Developing Midlife Metacognitive Strategy Training (M-MCST) program: A feasibility study with middle-aged adults to evaluate the design, implementation, and impact of a novel program in fostering healthy cognitive aging

Background Metacognitive skills mediate the role of cognitive reserves in aging and facilitate effective cognitive abilities. Metacognitive deficits may precede cognitive impairments, making it important to optimize metacognition as early as middle adulthood to promote cognitive communicative well-being. Thus, the present study aimed to develop and evaluate the feasibility of a novel metacognitive strategy training (MCST) program with neurotypical middle-aged adults (MAAs). Method This study aligns with the initial stage of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development. A modified nominal group technique was employed, involving a panel of five healthcare professionals to draft the strategy and execution-related aspects of the M-MCST. The feasibility of the developed protocol was then tested with twenty neurotypical middle-aged adults (MAAs) (Experimental group (EG)- 10; Control group (CG)- 10), on parameters such as recruitment, retention, adherence, changes in their cognitive performance, absolute self-estimation, and self-perception of performance using the Contextual Memory Test (CMT). Additionally, the EG participants provided reflections on the program's design, implementation, and impact to gauge participant acceptability of intervention. Results The MCST comprises seven sessions incorporating the adapted ‘stop-think-plan-do-check’ metacognitive strategy, client-centered personalized goal selection, and a daily diary method for tracking progress. Feasibility testing revealed 100% recruitment, retention, and protocol adherence along with significant improvements in CMT performance, absolute self-estimation discrepancy, and self-perception of performance among trained MAAs. The participants found the design and implementation aspects of the training program to be promising. Conclusion The MCST program guides healthcare professionals in the use of metacognitive strategy training with neurotypical adults, embedding it within everyday tasks. It incorporates mechanisms for monitoring strategy use, error awareness, and self-reflection through daily diaries. The findings demonstrate that the program is feasible and acceptable to MAAs and shows potential benefits for improving performance on the CMT and related metacognitive functioning. These findings support further evaluation of the program in large-scale efficacy trials and future investigations examining its potential contribution to broader constructs, such as cognitive reserve and healthy cognitive aging.