there will help us to stay focused on the conversation. And I’ll try and help you to stay on topic. That’s one of my jobs as well.’ Australia, Participant 8 Overall, the photo elicitation techniques used in this study were not always manageable for all participants. Similar to other research (48), we found that the stage of dementia as well as physical co-morbidities (e.g. hearing loss) made discussion of the photos and probing around responses more challenging. Some researchers used supports in the field such as repeating instructions or providing physical assistance with managing the handouts when in face-to-face environments. However, this was more challenging when working in online and telephone environments. Likewise, the length, complexity, and number of instructions in the resources required a level of sustained attention and involvement that was too demanding for some participants. In the Netherlands there was one interview that was relatively short. The participant had just finished an appointment at the memory clinic and explained they were tired. This impacted their ability to extensively answer questions, but they still engaged with the scenario and produced relevant information. The researcher did not want to create additional burden by asking too many indepth questions. Whilst improvements to both the research process and research instruments are possible, it is also likely that the type and nature of some people’s dementia and other physical co-morbidities may limit the usefulness of photo elicitation
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