Moukarzel Sara, Zlatar Zvinka Z, Hartman Sheri J, Lomas Derek, Feldman Howard H, Banks Sarah J
Department of Neurosciences University of California San Diego San Diego California USA.
Alzheimer's Disease Cooperative Study University of California San Diego San Diego California USA.
Alzheimers Dement (N Y). 2024 Mar 3;10(1):e12457. doi: 10.1002/trc2.12457. eCollection 2024 Jan-Mar.
With Alzheimer's disease and related dementias (ADRD) representing an enormous public health challenge, there is a need to support individuals in learning about and addressing their modifiable risk factors (e.g., diet, sleep, and physical activity) to prevent or delay dementia onset. However, there is limited availability for evidence-informed tools that deliver both quality education and support for positive behavior change such as by increasing self-efficacy and personalizing goal setting. Tools that address the needs of Latino/a, at higher risk for ADRD, are even more scarce.
We established a multidisciplinary team to develop the Healthy Actions and Lifestyles to Avoid Dementia (HALT-AD) program, a bilingual online personalized platform to educate and motivate participants to modify their risk factors for dementia. Grounded in social cognitive theory and following a cultural adaptation framework with guidance from a community advisory board, we developed HALT-AD iteratively through several cycles of rapid prototype development, user-centered evaluation through pilot testing and community feedback, and refinement.
Using this iterative approach allowed for more than 100 improvements in the content, features, and design of HALT-AD to improve the program's usability and alignment with the interests and educational/behavior change support needs of its target audience. Illustrative examples of how pilot data and community feedback informed improvements are provided.
Developing HALT-AD iteratively required learning through trial and error and flexibility in workflows, contrary to traditional program development methods that rely on rigid, pre-set requirements. In addition to efficacy trials, studies are needed to identify mechanisms for effective behavior change, which might be culturally specific. Flexible and personalized educational offerings are likely to be important in modifying risk trajectories in ADRD.
阿尔茨海默病及相关痴呆症（ADRD）构成了巨大的公共卫生挑战，因此需要帮助个人了解并应对其可改变的风险因素（如饮食、睡眠和身体活动），以预防或延缓痴呆症的发作。然而，能够提供高质量教育并支持积极行为改变（如增强自我效能感和个性化目标设定）的循证工具非常有限。针对ADRD风险较高的拉丁裔人群需求的工具则更为稀缺。
我们组建了一个多学科团队来开发“避免痴呆的健康行动与生活方式”（HALT-AD）项目，这是一个双语在线个性化平台，旨在教育和激励参与者改变其痴呆症风险因素。基于社会认知理论，并在社区咨询委员会的指导下遵循文化适应框架，我们通过快速原型开发、试点测试和社区反馈进行以用户为中心的评估以及完善等几个循环，迭代开发了HALT-AD。
使用这种迭代方法对HALT-AD的内容、功能和设计进行了100多项改进，以提高该项目的可用性，并使其与目标受众的兴趣以及教育/行为改变支持需求相契合。文中提供了试点数据和社区反馈如何为改进提供依据的示例。
与依赖严格预设要求的传统项目开发方法不同，迭代开发HALT-AD需要通过试错学习并具备工作流程的灵活性。除了疗效试验外，还需要开展研究以确定有效行为改变的机制，这些机制可能具有文化特异性。灵活且个性化的教育服务对于改变ADRD的风险轨迹可能很重要。
