# Implementation of a coach-supported mHealth intervention for dementia prevention in China: a qualitative study among Chinese participants and coaches in the PRODEMOS trial

## TL;DR

A mobile health app with remote coaching was tested in China to help prevent dementia by promoting lifestyle changes, and it was found to be acceptable and feasible for users.

## Contribution

This is the first qualitative study of the PRODEMOS mHealth intervention in China, highlighting its implementation and acceptability for dementia prevention.

## Key findings

- Participants found the PRODEMOS app easy to use and remote coaching convenient, though communication delays were noted.
- Feasibility depended on factors like smartphone literacy, daily routine integration, and coach-participant relationships.
- Positive feedback suggests potential for large-scale implementation if coaching and engagement challenges are addressed.

## Abstract

Modifiable risk factors have been linked to 45% of dementia cases. Mobile health (mHealth) interventions targeting lifestyle-related risk factors with remote coaching have the potential to reach underserved high-risk populations globally. To date, little is known about the implementation of such interventions in China.

Fifty semi-structured interviews were conducted with 14 participants and 11 health coaches involved in the PRODEMOS trial. This trial investigated whether a coach-supported mHealth application intervention can reduce dementia risk in people aged 55–75 years with multiple risk factors. Interviews were conducted three months and 12–18 months into the intervention, focusing on implementation outcomes among Chinese participants using thematic analysis.

Participants found the PRODEMOS app easy to use and remote coaching convenient, although coach responses were sometimes perceived as slow due to not logging into the mHealth platform simultaneously, thus delaying text chat communication. The intervention's appropriateness was shaped by its effectiveness in enhancing health awareness and meeting participants’ needs. Feasibility depended on integration into daily routines, participant progress, partner support, coach attention, smartphone literacy, and time availability. Challenges for the coaches included remote motivational interviewing and sustained participant-coach engagement, influenced by participant-coach relationships, social environment, and the COVID-19 pandemic. Participants generally adhered to goals, but fidelity varied. Integration into primary care was endorsed.

This first qualitative study of the Chinese arm of the PRODEMOS intervention demonstrates that it is an acceptable and implementable approach for promoting lifestyle changes in individuals at increased risk of dementia. While coaching is crucial for sustained engagement, it presents challenges when delivered remotely. Despite significant variability in participants' adherence, positive feedback underscores its potential for integration into primary care and large-scale implementation, provided issues with coaching and engagement are addressed. These findings offer valuable insights for practitioners and policymakers seeking to incorporate mHealth solutions into public health strategies for dementia prevention.

PRODEMOS: ISRCTN15986016.