Development of a Personalized Intervention to Motivate Health Behavior Change in Midlife Adults at Risk for Alzheimer's Disease

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PROJECT ABSTRACT Modifiable risk factors such as physical activity, healthy diet, stress reduction, and cognitive stimulation are associated with lower risk of Alzheimer’s disease (AD) and related dementias. Population-level engagement in positive health behaviors in midlife and early late life is low, and large, multi-domain prevention trials have reported a positive impact of lifestyle modification on risk for cognitive decline. However, adherence to trial protocols is poor despite intensive individualized coaching, raising concern about generalizability and the ability to motivate sustained behavior change. The objective of this Stage I intervention development project is to use the science of behavior change to develop a theoretically grounded, personalized health education intervention that will motivate sustained health behavior change to prevent or delay the onset of Alzheimer’s disease (AD). The intervention will be grounded in the Health Belief Model, a widely-used conceptual framework that posits that health beliefs including perceived threat of disease, perceived benefits and barriers, and self-efficacy (belief in one’s ability to change) are mediators of behavior change. The proposed project will enhance our existing 12-session basic healthy living education program to include evidence-based assessment of health belief factors and personalized education about the role these factors play in motivating and sustaining behavior change. We will use qualitative methods to develop an explanatory method for communicating personal health beliefs (Aim 1) and conduct a randomized controlled pilot trial to assess feasibility and the effect of the enhanced intervention versus basic health education alone on proximal outcomes including AD risk perception, self-efficacy, and AD risk knowledge (Aim 2). Results will motivate future efficacy studies investigating the impact of the enhanced healthy living education intervention on distal outcomes, including engagement in positive health behaviors, lower AD risk, and prevention of cognitive decline.