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Prevention of Dementia using Mobile phone Applications

Periodic Reporting for period 1 - PRODEMOS (Prevention of Dementia using Mobile phone Applications)

Reporting period: 2018-01-01 to 2019-06-30

We have previously shown that dementia may be prevented through risk factor modification, and that people who are at risk of dementia are willing and able to use an internet intervention to reduce their risk of cognitive decline and dementia. In PRODEMOS we will further investigate how to adapt, implement and upscale self-management of risk factors to prevent dementia and particularly how to make prevention of dementia accessible on a global scale using mobile Health. To reach this aim we will build on the existing Healthy Ageing Through Internet Counselling in the Elderly (HATICE) intervention which is based on self-management of dementia risk factors such as hypertension, high cholesterol, diabetes mellitus, unhealthy diet, smoking and physical inactivity using an interactive Internet approach. Using an implementation study design in the EU and China we will assess acceptability, feasibility, adoption, costs, sustainability and effectiveness of delivery of this dementia prevention strategy via mobile health.

The specific objectives of PRODEMOS are:
1. To prepare for large-scale implementation of a dementia prevention program using mHealth, by investigating current evidence and existing best practices with respect to prevention of dementia and the use of mHealth in preventive health care;
2. To explore attitudes towards self-management of risk factors for the prevention of dementia and identify cultural, socio-economical and educational barriers and facilitators to engage in mHealth prevention strategies in people with low socio-economic statis (SES) in high-income countries (UK) and populations in middle-income countries (China);
3. To close equity gaps and overcome inequalities in access to preventive mental health care between the EU and LMIC as well as between populations within EU countries by adapting an mHealth approach specifically to reach underserved populations including those with low SES;
4. To deliver a culturally appropriate mHealth platform based on a previously developed eHealth platform for self-management of dementia risk factors;
5. To perform a large-scale randomised controlled implementation trial on an mHealth platform for dementia prevention and evaluate the acceptability, appropriateness, feasibility, adoption, sustainability and costs along with its effectiveness on dementia risk reduction;
6. To pave the way for translation and broad implementation of dementia prevention using mHealth in future policy and practice by involving the target population and other stakeholders early in the process of socio-cultural adaptation of the mHealth platform.
To reach the objectives of PRODEMOS:

1. We have carried out a review on the effectiveness of mHealth interventions on reducing dementia risk
2. We have performed 40 qualitative interviews in China (14), UK (8) and the Netherlands (18) to assess these barriers and facilitators within our target population. Transcripts are currently being analysed.
We have performed 4 focus groups within the target population and an additional 15 focus groups and consultations with other stakeholders.
3. We are performing interviews with these populations and are adapting the platform accordingly. For instance with as little text as possible and if necessary short sentences and short bits of text.
4. We are using the experiences of the previously developed HATICE eHealth platform and the information collected in the review (objective 1) and the interviews and focusgroups (objective 2) in the development of the mHealth app.
5. We are currently preparing the trial by developing protocols, ethics applications, CRFs, and identifying partners and personnel for logistics, recruitment and measurement.
Sussex area:
- We are liaising closely with local Clinical Research Networks in the UK, in order to identify and recruit sites, and determine feasibility of the trial through the running of a small-scale pilot.
- We are operationalising the trial protocols for a pilot in the Brighton area, with 2 research active healthcare facilities, in order to test out and refine all staff training, protocols, and procedures we will be using for the main trial.
Cambridge area:
- Identification of GP practices within low SES areas has begun. Once finalised contact will be made with lead GPs to recruit them to the study.
- Conversations around logistical challenges with recruitment and screening of patients have taken place with the CRN who are liaising closely with UCAM . These conversations feed directly into the final protocol.
- Health coaches for the UCAM centre have been identified and training arranged for October 2019
Greater Beijing area:
- The English coach protocol-Version 1 document composed by AMC has been translated into Chinese for adaptation by CMU.
- CMU and 1 trial centre in China have obtained ethical approval. It is expected that all the other centres in China will have ethical approval for the pilot by August.
- Recruitment advertisement for the trial in China has been designed by CMU and distributed among the trial centres in China.
- BNI (1 trial centre in China) organised several meeting on the protocol and personnel for logistics and recruitment in China.
6. We have involved the target population and other stakeholders in the adaptation of the mHealth platform by means of interviews and focus groups.

(last update: 23-08-2019)
Where most innovative interventions target highly educated early adapters, PRODEMOS will target those populations who are generally not reached and who are rarely included in research projects. We will adapt the previously developed HATICE intervention to specifically suit these target populations most in need and who are not often reached by preventative initiatives. The iterative process involving assessment of barriers and facilitators using in-depth interviews in combination with assessment of user experience and acceptability assessment with the mHealth platform will lead to a highly tailored intervention with high likelihood of adoption.

We will have three levels of assessment of success. First we will evaluate the implementation success by focusing specifically on acceptability, adoption and feasibility in the target population. Secondly we will assess efficacy and sustainability of the intervention in the longer-term. This will include the effect on dementia risk and sustainability of our mHealth intervention to prevent dementia. Thirdly we will perform a health-economic evaluation from a societal perspective. A modest reduction of dementia risk at the individual level, can still lead to major impact at the population level due to the high prevalence of dementia risk factors (prevention paradox). This public health perspective is crucial when evaluating the potential success of large-scale implementation of our dementia prevention strategy.

PRODEMOS will make an evidence-based dementia prevention strategy using mobile Health technology accessible to those at increased risk of dementia who are currently not reached by preventive health care. Broad implementation of this strategy now can reduce the global dementia burden for the coming decades.
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