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

项目摘要 可改变的风险因素，如体力活动，健康饮食，减轻压力和认知刺激， 与阿尔茨海默病（AD）和相关痴呆症的风险较低有关。人口参与 中年和晚年早期的积极健康行为很低，大型多领域预防试验 报告了生活方式改变对认知能力下降风险的积极影响。然而，坚持审判 尽管进行了密集的个性化辅导，但协议仍然很差，这引起了对普遍性和能力的担忧 来激发持续的行为改变。第一阶段干预发展项目的目标是利用 行为改变的科学，以发展有理论基础的个性化健康教育干预 这将促使持续的健康行为改变，以预防或延迟阿尔茨海默病（AD）的发作。 干预将以健康信念模型为基础，这是一个广泛使用的概念框架， 健康信念，包括感知的疾病威胁，感知的利益和障碍，以及自我效能， （相信自己有能力改变）是行为改变的媒介。拟议项目将加强我们的 现有的12节基本健康生活教育计划，包括基于证据的健康评估 信念因素和个性化教育，这些因素在激励和维持中的作用 行为改变我们将使用定性的方法来发展一种解释性的沟通方法 个人健康信念（目标1），并进行随机对照试点试验，以评估可行性和 强化干预与单纯基础健康教育对包括AD在内的近端结局的影响 风险认知、自我效能和AD风险知识（目标2）。结果将激励未来的疗效研究 调查加强健康生活教育干预对远端结局的影响，包括 参与积极的健康行为，降低AD风险，预防认知能力下降。

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.