Pilot study of a mobile phone app and health coach intervention for dementia prevention in socially and economically deprived communities in the UK.

Problem

Dementia is a pressing public health concern and the burden of NHS care for dementia largely falls within primary care. The projected steep rise in global dementia prevalence will largely occur in low and middle-income countries and vulnerable populations in high-income countries. Up to 30% of all dementia is attributable to potentially modifiable risk factors. Innovative strategies are needed to bridge the gap between the theoretical benefits of effective dementia risk factor control and what is in fact achieved in practice. Mobile Health (mHealth) technology allows for scalable and widely implementable prevention programs using self-management for improvement of dementia risk factors such as smoking, diet and physical activity.

Approach

Here, we report a pilot study of a mobile phone application enabling goal-setting and behaviour change, and supported by a health coach. We included 20 participants aged 55-75, who had two CVD risk factors, lived in economically deprived areas in Sussex, and who were recruited through two general practices. We assessed the success of our methods and procedures for: recruiting participants, screening them for eligibility, installing the app on their mobile phones, randomising them, and starting the health coaching both face to face and through the app. Participants were followed up for 8 weeks. Participants were invited to a focus group to give feedback on the app and the study procedures.

Findings

Participants were invited to participate using a mailshot sent out from their GP surgery, only 3% of invited participants responded. A text-message follow-up was effective at reminding potential participants to call the study team. Many participants needed support in installing the app on their phones as well as ongoing technical support throughout the pilot. We identified that robust tracking systems needed to be in place to support participants through the study protocol. GP sites and health coaches needed study specific training and ongoing technical support. Focus groups found that participants are keen to reduce their risk of dementia, and like the concept of doing this through technology.

Consequences

Rolling out mobile phone technologies for dementia prevention in economically deprived and older populations comes with a host of challenges. Following lower than expected recruitment, our participants liked the idea of the app, but we found delivering an m-Health intervention required significant and ongoing technical support and robust resources for participants and staff involved. Although some clinical time could be saved using m-Health interventions, significant time was required from technical staff in order to support both patients and health coaches for the duration of the pilot. Learning from the pilot will inform the roll out of our large randomised controlled trial on the efficacy of the app, which will start later this year.