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Community Readiness Model Applied in Older Adults for the Promotion of Digital Cognitive Training: Mixed Methods
Cíntia Monteiro Carvalho1,2, Bruno Costa Poltronieri1,2,3, Beatriz Pereira da Silva Lima1
1Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Background:
Digital cognitive training, which involves structured, digital exercises designed to enhance cognitive functions, has shown potential benefits for older adults. While digital cognitive training has shown potential benefits for older adults, successfully incorporating it into their daily routines remains a challenge. Community readiness refers to the group's ability and capacity for a behavior change to be more effective and sustainable. In this study, readiness specifically refers to the community's preparedness to engage in and sustain digital cognitive training.
Objective:
This study aimed to evaluate the feasibility of the Community Readiness Model (CRM) to identify facilitators and barriers in implementing training and applying supportive strategies to increase readiness.
Methods:
This mixed methods feasibility study was conducted as part of a stepped-wedge randomized controlled trial examining the effects of digital cognitive training on functionality and cognition in older adults. Fifty-six participants were recruited from a nursing home and the community and were allocated to one of two training protocols: one group played digital leisure games for 10 hours followed by 10 hours of digital cognitive training, while the other group completed 20 hours of digital cognitive training. Readiness levels were assessed using CRM through semistructured individual interviews conducted before the intervention. Additionally, the CRM was administered to a sample of stakeholders to evaluate community-level readiness. Following the implementation of strategies aimed at enhancing readiness, as well as the delivery of the digital cognitive training, the interviews were readministered to evaluate changes in readiness levels.
Results:
Before the training, participants demonstrated low levels of readiness, with a median CRM total score of 3.6 (IQR 2.2-4.6) in the 10-hour training group and 3.7 (IQR 2.7-4.3) in the 20-hour group. To address this, several strategies were implemented: dissemination of psychoeducational content via social media, distribution of cognitive exercise guides, stakeholder engagement to raise project awareness, and provision of necessary devices along with comprehensive support throughout the training. Following the implementation of these strategies and the training sessions, a significant increase in readiness was observed. Both groups achieved a median CRM total score of 6 (IQR 5-7). Participants identified key facilitators as interest in the training, noticeable cognitive improvements, team support, motivation to continue, the challenge presented by the training, and overall satisfaction. The primary barrier reported was difficulty using the technology.
Conclusions:
The CRM demonstrates strong feasibility as a tool for identifying facilitators and barriers that can inform strategies to enhance readiness for digital cognitive training in older adults. The observed increase in readiness scores following the implementation of targeted strategies highlights the CRM's potential to guide the development of effective, supportive interventions. These findings emphasize the importance of addressing technological challenges while harnessing motivating factors to promote the successful adoption of digital cognitive training within this population.
