Socio-ecological barriers to behavior change-oriented dementia prevention: a qualitative study of healthcare professionals' perspectives.

Abstract

Objectives: This qualitative study aimed to: (1) identify socio-ecological barriers to behavior change-oriented dementia (AD/ADRD) prevention from the perspectives of healthcare professionals, and (2) propose strategies to address these barriers during a clinical trial for an AD/ADRD prevention program (My Healthy Brain).

Method: Multidisciplinary healthcare professionals involved in geriatric care (N = 26, M experience > 17 years) from diverse clinics within a medical center participated in focus groups. Using the Socio-Ecological Model (SEM), 5 focus groups were conducted to identify individual, interpersonal, institutional, community, and societal barriers. The Expert Recommendations for Implementing Change (ERIC) framework informed evidence-based strategies to overcome these barriers.

Results: Healthcare professionals identified barriers, including limited resources, language and technological barriers, provider dismissiveness, competing institutional priorities, underrepresentation of minority groups, and biases towards biomedical treatments. Strategies to address these barriers involved enhancing accessibility, increasing provider training and support, integrating interventions within clinic operations, fostering community partnerships, and addressing societal misconceptions and biases.

Conclusion: Integrating SEM and ERIC frameworks yielded strategies that will be used in My Healthy Brain trial to enhance equity and responsiveness to diverse older adults. Our results can inform efforts to address multi-level barriers to AD/ADRD prevention and the larger contexts influencing risk factors.