| BackgroundThe aging population in China is faced with a severe challenge of dementia.Prompt helpseeking in people with subjective cognitive decline(SCD)is beneficial to early diagnosis and intervention of cognitive disorders.According to the theory of planned behavior,SCD group’s help-seeking behavior was predicted by their intention to seek help,while such decision-making process may be affected by a complex combination of psychosocial factors.Therefore,it is necessary to explore the mechanisms underlying the formation of help-seeking intention in the SCD population,especially the role of various belief structure components.Based on this exploration,a strategy to increase the SCD group’ s willingness for help-seeking could be expected,through which early diagnosis and early intervention for dementia could be effectively promoted.ObjectivesThe aims of this study were to explore the formation of help-seeking intention mechanism and construct a framework of intervention strategies to increase SCD groups’ willingness to seek help,MethodsThe study was implemented in three stages.In the first stage,a help-seeking intention questionnaire based on the theory of planned behavior was developed and validated.In order to elicit salient beliefs and construct a help-seeking behavior intention questionnaire,semi-structured interviews of 16 community SCD individuals were conducted to understand the attitudes and beliefs related to help-seeking.A questionnaire survey was carried out among 127 individuals with SCD in a community health center in Beijing to verify the reliability and validity of the instrument.A hypothetical mechanism model for the formation of help-seeking intention of people with SCD was proposed based on a systematic literature review in the following stage.The theoretical mechanism model was validated by investigating the help-seeking intention and its associated factors in 248 middle-aged and older adults aged 50 years or older with SCD complaints,applying structural equation modeling in terms of direct and indirect measures.Based on the above conclusions,in the third stage,a preliminary draft of intervention strategies to stimulate help-seeking intention in the SCD population was proposed in combination with literature research.The preliminary version of the intervention strategies was evaluated by twelve experts.After two rounds of expert consultation,the intervention strategies to stimulate the help-seeking intention of the SCD population was finally formed.Results1.The reliability and validity of the developed help-seeking behavioral intention questionnaire was acceptableThe questionnaire of help-seeking behavior intention included the help-seeking intention subscale,the help-seeking attitude subscale,the help-seeking subjective norm subscale,and the help-seeking behavior perceived control subscale,with a total of 35 items.The correlation coefficients of the questionnaire items and the total scores of the corresponding subscales were all greater than 0.30.The Cronbach’s a of each scale ranged from 0.57 to 0.96,and the retest reliability ranged from 0.73 to 0.88.The item-level content validity index were more than 0.83.The scale-level content validity index/universal agreement for each subscale ranged from 0.67 to 0.81,and scale-level content validity index/average agreement ranged from 0.92 to 0.97.The help-seeking attitude subscale,the help-seeking subjective norms subscale,and the help-seeking behavior control subscale included a direct measure component and an indirect measure component,with correlation coefficients of 0.75,0.30,and 0.55 between the two components,respectively.Exploratory factor analysis was conducted on the direct measure items of the helpseeking attitude subscale,the help-seeking subjective norm subscale,and the help-seeking behavior perceived control subscale as a whole,and three common factors were extracted,with a cumulative variance contribution of 61.96%.There was no cross-loading of items except for item 2 in the perceived control of help-seeking behavior subscale,which suggested loading on both the attitude factor and the perceived control of behavior factor.2.The formation mechanism of help-seeking intention was confirmed through a crosssectional studyThe score of intention to seek help of 248 participants was 4.74±1.67,with statistically significant differences among study participants with different levels of education,social activity participation,and number of chronic diseases(t=0.235,P=0.013;t=2.010,P=0.046;F=3.762,P=0.025).Individual characteristics(age,participation in social activities,literacy)had indirect effect on help-seeking intentions by influencing one’s overall cognitive functioning status and through help-seeking attitudes and perceived behavior control(β=-0.036;β=0.065;β=0.024).The cognitive functioning status had indirect positive effect on help-seeking intention(β=0.218).Help-seeking attitudes(β=0.875)and perceived control(β=0.114)were significantly associated with help-seeking intentions(R2=93.6%).Help-seeking subjective norms did not predict help-seeking intention in the direct measure model.In the indirect measure model,the most significant coefficient of effect was on attitudes toward help-seeking intention(β=0.786),followed by control belief(β=0.115),while the path coefficient of the effect of normative beliefs was the smallest(β=0.093).The whole model offered an explanation for the 81.6%variance in help-seeking intention.3.The intervention strategy for increasing the willingness to seek help among people with SCD was finalizedIt was included four modules and twenlf themes,including problem perception,elimination of misconceptions,positive confrontation,and planning for the futureConclusionThe intention to seek help is slightly positive in the SCD population.The hypothetical framework of the formation mechanism of help-seeking intention constructed based on the theory of planned behavior was veriflied.Attitude toward help-seeking plays a significant role in the intention to seek professional help among the SCD group,followed by the perceived control of behavior and the presence of descriptive norms in the subjective norms.The help-seeking attitude could be taken as an essential target for intervention programs that aim to stimulate help-seeking intention of the SCD population in China.The intervention could be implemented in a variety of forms,based on the characteristics of different decision-making stages and people’s diverse need.The help-seeking intention questionnaire designed based on the theory of planned behavior could be used to investigate the help-seeking intention of the SCD population in China. |
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