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

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.

Duke Scholars

Author Bei Wu School of Nursing