Exploring Older Adults’ Pre-Intervention Motivations, Attitudes, Expectations, and Barriers to Participation in the FINGER-NL Lifestyle Intervention to Maintain Optimal Cognitive Functioning: A Qualitative Interview Study

Multidomain lifestyle interventions hold promise for preventing cognitive decline, but personalized approaches are essential for (maintaining) behaviour change and adherence. The Dutch FINGER-NL trial is based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and includes 7 lifestyle intervention components, supported by technological elements. This study describes older adults' motivations and attitudes regarding participation and lifestyle changes at the start of the FINGER-NL trial. This study followed a qualitative descriptive design, using in-depth, semi-structured interviews with 40 purposively selected participants of the FINGER-NL trial. Thematic analysis was applied. For theme (1) 'Reasons to participate', most participants mentioned personal gain, aiming to improve cognitive and physical health. Dementia prevention was a key motivator, driven by concerns about ageing, cognitive decline, and a desire for behavioural change. Public interest and contributing to a broader societal solution were also mentioned. Knowledge about dementia (prevention) was limited, and perceptions were largely shaped by personal experiences of dementia with close ones. In theme (2) 'Contextual factors influencing participation' are discussed, including work, living situation, and health conditions. According to participants, the main 'Lifestyle-related areas for improvement', theme (3), were diet and physical activity, followed to a lesser extent by cognition, sleep, social activities, and stress management. Theme (4) 'Expectations regarding FINGER-NL' discussed barriers to change which included physical health of participants, time constraints, established habits, and financial limitations. Participants emphasized the need for counselling, coaching in diet and exercise, experiencing positive effects of lifestyle change, participation in group setting and practical aspects, such as appointment reminders to support their commitment and adherence to the study. Participants held different experiences and opinions regarding 'Use of technology', theme (5). Personal experiences with dementia strongly influenced the motivation to participate in FINGER-NL, creating urgency for behaviour change. Participants expressed the wish to receive tailored interventions addressing individual needs and circumstances. Longitudinal follow-up within FINGER-NL promises valuable insights for future interventions.