Implementing cognitive training in primary health care for older adults with MCI: study protocol for a type 3 hybrid effectiveness-implementation cluster-randomized factorial trial

Dementia prevention is an urgent global health priority in aging populations. Mild cognitive impairment (MCI) presents a key window for intervention, where cognitive training can effectively slow progression to dementia. There remains a need for implementation strategies that activate primary healthcare providers (the first point of contact) to deliver such interventions. This study aims to evaluate a multi‑component implementation strategy (enhanced training, financial incentives, and leadership engagement) to promote the delivery of cognitive training for elderly with MCI by family doctor teams in primary care. This study employs a hybrid type 3 effectiveness-implementation cluster-randomized trial. Guided by the Multiphase Optimization Strategy (MOST) framework, a 2 × 2 × 2 factorial design is used to examine the main effects and interactions of three intervention components (enhanced training, financial incentives, and leadership engagement), thereby generating empirical evidence for optimizing the implementation strategy. It will be conducted across 16 community health centers (CHCs) in Beijing, targeting family doctor teams as the primary intervention units. The active intervention will last 6 months, followed by a 6‑month observational follow‑up to assess sustainability. The primary outcome is the initiation of cognitive training delivery by primary healthcare providers (change from non‑delivery to delivery). Secondary outcomes include providers’ self‑efficacy, patients’ cognitive function, beneficiary coverage, and implementation‑related measures. This study will inform the integration of cognitive training into routine primary care, support the design of community-based dementia prevention strategies, and contribute to promoting healthy aging. The findings will provide actionable evidence for policymakers engaged in active dementia prevention and control globally. The study was registered with the Chinese Clinical Trial Registry ChiCTR2600116108. Registered 05 Jan 2026.