Developing a Mobile App-Based Intervention to Promote Cognitive Health in Older Chinese Americans

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ABSTRACT Older Chinese Americans are one of the fastest growing populations in the United States, who face many social and economic barriers. Over 70% of older Chinese Americans are first generation immigrants, nearly 20% are living below the poverty line (9% in general US older adults), and close to half of them have limited English proficiency. These socioeconomic disadvantages shared by older Chinese Americans will not only contribute to an increased risk of developing Alzheimer's disease and related dementias (ADRD), but also inequitable access to effective strategies to promote cognitive health. Cognitive training is one of the few interventions shown to be beneficial to the maintenance or enhancement of cognitive function in older adults with normal cognition or mild cognitive impairment. The widespread use of mobile phones offers an unprecedented opportunity to deliver cognitive training interventions remotely to a large population at relatively low cost. This is particularly relevant to the immigrant populations as they often reside in ethnic enclaves and rely heavily on smartphones and apps to build social networks and to access local services. Despite the promise of mobile app-based cognitive training, most prior interventions were tested exclusively in non-Hispanic Whites. Currently, no tailored cognitive training program exists that can accommodate the unique immigration history, cultural values, and linguistic properties of older Chinese Americans. To address this gap, we aim to develop a mHealth intervention for cognitive training that is culturally and linguistically relevant to older Chinese Americans. We will leverage our strong partnership with a local Chinese community organization, industry partner, and interdisciplinary expertise in cognitive aging, ethnogeriatrics, implementation science, and experience-based codesign. More specifically, the proposed aims are: Aim 1: To adapt empirically supported cognitive training components into a culturally and linguistically relevant cognitive training intervention protocol. Aim 2: To conduct a pilot randomized controlled trial of the proposed cognitive training intervention to evaluate the feasibility, acceptability, and obtain preliminary effect sizes on outcomes including global cognition (primary), mental health, physical functioning, and quality of life. This study will provide the scientific groundwork for a multi-site large scale randomized control trial to test the real-world efficacy of this cognitive training intervention. In addition, this project will further our knowledge of methods to support engagement of ethnic minority communities in clinical research studies. Taken together, these efforts are expected to ultimately facilitate the implementation of effective, sustainable, and scalable mHealth interventions to promoting cognitive aging specifically suited for ethnic minority older adults.