Dementia currently affects 57 million people globally and ranks as the 7th leading cause of death among all diseases.1 As a major cause of disability and dependency among older adults, it brings about profound physical, psychological, social, and economic consequences not only for those living with dementia but also for their families and caregivers.2 Early detection, along with early intervention and treatment, is critical in mitigating these consequences,3, 4, 5 and thus cognitive screening for older adults has become a common practice in primary care settings.6 However, prior studies have reported a high refusal rate among the elderly for dementia diagnostic workup following positive screening results,7, 8, 9 presenting a significant challenge for effective dementia intervention programs.

Risk communication has been widely applied in health communication to encourage individuals to adopt preventive health behaviors.10,11 Research demonstrates its effectiveness in various contexts, including 1) promoting vaccinations, such as the annual flu shot12 and HPV vaccine13; 2) increasing adherence to medication regimes for chronic conditions like hypertension and diabetes14; and 3) enhancing participation of disease screening, such as mammography and Pap smear participation, hepatitis B screening, and HIV testing.15 However, the effectiveness of risk communication in changing health behaviors is not universally agreed upon, and some studies have reported minimal or no impact. For instance, logistical barriers such as access and affordability of vaccines lead to vaccine hesitation of parents and guardians even though they are informed of the health risk to children.16 Moreover, a randomized controlled trial reported that risk communication in the form of a smoking cessation booklet was not effective for quit rate among smoking cancer patients.17 These mixed results indicate that the success of risk communication is context-dependent and influenced by various factors. Despite its widespread use, limited research has explored the application of risk communication to increase participation in dementia diagnostic workups, particularly among older adults with positive screening results. Understanding the characteristics of the target audience and tailoring the risk communication framework accordingly is essential for developing effective strategies.

A number of models have been applied to explore factors that influence people’s preventive health behaviors. First, the Health Belief Model (HBM) examines how individuals perceive health conditions through six key factors: susceptibility, severity, benefits, barriers, cues to action, and self-efficacy.18 When communicators tailor messages to these components, they emphasize the personal relevance of health risk, the grave consequences of untreated disease, and the benefits of early diagnosis. Additionally, addressing perceived barriers through reassurance, providing specific cues for action, and enhancing self-efficacy are integral to this approach.19 Second, the Social Ecology Model (SEM) highlights the multiple levels of influence on health behaviors, including individual, interpersonal, organizational, community, and policy levels.20 Therefore, SEM-based risk communication involves conveying disease knowledge, leveraging social support from family and friends, ensuring institutional backing from healthcare providers, engaging community resources, and promoting supportive public policies. Despite their extensive application in health behavior interventions, researchers rarely utilize HBM and SEM in risk communication for older adults at risk for dementia.21,22 Also, their effectiveness in influencing health behaviors, particularly among older adults in collectivist cultures like China, has not been sufficiently compared. A comparison of the models’ effectiveness could provide insights into designing culturally sensitive health interventions.

In response to the global action plan proposed by the World Health Organization,23 rapidly aging countries such as China have initiated policy programs (e.g., dementia-friendly community) to foster environments that support individuals with dementia and their caregivers.24 These programs aim to align with the seven action areas detailed in the global action plan, especially in the aspects of increasing dementia awareness and friendliness and achieving risk reduction and early diagnosis. Therefore, exploring effective measures to increase the participation in diagnostic workups has significant policy implications globally. Identifying strategies that successfully encourage older adults to undergo dementia diagnostic assessments can inform policy development and implementation in various countries, ultimately improving early detection and treatment of dementia. These initiatives in China can shed light on best practices and serve as models for other nations facing similar demographic challenges.