JMIR Publications

ABSTRACT

Background:

As the global prevalence of dementia continues to rise, multi-domain lifestyle interventions that address modifiable risk factors associated with pathological cognitive decline are expanding. While some digital options have been developed to increase the reach and scalability of these programs, due to cultural differences, the efficacy of programs in one population cannot easily be generalized to populations in other countries.

Objective:

The purpose of this investigation was to examine the usability and engagement of a digitally delivered multi-domain cognitive lifestyle intervention developed in the US for a Japanese population.

Methods:

This feasibility investigation utilized a quasi-experimental, single-arm, non-randomized, longitudinal design where participants engaged in the behavioral intervention on a smartphone. Of the 559 participants that initially enrolled (age = 51 ± 7.5 years, 51% female), 242 completed the final testing trial. Participants enrolled in a multidomain lifestyle program consisting of: (a) psychoeducational material, (b) physical activity tracker, (c) nutrition tracker, (d) audio-based meditations, and (e) health coaching. Engagement with the program was assessed through total number of app sessions as well as the use of the exercise, diet, and meditation tracking features within the app. The total number of minutes exercised was collected through subjective user inputs and nutrition was quantified by the MIND diet adherence score.

Results:

Significant relationships (all p < 0.05) existed between overall nutrition score and frequency of nutrition tracking (r = 0.18), frequency of physical activity tracking (r = 0.19), and the total number of minutes exercised (r = 0.22). Total minutes exercised was significantly correlated with total app sessions (r = 0.57), frequency of physical activity tracking (p < 0.001, r = 0.85), frequency of nutrition tracking (r = 0.64), number of times participants meditated (r = 0.46), and total lessons read (r = 0.36). The number of completed lessons was significantly related to frequency of physical activity tracking (r = 0.40), frequency of nutrition tracking (r = 0.43), the total number of times participants meditated (r = 0.35), and total minutes exercised (r = 0.33). Dividing the cohort into two groups based on lesson completion (< 10 lessons completed vs ≥ 10 lessons completed), significant differences were observed between total minutes exercised, frequency of physical activity tracking, frequency of nutrition tracking, and the total number of times participants meditated (all p < 0.001).

Conclusions:

Overall, this cross-cultural feasibility study in Japanese users demonstrated that the various engagement metrics were significantly correlated, and greater engagement was related to improved nutrition scores and increased time exercising. Additionally, the relationships between lesson completion and other engagement metrics suggests there may be value in exploring mechanisms that enhance lesson completion. Future research should examine the program in randomized control trials to more rigorously evaluate program efficacy. Clinical Trial: N/A. As this was a retrospective analysis, there was no trial registration for this manuscript. This is similar to the work published in JMIR mHealth uHealth by Neriah & Geliebter (2019). Weight Loss Following Use of a Smartphone Food Photo Feature: Retrospective Cohort Study.