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Several modifiable health and lifestyle factors are consistently associated with dementia risk and it is estimated that significantly fewer people would develop dementia if the incidence of risk factors could be reduced. Despite this, Australians’ awareness of the health and lifestyle factors associated with dementia risk is low. Within a national community education campaign, Alzheimer’s Australia developed a dementia risk reduction website providing information about modifiable risk or protective factors for dementia.
This study aimed to assess the usefulness of the website content in improving knowledge and enabling adoption of recommended strategies, and to examine what additional resources consumers need.
Visitors to the website over a 3 month period were invited to complete an online survey, which asked them to rate their knowledge of dementia risk reduction before and after visiting the site, how important monitoring their health related behavior was to them before and after visiting the site, their current behavior related to health and lifestyle factors associated with dementia risk, their intentions to change behavior, and the usefulness of potential additional resources to help them do so.
For this study, 123 Australian adults responded to the survey. 44.7% (55/122) were aged over 60 and 82.1% (98/119) were female. Respondents’ ratings and comments indicated they generally found the content interesting, informative, and helpful to them. Respondents’ ratings of their knowledge about the links between health and lifestyle factors and dementia risk significantly increased after visiting the website (
A dementia risk reduction website providing information about the current evidence and practical strategies was of interest and was useful to the Australian community. Benefits for visitors included increased knowledge and increased motivation to address relevant behaviors. Many visitors to the site were already health conscious, indicating that more needs to be done to get dementia risk reduction messages to the wider community. More interactive and personalized resources in future interventions may offer additional benefits to individuals.
The prevalence of dementia worldwide is increasing with the ageing population. In Australia, it is projected to increase four-fold to around 1 million people by 2050 [
Several modifiable health and lifestyle factors are consistently associated with the risk of developing dementia from all causes, including Alzheimer’s disease [
Preventative health approaches that facilitate lifelong mental, physical, and social activity, healthy eating and lifestyles, and prevention or control of vascular risk factors have the potential to reduce the number of people developing dementia [
Despite this potential, most people have little knowledge about dementia risk factors [
To improve public awareness, Alzheimer’s Australia (Australia’s national dementia association) developed a community education program about dementia risk reduction called Mind your Mind (MYM). The program provides information about health and lifestyle behaviors associated with lower risk of developing dementia. The 7 MYM “signposts” (body, brain, diet, habits, head, health checks, social life) deal with aspects of behavior related to modifiable risk factors for dementia. The program initially relied on community education forums and printed resources, but these have limited reach. To improve accessibility to MYM, the program now includes online resources as described in the Methods section below.
In developed countries including Australia, the vast majority of people are Internet users (in 2011 an estimated 89.8% of Australians were Internet users [
In 2010, a MYM website was launched [
The MYM website was developed to provide the Australian community with accessible and engaging information about the current evidence for lifestyle and medical factors associated with dementia risk.
An online survey was developed using SurveyMonkey [
Most items asked respondents to rate a specific attribute of the information provided on the website using a 5-point rating scale. Respondents were also able to enter additional comments. Where items asked respondents to rate attributes of the various sections of the website or of the information provided about specific risk or protective factors, respondents were instructed to select “not applicable” for any sections or factors they had not looked at. The survey also included open questions about what lifestyle changes respondents intended to make and what additional resources might help them.
Users of the website from April to June, 2011, were invited to participate in the study via an information page on the MYM website with a link to the survey. Eligible participants included adults 18 years of age and over residing in Australia. Participants were anonymous but the survey asked for demographic information including age, gender, place of residence, medical status, education, and occupation. 123 people responded to the survey, however not everyone completed all questions.
For items rating attributes of the website using a 5-point scale, the mean rating across participants who provided a rating was calculated. Non-responders to individual questions were excluded from the analysis of those questions.
Description of the contents of each section of the MYM website.
Section | Contents |
About dementia | what is dementia, symptoms, forms of dementia, risk factors |
MYM | summary of evidence, practical advice, and links to resources for risk or protective factors: mental activity, diet, physical activity, social activity, blood pressure, cholesterol, diabetes, body weight, smoking, alcohol, head injury |
Resources | downloadable information sheets, brochures and papers, frequently asked questions, quiz answers |
Health professionals | downloadable guidelines and summary of evidence, resources for clinicians and patients for risk or protective factors: mental activity, diet, physical activity, social activity, blood pressure, cholesterol, diabetes, body weight, smoking, alcohol, head injury, depression |
Research | dementia prevention research generally, current Australian research |
Quizzes | three 10-question multiple choice quizzes on MYM, the brain, and music |
Blog | brief articles on new research, publications, or resources |
Screenshot of the Mind your Mind website home page.
The majority of respondents were 50-69 years of age (see
There were no significant differences between responders and non-responders to each section of the survey regarding age group (
Characteristics of respondents.a
Characteristic | n (%) | |
|
||
|
18-30 | 10 (8.2) |
|
31-40 | 14 (11.5) |
|
41-50 | 12 (9.8) |
|
51-60 | 31 (25.4) |
|
61-70 | 40 (32.8) |
|
71-80 | 13 (10.7) |
|
>80 | 2 (1.6) |
|
||
|
Year 6 | 2 (1.7) |
|
Year 8 | 3 (2.5) |
|
Year 10 | 23 (19.0) |
|
Year 12 | 17 (14.0) |
|
Diploma | 25 (20.7) |
|
Bachelor degree | 26 (21.5) |
|
Postgraduate degree | 25 (20.7) |
|
||
|
Managers and self-employed | 8 (6.8) |
|
Professionals | 49 (41.5) |
|
Technicians and trade workers | 5 (4.2) |
|
Community and personal service workers | 12 (10.2) |
|
Clerical and administrative workers | 31 (26.3) |
|
Sales workers | 4 (3.4) |
|
Machinery operators and drivers | 2 (1.7) |
|
Labourers | 1 (0.8) |
|
Students and housewives | 6 (5.1) |
aN varied based on the number of respondents from 123 total participants who answered each question.
Respondents were asked what made them interested in dementia risk reduction and visiting the website.
Respondents overall impressions of the website were generally positive. Comments indicated that people found the content interesting, useful, and enlightening. For example, a female respondent past 70 years of age wrote,
Thank you for providing such a wealth of information on the subject. To have so much info on one site is fantastic.
However, a few respondents commented that the layout of the site could be made more interesting or that there was too much text. As shown in
Respondents found the website easy to navigate. As shown in
Respondents generally reported that the information provided was helpful to them, with ratings for most sections between 4 (quite helpful) and 5 (very helpful), as shown in
Respondents generally found the information provided easy to read and understand. As shown in
As shown in
On average, respondents rated how much they learned from the website sections between 3 (something) and 4 (a fair bit), as shown in
Proportion of respondents who selected the given reasons for their interest in the website (N=116).
Reason | n (%) |
I care for someone who has dementia | 15 (12.9) |
I have a family history of dementia | 31 (26.7) |
I feel I am getting to the age when dementia could affect me | 34 (29.3) |
I am worried about my memory or thinking | 36 (31.0) |
I am worried about someone close to me | 22 (19.0) |
The website was recommended to me by someone else | 33 (28.4) |
The information is relevant for my work | 12 (10.3) |
Proportion of respondents who selected the given options for what they hoped to learn from the website (N=116).
Topic | n (%) |
How to slow the progress of dementia | 61 (52.6) |
Whether dementia can be prevented | 46 (39.7) |
Whether I am at risk of getting dementia | 51 (44.0) |
Whether someone close to me is at risk of getting dementia | 21 (18.1) |
How to improve my memory or thinking | 72 (62.1) |
What to do to reduce the risk of getting dementia | 90 (77.6) |
Mean (SD) ratings for questions asked in relation to website sections.
Section | Overall impressiona
|
Easy to understandb
|
Easy to navigatec
|
Helpful informationd
|
How much did you learn?e
|
|
n=88 |
n=86 |
n=85 |
n=83 |
n=84 |
Whole website | N/A | N/A | 4.23 (0.91) | 4.13 (0.82) | 3.72 (0.96) |
Home page | 4.02 (0.78) | 3.35 (0.74) | N/A | N/A | N/A |
About dementia | 4.38 (0.81) | 3.36 (0.74) | 4.26 (0.86) | 4.34 (0.75) | 3.81 (0.94) |
MYM | 4.51 (0.70) | 3.33 (0.77) | 4.28 (0.85) | 4.26 (0.82) | 3.84 (0.99) |
Resources | 4.11 (0.90) | 3.26 (0.71) | 4.33 (0.81) | 4.10 (0.86) | 3.83 (0.95) |
Health professionals | 3.85 (0.92) | 3.31 (0.76) | 4.26 (0.83) | 3.89 (0.98) | 3.71 (0.92) |
Research | 4.21 (0.99) | 3.29 (0.80) | 4.34 (0.75) | 4.05 (0.94) | 3.93 (0.91) |
Quizzes | 4.09 (1.02) | N/A | N/A | N/A | N/A |
Blog | 3.43 (1.38) | 3.47 (0.73) | N/A | 3.59 (1.10) | 3.41 (1.08) |
aWhat is your overall impression of the various sections of the website; how interesting and appealing are they? 1=not at all; 2=not very; 3=somewhat; 4=quite; 5=very (interesting)
bIs the information provided in the various sections of the website easy to read and to understand? 1=very complex; 2=somewhat complex; 3=just right; 4=somewhat simplistic; 5=very simplistic
cDo you find the website and its sections easy to navigate? 1=very difficult; 2=somewhat difficult; 3=neither easy nor difficult; 4=somewhat easy; 5=very easy
dHow helpful is the information provided on the MYM website to you? 1=not at all; 2=not very; 3=somewhat; 4=quite; 5=very (helpful)
eHow much do you feel you learned from the MYM website? 1=nothing at all; 2=not very much; 3=something; 4=a fair bit; 5=a great deal
Mean (SD) ratings for questions asked in relation to specific risk or protective factors.
Risk /protective factor | Current behaviora
|
Intention to changeb
|
Was information easy to understand?c
|
How well did information equip you?d
|
Are practical tips relevant and useful?e
|
|
n=67 |
n=67 |
n=66 |
n=65 |
n=65 |
Alcohol | 4.16 (0.86) | 3.75 (1.05) | 3.35 (0.73) | 4.06 (0.76) | 4.03 (1.0) |
Blood pressure | 4.21 (0.73) | 4.08 (1.04) | 3.37 (0.78) | 3.92 (0.91) | 4.20 (0.86) |
Body weight | 3.77 (0.97) | 4.23 (0.86) | 3.39 (0.77) | 4.00 (0.90) | 4.19 (0.77) |
Cholesterol | 3.85 (0.78) | 4.14 (0.98) | 3.40 (0.77) | 4.11 (0.86) | 4.21 (0.86) |
Diabetes /blood sugar | 4.17 (0.80) | 4.03 (1.07) | 3.41 (0.79) | 4.17 (0.81) | 4.15 (0.86) |
Diet | 3.83 (0.84) | 4.18 (0.99) | 3.38 (0.76) | 4.08 (0.9) | 4.20 (0.75) |
Head injury | 4.38 (0.68) | 4.29 (0.76) | 3.38 (0.76) | 4.10 (0.84) | 3.96 (1.02) |
Mental activity | 4.20 (0.78) | 4.26 (0.96) | 3.39 (0.78) | 4.05 (0.90) | 4.31 (0.81) |
Physical activity | 3.64 (0.95) | 4.36 (0.82) | 3.41 (0.78) | 4.11 (0.87) | 4.18 (0.79) |
Smoking | 4.74 (0.59) | 4.47 (0.72) | 3.40 (0.77) | 3.90 (1.04) | 3.63 (1.33) |
Social activity | 4.02 (0.83) | 4.23 (0.83) | 3.39 (0.78) | 4.05 (0.82) | 4.20 (0.86) |
aHow well do you think you are currently doing in relation to the factors listed? 1=very badly; 2=somewhat badly; 3=could do better; 4=pretty well; 5=very well
bHow strong is your intention to make changes to improve what you do in relation to the factors listed? 1=very weak; 2=somewhat weak; 3=considering it; 4=somewhat strong; 5=very strong
cHow easy to understand was the information provided for each of the factors listed? 1=very complex; 2=somewhat complex; 3=just right; 4=somewhat simplistic; 5=very simplistic
dHow well did the information provided equip you to improve what you do in relation to the factors listed? 1=not at all; 2=not much; 3=a little; 4=quite well; 5=very well
eAre the practical tips, activities, strategies and resources provided for the factors listed generally relevant and useful to you? 1=completely useless; 2=somewhat useless; 3=a little useful; 4=somewhat useful; 5=very useful
Mean ratings of knowledge about the link between risk or protective factors and dementia risk before and after visiting the Mind your Mind website (n=68). Ratings: 1=nothing at all; 2=not much; 3=a little; 4=quite a bit; 5=a lot.
As shown in
The average rating of how well respondents (n=81) felt the information provided equipped them to do something about reducing their risk of dementia was 3.78 (SD 0.89), between “a little” and “quite well”. 56 (69.1%) said the information provided equipped them “quite well” or “very well”. Average ratings of how well the information provided for specific risk or protective factors equipped respondents to improve what they do in relation to the factors are shown in
As shown in
Average ratings for how well respondents felt they were currently doing in relation to specific risk or protective factors were between 3 (could do better) and 4 (pretty well) or 4 and 5 (very well), as shown in
Of the 81 respondents, 45 (55.6%) rated their intention to make lifestyle changes to reduce their risk of dementia as 4 (somewhat strong) or 5 (very strong), and 28 (34.6%) rated their intention as 3 (considering it). The mean rating was 3.68 (SD 1.01). Only 22 (27.1%) said their intention to visit their doctor to discuss dementia risk reduction was “somewhat strong” or “very strong”, and a 21 (25.9%) were “considering it”. The mean rating was 2.63 (SD 1.29). Of those who felt they needed to change, respondents on average rated their intention to make changes to improve what they do in relation to specific risk or protective factors between 4 (somewhat strong) and 5 (very strong) for most factors, as shown in
When asked to specify what changes they intend to make, 35 people provided a response. As shown in
Respondents rated how helpful they felt 12 suggested resources would be to them, if provided in addition to the information on the website. As shown in
Respondents were asked an open question about what other information, advice, or resources they would like to see on the website and 18 people provided a response. Suggestions included opportunities to volunteer for research, information on local groups and clubs, diet and supplement information, personal stories, and information on other risk factors such as age and drugs. Respondents were also asked what else they needed to help them make changes in relation to specific risk or protective factors. The responses from 18 respondents are summarized in
Mean ratings of importantance of monitoring behavior in relation to risk or protective factors before and after visiting the Mind your Mind website (n=67). Ratings: 1=not at all; 2=only mildly; 3=somewhat; 4=quite; 5=very (important).
Number of respondents who stated intentions to make improvements in specific areas of behavior.
Mean (SD) ratings of how useful respondents felt suggested additional resources would be to them (n=65). Ratings: 1=not at all; 2=not very; 3=somewhat; 4=quite; 5=very (helpful).
Potential resource | Mean rating (SD) |
An assessment, that you could complete online, to determine your individual risk of developing dementia (eg, a 10% risk). | 4.20 (1.01) |
An assessment, that you could complete online, to identify your personal risk factors for developing dementia (that is, the things in your life that you could improve). | 4.29 (0.80) |
One off advice about what you can do to reduce your risk of dementia, based on your assessment, that is tailored to your individual circumstances. | 4.19 (0.86) |
Personalized dementia risk reduction programs for you to follow over time, based on your assessment and tailored to your individual circumstances. | 4.10 (1.07) |
Regular reminders and new challenges to help you follow your personalized dementia risk reduction programs. | 4.03 (1.08) |
The results of your assessment for you to take to your GP to help you discuss dementia risk reduction with them. | 4.18 (0.98) |
Regular reminders to see your GP to monitor any medical aspects of dementia risk reduction that apply to you. | 3.76 (1.28) |
General educational sessions about dementia risk reduction that you could attend to learn more, discuss issues and ask questions. | 3.80 (1.16) |
Activities or workshops to learn practical dementia risk reduction strategies (eg, healthy cooking, memory strategies, exercises). | 3.81 (1.22) |
Regular general updates, not personalized, such as a newsletter. | 3.77 (1.05) |
Regular updates on the latest dementia risk reduction research. | 4.06 (0.97) |
Information about services in your local area that you could utilize to help you do more dementia risk reduction activities. | 4.06 (1.03) |
Selected responses to the open question “What else do you think you need to help you to make changes to improve what you do in relation to the factors listed? Are there any particular resources, facilities, information, services, etc, that you think would help you?”
Risk or protective factor | Suggested resources |
Alcohol | Safe level of consumption |
Blood pressure | Fact sheet on lowering BP |
Cholesterol | List of foods with cholesterol ratings |
Diet | List of foods with salt, sugar, etc ratings |
Mental activity | Brain exercises |
Physical activity | Tips to make it easy to exercise |
Social activity | Tips to make it easy to socialize |
This study aimed to evaluate users’ perceptions of a website providing information and resources related to health and lifestyle factors associated with the risk of developing dementia. An online survey revealed that the MYM website was viewed as being helpful and the majority of respondents perceived the website content to be interesting, informative, easy to understand, and useful.
The “MYM” and “About Dementia” sections were rated as the most interesting and helpful, suggesting visitors to the website were most interested in information about reducing dementia risk. This was supported by the finding that the most selected reasons given for visiting the website were concerns about memory or thinking and wanting to know what to do to reduce dementia risk. A recent Australian community survey found that the fear of developing dementia was second only to the fear of having cancer [
A study investigating the preferences of potential users of websites providing physical activity interventions found that ease of use was considered essential to the design of an appealing website [
One of the principal aims of the MYM website was to improve knowledge about dementia risk factors and what individuals can do to reduce their risk. Respondents’ ratings of their knowledge about the links between given risk or protective factors and dementia risk significantly increased after visiting the website for all factors. Prior knowledge was rated highest for mental activity and physical activity, and lowest for diabetes and cholesterol. This was consistent with previous community survey findings that there was some awareness of the links between mental stimulation and dementia risk reduction, and physical health and dementia risk reduction, but there was very little awareness of the association with cardiovascular risk factors [
Another principal aim of the MYM website was to promote behavior change by providing users with information and resources to assist them to adopt lifestyle and health strategies that may reduce their dementia risk. In this cross-sectional study, we did not measure actual behavior change, but assessed perceived importance of monitoring behavior and intentions to change behavior. Respondents’ ratings of how important to them monitoring what they do in relation to given risk or protective factors significantly increased after visiting the website for all factors except smoking. The smaller increase in importance for smoking was likely due to very few respondents being smokers (the highest average rating for how well respondents were currently doing in relation to risk or protective factors was for smoking).
The majority of respondents rated how much the information provided overall motivated them to do something about reducing their dementia risk as “quite a bit” or “a lot”, suggesting the website content was able to encourage users to consider behavior change. This was also supported by the finding that 73/81 (90.2%) respondents rated their intention to make lifestyle changes as “very strong”, “somewhat strong”, or “considering it’. Of course, intentions do not always translate into actions and it is well recognized that raising awareness and motivation are only part of the process of behavior change. Only 43/81 (53.1%) respondents rated their intention to visit their doctor as “very strong”, “somewhat strong”, or “considering it’. This may suggest that people do not see medical support in this area as important. The older age group making up the majority of respondents may already be having the recommended regular checks of cardiovascular risk factors, and therefore do not see the necessity to visit to the doctor another time.
Among those who felt they needed to change, the highest rating for intention to change was for smoking, followed by physical activity. There are many public messages about the dangers of smoking. Perhaps the association with increased dementia risk could help motivate smokers to try to quit. Physical activity is an issue many people think about given its prominence in public health messages and the media. More people specified increasing physical activity as a change they intended to make than any other factor.
The personal relevance and applicability of Web-based health information has previously been shown to be important to users [
Potential additional resources that might help people to adopt the healthy behaviors recommended on the MYM website were suggested, and respondents were asked to rate how helpful these would be to them. The high ratings given suggested that respondents’ motivation to address their health related to dementia risk was high, and that in general people were looking for practical resources to assist them. Personalized assessments of their risk factors, tailored advice to address risk factors, and assessment results to take to their doctor were rated highest. Previous studies have similarly found that health website users would like to see more interactivity and more specific practical information that tells them exactly what they need to do, making it easy for them to adopt healthier behaviors [
Survey respondents were predominantly female and well-educated, consistent with findings that these demographic characteristics were associated with more frequent health-related Internet use [
Respondents rated their current healthy behavior related to the risk or protective factors on average as doing “pretty well”, suggesting the people most likely to access the MYM website and respond to the survey felt that they were already leading a healthy life. This was consistent with previous findings and suggests that another important target group for future Web-based health interventions is those with weak health motivation [
Generalizability of the findings from the current study to the general community was limited by the use of a self-selected sample, and a lack of data on visitors to the website who did not complete the survey. Because an opt-in survey was used, it was not possible to calculate a response rate for the survey or to determine any demographic differences between survey respondents and visitors who did not participate in the survey. While the resulting sample size was modest, the study was able to detect significant positive effects of visiting the MYM website.
A further limitation of the current study was that knowledge about risk or protective factors for dementia and the importance ascribed to them were not assessed before participants viewed the website. Their subjective report of prior knowledge and importance were assessed with the survey after they had read the website. The study was also unable to measure whether participants actually made lifestyle changes. Nevertheless, respondents’ felt their knowledge had increased, as had the importance they ascribed to monitoring their health-related behavior.
Further longitudinal studies are required to better assess knowledge prior to exposure to the MYM information, and any lifestyle modifications after exposure. Future research should also examine whether the beneficial effects of providing dementia risk reduction information can be enhanced by also providing interactive and personalized Web-based features. Enhancements to the MYM website are in development which will include the ability for users to assess their dementia risk and be provided with tailored advice and resources. Research is also underway to evaluate whether such an interactive program results in better health outcomes for users than an information website alone. This ongoing research program aims to inform future developments of dementia prevention initiatives for Australia [
This study has demonstrated that a dementia risk reduction website successfully increased users’ knowledge and the importance they attributed to monitoring their health behavior. Positive ratings of the website content suggest it was relevant to users and presented in a manner they easily understood. Users felt well-equipped to improve their behavior and found the practical tips provided useful. They also felt that suggested additional resources would be helpful, such as interactive and personalized resources on the website to further engage people to enable behavior change. These findings will inform future developments of the MYM program and website.
Mind your Mind
This research was funded by the Australian Dementia Collaborative Research Centres. Kaarin Anstey, Henry Brodaty, and Michael Woodward provided helpful advice on the website content. The Alzheimer’s Australia Consumer Dementia Research Network provided helpful comment on the survey design.
The author is an employee of Alzheimer’s Australia, the trademark and copyright owner of Mind your Mind and the Mind your Mind website.