Health changes from trans-theoretical model-based education in older adults with mild cognitive impairment: A...

Low awareness and misconceptions surrounding mild cognitive impairment highlight the urgent need for effective health education. Reluctance to seek intervention and poor adherence to management strategies make behavior-oriented health education essential.

To assess the effectiveness and clinical significance of a trans-theoretical model-based health education program on cognitive-behavioral outcomes in older adults with mild cognitive impairment.

A two-arm and assessor-blinded randomized controlled trial.

100 community-dwelling older adults with mild cognitive impairment in Huzhou, China.

Participants were randomly assigned to a trans-theoretical model-based health education program (weekly 45-60 min sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or a wait-list control group receiving standard health education. Disease knowledge, behavioral stage, and adherence to health management behaviors were assessed at baseline, 8-week, and 20-week. Effects were evaluated at the group level via generalized estimating equation and at the individual level using reliable and clinically significant change.

The trans-theoretical model-based health education program demonstrated significant effects over the wait-listed control. Generalized estimating equation analyses showed statistically significant effects on behavioral stage (β_8-week = 1.04, 95%CI = 0.34-1.75; β_20-week = 1.72, 95%CI = 0.95-2.49), disease knowledge (β_8-week = 1.14, 95%CI = 0.26-2.02; β_20-week = 1.78, 95%CI = 0.87-2.69), and adherence to health management behaviors (β_8-week = 6.20, 95%CI = 2.03-10.37; β_20-week = 10.74, 95%CI = 6.47-15.01) at both measured intervals. Additionally, global cognitive function (β_8-week = 0.60, 95%CI = - 0.18-1.38; β_20-week = 2.42, 95%CI = 1.64-3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β_8-week = 0.16/0.38, 95%CI = - 0.21-0.53/-0.18-0.94; β_20-week = 0.96/1.80, 95%CI = 0.57-1.35/1.17-2.43) improved significantly over time. Reliable and clinically significant change analyses at 8 weeks indicated significant improvements in the intervention group: 57 % of participants improved in disease knowledge (22 % clinically significant), 90 % in adherence to health management behaviors (17 % clinically significant), and 61 % in global cognitive function (10 % clinically significant). By 20 weeks, these rates increased to 63 % (29 %), 100 % (25 %), and 78 % (27 %). However, non-significant improvements in depression symptoms and sleep quality were found at individual-level assessment.

This study shows that the trans-theoretical model-based health education program effectively enhances cognitive-behavioral health outcomes in older adults with mild cognitive impairment, with benefits persisting for 12 weeks. Future research should further explore the potential mechanisms underlying the cognition and behavior-enhancing effects of this program.

ChiCTR1900028351.