Behaviour change techniques used in interventions targeting dementia risk factors amongst older adults in rural and remote areas: A systematic review and meta-analysis

Behavioural interventions targeting health risk factors within rural areas are often not tailored to effectively address the needs and socio-environmental barriers to access and behaviour change faced by these communities. Little is known about the underlying behaviour change mechanisms that contribute to reducing dementia risk for communities living in regional and rural areas. This systematic review and meta-analysis aimed to summarise the effectiveness of behavioural interventions targeting late-life single modifiable dementia risk factors (physical inactivity, poor diet, social isolation and depression) and the mechanisms used to contribute to behaviour change. Six databases were searched to identify regional and rural behavioural interventions targeting modification of late-life dementia risk behaviours between 2000 and 2024. Behaviour change techniques (BCTs) and outcomes for each intervention were extracted. Where possible, meta-analyses were performed to assess the effectiveness of the behavioural intervention on outcomes related to dementia risk. Out of 42,529 articles, 49 studies were included: 22 on physical inactivity, 6 on poor diet, 9 on social isolation, and 12 on depression. Many BCT categories were applied (M = 14.8, SD = 10), with high use of goals and planning (49/49 interventions; 100 %), shaping knowledge (47/49 interventions; 95.9 %), social support (43/49 interventions; 87.8 %) and comparison of outcomes (38/49 interventions; 77.6 %). Social isolation interventions used the most BCTs (M = 18.3; SD = 8.5), followed by depression (M = 17.6; SD = 10.7), physical inactivity (M = 16.0; SD = 11.5), and poor diet (M = 5.2; SD = 3.1). Although effectiveness was limited across interventions, apart from cognitive behavioural therapy for depression (SMD -0.39, 95 % CI -0.55 to -0.24), future programs targeting dementia risk factors would benefit from incorporation of BCTs. Simultaneously, consideration of the socio-environmental context, accessibility, and community involvement in rural and regional areas may improve the sustainability of interventions.