Developing the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia program

Sara Moukarzel; Zvinka Z Zlatar; Sheri J Hartman; Derek Lomas; Howard H Feldman; Sarah J Banks; HALT‐AD Study Group

doi:10.1002/trc2.12457

Developing the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia program

Alzheimers Dement (N Y). 2024 Mar 3;10(1):e12457. doi: 10.1002/trc2.12457. eCollection 2024 Jan-Mar.

Authors

Sara Moukarzel^{1

2}, Zvinka Z Zlatar³, Sheri J Hartman⁴, Derek Lomas⁵, Howard H Feldman^{1

2}, Sarah J Banks^{1

3}; HALT‐AD Study Group

Affiliations

¹ Department of Neurosciences University of California San Diego San Diego California USA.
² Alzheimer's Disease Cooperative Study University of California San Diego San Diego California USA.
³ Department of Psychiatry University of California San Diego San Diego California USA.
⁴ Herbert Wertheim School of Public Health University of California San Diego San Diego California USA.
⁵ Faculty of Industrial Design Engineering University of Delft Delft The Netherlands.

Abstract

Introduction: 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.

Methods: We established a multidisciplinary team to develop the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia (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.

Results: 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.

Discussion: 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.

Keywords: LatinX; behavior change; dementia; digital learning; education; health equity; modifiable risk factors; online program; risk reduction; social cognitive theory.