MindCare Digital: a culturally adapted, evidence-informed, web-based dementia prevention intervention for Culturally and Linguistically Diverse (CALD) communities in Australia

Arm 1: MindCare-D MindCare-D is a culturally adapted, evidence-informed, web-based dementia prevention intervention. It was developed using co-design methods, with input from individuals belonging to the 4 target Culturally and Linguistically Diverse (CALD) communities obtained during 9 in-person community workshops. The intervention comprises 16 modules focussed on preventing dementia by addressing modifiable risk factors (i.e., hearing loss, vision loss, smoking, low levels of education, social isolation, depression, traumatic brain injury, air pollution, alcohol consumption, obesity, physical inactivity, high blood pressure, high cholesterol, diabetes, sleep disturbance, and healthy diet). Each module will include a 5-minute video presented by a health professional or respected community leader, followed by ~5 minutes of culturally tailored written guidance outlining the risk factor and practical strategies for behaviour change. Modules will conclude with a structured goal-setting activity in which participants will select a goal from a predefined list aligned with the module topic. Links to reputable government and not-for-profit health resources will be provided to support further learning and action. The modules will be delivered via La Trobe University's online learning management system (LMS). Participants will receive an individual username and password in order to access the LMS. The first two modules will be available immediately however subsequent modules will be released on a fortnightly basis to promote progressive engagement and minimise cognitive burden. Each module will require approximately 15 minutes to complete; however, participants will be able to engage at their own pace and revisit content without time restrictions or minimum engagement thresholds. In Arm 1, MindCare-D modules will be available from the time of their release (as per fortnightly release schedule) until the end of the 24-month study period. The modules will remain accessible to participants even after initial completion. MindCare-D will comprise 5 versions to ensure cultural and linguistic relevance: a plain English language master version and 4 culturally tailored versions for South Asian, Middle Eastern, Sub-Saharan African, and Pacific Islander communities. While the core structure, theoretical foundations, and behavioural targets will remain consistent across versions, examples, imagery, dietary references, and contextual messaging will be tailored to reflect each community’s cultural values, lived experiences, and health beliefs. Materials will be available in simple English (Pasifika communities) and translated into Arabic and Persian (Middle Eastern communities), Hindi (South Asian communities), and Swahili (Sub-Saharan African communities). Arm 2: MindCare-D Plus Participants allocated to MindCare-D Plus will receive the MindCare-D modules in addition to personalised behavioural support for 12 months. This will include a semi-structured 15 - 20-minute monthly telephone coaching session delivered by a qualified health professional (dietitian, neuropsychologist, or medical practitioner). Coaching sessions will focus on reviewing participant-selected goals, identifying barriers, reinforcing motivation, and supporting problem-solving. Participants will receive coaching sessions with each health coach, but these may not always be equally distributed (e.g., 5 sessions x dietitian; 3 sessions x neuropsychologist; and 4 sessions x medical practitioner) due to staff leave, participant availability, and/or other unforeseen reasons. However, the research team will develop a health coaching schedule to allow participants opportunity to receive coaching/support from each of the different health professionals. Participants will be asked to schedule their monthly coaching sessions via Microsoft Bookings. If participants miss/cancel their scheduled coaching session, the research team will attempt to reschedule the session at an alternatively convenient time. There is possibility that participant availability may change during the study period, therefore a range (minimum of 10; maximum of 12) for the number of coaching sessions which should be completed has been pre-specified. Interpreter support will be available during the coaching sessions, if required. Participants will also receive approximately twice weekly, one directional, SMS messages delivered in their preferred language. A text message service (TNZ) will be utilised to automatically send the SMS messages from REDCap. Messages will be tailored to individual goals and will reinforce behavioural strategies introduced within the program. For example, a motivational SMS about hearing ("Hi [Participant's Name], it’s [Sender Name] here from MindCare Digital. Staying connected with others becomes easier when hearing is clear. A simple check can help you stay involved.") may be sent after the healthy hearing module is released in the LMS. In Arm 2, the modules will also be available from the time of their release (as per fortnightly release schedule) until the end of the 24-month study period. The modules will remain accessible to participants even after initial completion. Behavioural support through health coaching and SMS messages will be provided to participants for the first 12 months of the study period. The behavioural support will be personalised in that participants will have an opportunity to guide discussions around their selected goals during coaching sessions. The sessions are intended to be semi-structured therefore participants can also discuss particular risk factors they may be concerned about and/or any module content that they may have queries about. Additionally, the research team will select and send SMS messages which align with participants goals and/or intervention content that they have engaged with at the time. Adherence and fidelity to the intervention will be monitored using several strategies. The LMS will automatically capture MindCare-D module adherence through website analytics (e.g., log-in frequency, time spent on modules, module access patterns, and goal selections). For MindCare-D Plus, record of SMS message delivery logs, coaching session attendance and discussions will be maintained. Furthermore, the research team will monitor fidelity of intervention delivery using a fidelity checklist and will document any modifications/adaptations made to the intervention.