Conectar
To examine the association between caregiving context and the health and well-being of community-dwelling people with dementia (functional ability, physical function, depression, quality of life and health-related quality of life) and their informal carers (health-related quality of life) at the pre-rehabilitation stage and the potential mediating role of caregiving context variables.
Cross-sectional study.
Secondary analysis of baseline data from a randomised controlled trial of 130 dementia care dyads—the Interdisciplinary Home-based Reablement Programme (2018–2022). Bivariate analyses were applied to identify key caregiving context variables—co-residence, sole carer status, additional caring responsibilities, client-carer relationship and subjective carer burden (carer burden hereafter)—associated with health outcomes. Subsequently, multivariable linear regression models were developed. To examine carer burden, two models were run for each outcome: one with caregiving context variables and covariates, and the other adding carer burden. The mediating effects of the identified caregiving context variable were examined using post hoc mediation analysis.
Spouse/partner carer relationship was significantly associated with better client well-being, including lower depressive symptoms and higher quality of life scores compared to adult child and other relationships. Higher carer burden was strongly associated with lower functional ability, more depressive symptoms, lower quality of life for clients and lower health-related quality of life for both clients and carers. Including carer burden in regression models explained the greatest variance across most models. Carer burden fully mediated the association between additional caring responsibilities and client functional ability, and partially mediated the association between other carers and client depression.
Carer burden needs to be carefully considered in supporting the health and well-being of dementia carer dyads.
Addressing carer burden and tailoring support to carers are essential for optimising health impacts for dementia carer dyads.
STROBE checklist.
None.
ClinicalTrials.gov identifier: ACTRN12618000600246
To assess career satisfaction among Chinese nurses, explore influencing factors, and examine the mediating role of role breadth self-efficacy (RBSE) in the relationship between subjective age and career satisfaction.
A multi-centre, cross-sectional study.
Between June and October 2024, 2033 questionnaires were distributed to nurses across seven geographic regions in China, collecting data on demographics, subjective age, RBSE, and career satisfaction. Descriptive statistics, Pearson correlation analysis, multiple linear stepwise regression, and path analysis were used to identify determinants of career satisfaction and test the mediating effect of RBSE.
The effective response rate was 97%. Chinese nurses reported moderate-to-high career satisfaction, younger subjective age relative to chronological age, and moderate RBSE levels. Multivariate linear regression analysis identified education level, work institution, salary, weekly working hours, subjective age, and RBSE as significant predictors of career satisfaction. Path analysis revealed a significant negative association between subjective age and career satisfaction (β = −0.23, p < 0.001), which was partially mediated by RBSE (indirect effect = −0.11, 95% CI: −0.18 to −0.05).
The career satisfaction of Chinese nurses is at a moderately high level; the influencing factors include the intensity of nursing work and salary levels. There is a certain difference between the subjective age and the chronological age of Chinese nurses. RBSE partly mediates the relationship between subjective age and career satisfaction.
Valuing the breadth of nurses' roles, self-efficacy, and subjective age may help improve job satisfaction.
What problem did the study address?: This study elucidates the present level of career satisfaction among nurses in China and the variables affecting it. What were the main findings?: The subjective age of Chinese nurses influences career satisfaction, with RBSE partly mediating the connection between subjective age and career satisfaction. Where and on whom will the research have an impact?: This study presents novel variables of subjective age and RBSE in the investigation of factors influencing career satisfaction among Chinese nurses, offering new avenues for enhancing career satisfaction in this demographic in the future.
We adhered to STROBE guidelines for cross-sectional research.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study aimed to examine the level of vicarious posttraumatic growth among intensive care unit nurses in China and explore the mediating role of death coping ability in the relationship between moral resilience and vicarious posttraumatic growth.
A multicentre, cross-sectional study was conducted in accordance with the STROBE guidelines.
Between January and March 2025, a questionnaire survey was conducted among 666 intensive care unit nurses from nine tertiary Grade A hospitals across five provinces in China. Participants completed three standardised instruments: the Rushton Moral Resilience Scale, the Coping with Death Scale–Short Version, and the Vicarious Posttraumatic Growth Inventory. We used IBM SPSS 27.0 for descriptive statistics, univariate analyses, and correlation analyses, and employed AMOS 27.0 to perform structural equation modelling for testing mediation effects.
Intensive care unit nurses demonstrated a moderate level of vicarious posttraumatic growth. Moral resilience was positively associated with both death coping ability and vicarious posttraumatic growth. Death coping ability was found to play a partial mediating role in the relationship between moral resilience and vicarious posttraumatic growth.
Moral resilience and death coping ability are key factors associated with vicarious posttraumatic growth among intensive care unit nurses. Nurses with stronger moral resilience are more likely to cope constructively with death-related stress, which may support psychological growth in trauma-intensive environments.
This study highlights the need to enhance intensive care unit nurses' moral and emotional capacities through ethics education, emotional coping training, and institutional support strategies. Strengthening these competencies may foster professional development and mental wellbeing in critical care settings.
To describe the perspectives of individuals receiving haemodialysis regarding health literacy in fluid management.
A qualitative descriptive approach using directed content analysis of interviews from an explanatory mixed methods study.
Semi-structured individual interviews were conducted from September 2020 to February 2021 with 28 individuals receiving haemodialysis who had attended a prior quantitative study. A directed qualitative content analysis approach was used to identify categories and subcategories emerging from the data.
Six categories of health literacy were identified: (1) active health management, (2) engagement with healthcare providers, (3) understanding and support from healthcare providers, (4) social support, (5) health information literacy and (6) navigation of the healthcare system.
Based on their real-life experience, individuals receiving haemodialysis have unique health literacy needs regarding fluid management. A comprehensive understanding of these unique needs is crucial in creating person-centered interventions to address inadequate fluid restriction.
Interventions to address inadequate fluid restriction should be person-centered, considering each individual's unique health literacy needs. This involves conducting a comprehensive assessment of individuals' health literacy needs, empowering individuals to actively engage in health, engaging the entire support network and facilitating health information literacy in line with individuals' preferences.
This study offers detailed insights into the health literacy needs related to fluid management in individuals undergoing haemodialysis. The findings could inform the development of person-centered fluid management strategies for these individuals.
We adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
To understand the current situation of nurses' compassion competence and analyse the characteristics and influencing factors of different categories of nurses' compassion competence based on latent profile analysis, to provide a theoretical basis for formulating targeted compassion training programmes.
A cross-sectional study.
From June to October 2023, 550 nurses from tertiary grade A hospitals in Shandong province were selected by convenience sampling and investigated by utilising a demographic characteristics questionnaire, the Compassion Competence Scale for the Nurses, the Mindful Attention Awareness Scale and the Maslach Burnout Inventory-Human Service Survey. Latent profile analysis was performed to explore the potential categories of nurses' compassion competence, and single-factor analysis and logistic regression analysis were used to explore the related influencing factors.
A total of 513 nurses were included. The compassion competence of nurses could be divided into four categories: the compassion competence deficient group (7.56%), the compassion competence low-imbalanced group (15.35%), the compassion competence high-balanced group (50.38%) and the compassion competence excellent group (26.70%). Department, years of working, humanistic care training experience, whether work is supported by colleagues and leaders, mindfulness and job burnout were the influencing factors of different potential categories (all p < 0.05).
There are four categories into which nurses' compassion competency can be categorised. Nursing managers and medical institutions can formulate precise training methods that enhance nurses' compassion competency based on the traits of various nurse categories in order to improve the quality of nursing service.
The results of this study help to understand the categories and heterogeneity of nurses' compassion competence and provide a basis for nursing managers and medical institutions to improve the compassion competence of different categories of nurses.
All participants were nurses who completed an electronic questionnaire related to this study.
This study aimed to (1) evaluate the effectiveness of e-health interventions in improving physical activity and associated health outcomes during pregnancy, (2) compare the e-health functions employed across interventions and (3) systematically identify the behaviour change techniques (BCTs) used and examine their interrelationships.
A systematic review and meta-analysis following the PRISMA 2020 guidelines.
Randomised controlled trials were included. Meta-analyses and subgroup analyses were performed using RevMan 5.3. Social network analysis was conducted to determine the most central BCTs within the intervention landscape.
Ten databases were searched, including PubMed, Embase, Web of Science, Cochrane Library, ProQuest, Scopus, SinoMed, China National Knowledge Infrastructure, WanFang and the China Science and Technology Journal Database, from inception to April 22, 2024.
Thirty-five studies were included. Pooled analyses indicated that e-health interventions significantly improved both total (SMD: 0.19; 95% CI: 0.10 to 0.27; I 2 = 55%) and moderate-to-vigorous physical activity (SMD: 0.16, 95% CI: 0.06 to 0.26; I 2 = 53%) in pregnant women. Subgroup analyses revealed that interventions based on theoretical frameworks and those not specifically targeting overweight or obese women demonstrated greater effectiveness. Additionally, e-health interventions were associated with significant reductions in both total and weekly gestational weight gain. Six of the twelve e-health functions were utilised, with ‘client education and behaviour change communication’ being the most prevalent. Thirty unique BCTs were identified; among them, ‘instruction on how to perform the behaviour’, ‘self-monitoring’, ‘problem solving’, and ‘goal setting’ showed the highest degree of interconnectedness.
E-health interventions are effective in enhancing physical activity and reducing gestational weight gain during pregnancy. Incorporating theoretical frameworks and well-integrated BCTs is recommended to optimise intervention outcomes.
Integrating e-health interventions into existing perinatal care models holds promise for enhancing physical activity among pregnant women and improving maternal health outcomes.
This study adhered to the PRISMA checklist.
No patient or public involvement.
The study protocol was preregistered in the International Prospective Register of Systematic Reviews (CRD42024518740)
To examine the relationships among social support, eHealth literacy and eHealth technology acceptance among patients with chronic illnesses, and investigate whether eHealth literacy plays a mediating role.
A cross-sectional correlational study.
A total of 202 patients with chronic illnesses were recruited from outpatient clinics and communities in Taiwan. Data were collected via structured questionnaires and analysed using SPSS and PROCESS macro with 1000 bootstrap samples.
eHealth literacy was the strongest predictor of technology acceptance. Although social support was positively associated with eHealth literacy, it did not directly predict technology acceptance after controlling for eHealth literacy, indicating a full mediation effect.
eHealth literacy is a crucial mechanism through which social support influences health technologies acceptance. Interventions to improve eHealth literacy, particularly those integrated with social support strategies based on different cultural backgrounds, enhance digital engagement among chronic illnesses.
Healthcare professionals and policy-makers should design literacy-sensitive interventions that leverage social networks and involve significant others to promote meaningful eHealth engagement in disease management.
eHealth literacy fully mediates the relationship between social support and eHealth technology acceptance, proving that social support alone does not directly increase adoption without improving eHealth literacy. eHealth literacy is the strongest predictor of eHealth technology acceptance, emphasising its central role in bridging the gap between social support and eHealth engagement.
This study followed the STROBE checklist guideline.
No patient or public involvement.
Physiological, psychological, and social changes may make older adults more vulnerable to stressors and lead to adverse health outcomes. It remains unclear whether interventions targeting coping strategies in older adults are effective.
This study aimed to systematically review and summarize existing interventions aimed at improving coping strategies in older adults and analyze intervention effectiveness.
A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials (RCTs) and quasi-experimental studies. Two researchers independently performed literature screening, quality assessment, and data extraction.
A total of 9 studies were included, comprising 7 RCTs and 2 quasi-experimental studies. Meta-analysis revealed that the interventions significantly enhanced the use of problem-focused coping strategies among older adults (SMD = 0.37, 95% CI: 0.12 ~ 0.63, p = 0.005, I 2 = 39%). However, there was no significant effect on emotion-focused coping strategies (SMD = −0.07, 95% CI [−0.62, 0.48], p = 0.80, I 2 = 76%). Moreover, no significant statistical differences were observed between the intervention group and the control group in terms of positive (SMD = 1.49, 95% CI [−0.23, 3.21], p = 0.09, I 2 = 98%) or negative coping strategies (SMD = −0.76, 95% CI [−1.79, 0.28], p = 0.15, I 2 = 96%).
Interventions targeting coping strategies can significantly improve the problem-focused coping strategies of older adults. It is crucial to help older adults accurately recognize daily stressors, acquire emotional regulation strategies, and enhance coping skills. More large-scale RCTs are needed to draw more robust conclusions.
To systematically review published studies on the post stroke delirium risk prediction models; and to provide the evidence for developing and updating the clinically available prediction models.
Systematic review.
Systematically searched studies on 10 databases, which were conducted from inception to 9 January 2025. The studies of post-stroke delirium risk prediction models were included.
Extracted the data from the selected studies. The Prediction Model Risk of Bias Assessment Tool checklist was used to evaluate the risk of bias of the models. The meta-analysis of model performance and common predictors was performed by Revman 5.4 and Medcalc.
A total of 12 studies were included, and 21 risk prediction models for post-stroke delirium were constructed. The combined effect size of area under the receiver operating characteristic curve was 0.84. All studies were found to have a high risk of bias and good applicability. Meta-analysis showed: National Institutes of Health Stroke Scale score, age, neutrophil-to-lymphocyte ratio, neglect, visual impairment and atrial fibrillation were independent predictors of post-stroke delirium.
The included studies all found to have a high risk of bias; future studies should focus on adopting more scientifically rigorous study designs and following the standardised reporting guidelines to enhance extrapolation and facilitate its clinical application.
This review may promote clinical healthcare workers to develop and update clinically available prediction models, thereby establishing risk prediction models with strong clinical utility.
This study presents the first systematic evaluation of delirium risk prediction models in stroke patients, thereby facilitating the choice, use and develop of the clinical usable post stroke delirium risk prediction models.
This review adhered to the PRISMA guidelines.
No patient or public contribution.
RD42024620360 (PROSPERO According to JAN Guidelines).
This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.
A prospective cohort design.
A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.
The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.
We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.
These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.
This study adhered to the STROBE checklist.
Patients and their caregivers contributed by participating in the study and completing the questionnaire.
To quantify how specific patient-level characteristics influence the actual amount of mobilisation received during ICU care, thereby identifying key predictors to support individualised mobilisation strategies.
A prospective observational study was conducted in four tertiary hospitals among a convenience sample of 141 critically ill patients from July to November 2023. Data on mobilisation and patient characteristics were collected using standardised data collection tools, including a mobilisation log and a demographic information sheet. Data were analysed using non-parametric tests, Spearman correlation analysis, and multivariate regression to examine associations between early mobilisation and patient-related factors.
Males and surgical patients engaged in more activity (p < 0.001). Muscle strength (r = 0.568, p < 0.001) and haemoglobin levels (r = 0.207, p = 0.014) were positively associated with mobilisation, while higher disease severity (r = −0.321, p < 0.001) and greater pain (r = −0.284, p < 0.001) were linked to reduced activity. Muscle strength, disease severity, surgical status, and sex were independent predictors, explaining 32.5% of the variance.
Early mobilisation in the ICU is influenced by various patient-related factors. Protocols should be tailored to individual patient profiles to enhance outcomes.
This study provides guidance for ICU clinicians to develop targeted mobilisation strategies that consider patients' specific clinical profiles. Tailored approaches may help optimise early mobilisation practices and patient outcomes.
To clarify the definition and evolution of Patient and Public Involvement and Engagement (PPIE) and identify its attributes, antecedents, and consequences in health-related research.
This study follows Rodgers' evolutionary concept analysis with a seven-step framework.
Datasets were searched using terms related to PPIE and key categories (i.e., attributes, antecedents, and consequences). Data were sourced from CINAHL, PsycInfo, Scopus, PubMed, and Web of Science covering publications from inception to October 31, 2024. Document titles, abstracts, and keywords were manually screened to identify relevant studies for full-text review.
A total of 1751 documents were screened, resulting in 38 eligible studies included in the final analysis. PPIE has evolved from a narrow focus on patient inclusion and participation, where patients had minimal influence on research and researchers resisted sharing control of research, to a collaborative model emphasising sustained partnerships, shared contributions, equitable power distribution, and active involvement across research stages. This shift has been driven by research innovation, a growing emphasis on healthcare equity and patient-centred care, technological advances, and stakeholder advocacy (e.g., patients, funders, ethics committees). While PPIE enhances research relevance and impact, barriers, such as resource constraints, power imbalances, patient limited research capabilities and increased researcher workload persist. Facilitators, such as training programmes, standardised guidelines, flexible arrangements and transparent communication can enable meaningful partnerships.
The concept of PPIE is evolving toward greater clarity and consistency in research, positioning patients and the public as active, essential contributors rather than passive participants. Barriers and facilitators were identified to inform its utilisation in research.
This study clarifies the conceptual ambiguities of PPIE, informs theory development, and provides actionable insights. Healthcare and nursing researchers can draw on its findings to utilise PPIE to enhance collaborative and inclusive research practices that align with the needs of patients and the public.
This study adheres to the PRISMA (2020) reporting guidelines for systematic reviews.
One of our co-authors is a patient with lived experience of cancer, who contributed valuable comments and suggestions to enhance this paper.
To explore the experiences, perceptions, and role adaptation of nursing PhDs in hospital settings in China.
A descriptive phenomenological qualitative study.
Individual in-depth interviews were conducted with eight female nursing PhD holders from eight tertiary hospitals across five provinces between November 2024 and February 2025. Data were concurrently collected and analysed using NVivo 11.0, guided by Colaizzi's seven-step analysis.
Four main themes were identified: (1) Multidimensional motivations for choosing hospital work; (2) professional challenges; (3) perceived professional value and benefits; and (4) career expectations and developmental recommendations. Fifteen subthemes further detailed these dynamics.
This study offers a nuanced understanding of the career development of nursing PhDs within hospital settings. The findings reveal the complex interplay of factors influencing their decisions to enter clinical practice. Moreover, it underscores the dual challenges of role ambiguity and limited resources, while also illustrating the transformative potential of applying academic training to drive clinical innovation among nursing PhDs in hospital environments.
These findings offer critical insights for hospital administrators and educational policymakers. By elucidating the career development challenges and opportunities for nursing PhDs, the study underscores the need for tailored talent management frameworks and targeted educational reforms. The findings have important implications for hospital settings in China and offer guidance for global strategies in talent management and clinical education reform, ultimately contributing to improved patient care and healthcare outcomes.
Adhered to COREQ guidelines for qualitative research.
None.
Home-based exercise offers a cost-effective way to receive thorough rehabilitation without the requirement of costly supervised treatment.
To investigate the effects of home-based exercise on the balance ability in post-stroke patients.
A thorough search was carried out on various databases, such as Cochrane Library, Web of Science, PubMed, Embase, and China National Knowledge Infrastructure Library, until October 2024. The inclusion criteria were limited to randomized controlled trials that evaluated the impact of home-based exercise interventions.
The meta-analysis indicated that home-based exercise significantly improved static balance ability (Berg Balance Scale [BBS]: MD = 3.45, 95% CI [1.43, 5.47], I 2 = 71%, p = 0.0008, random-effects model). Conversely, the analysis revealed that the home-based exercise group did not exhibit a statistically significant improvement in the Time up and Go Test (TUG) when compared to the control group (TUG: MD = −0.34, 95% CI [−4.30, 3.61], I 2 = 96%, p = 0.86, random effects model). The subgroup analysis revealed that home-based exercise significantly enhanced balance ability in patients with subacute stroke (BBS: p < 0.0001; TUG: Overall effect p = 0.02). However, no significant improvement was observed in patients with chronic stroke (BBS: p = 0.39). Regarding the duration of intervention, both short-term and long-term interventions were effective on the BBS (p < 0.0001 and p = 0.0008, respectively), although no significant difference was found for the TUG. Participants engaging in exercise for more than 90 min per week demonstrated greater improvements in balance ability (BBS: p < 0.0001; TUG: p = 0.02). When considering national economic levels, significant effects on the BBS were observed in both developed and developing countries (p = 0.0001 and p < 0.0001, respectively), while significant effects on the TUG were noted only in developing countries (p = 0.04).
Home-based exercise interventions showed significant results in improving static balance in patients with subacute stroke, especially home-based exercise that lasted longer than 12 weeks and lasted at least 90 min per week. However, more methodologically rigorous randomized controlled trials are needed to validate these results. In addition, the optimal exercise program and type to optimize the balance ability of stroke patients also need further research.
Advance care planning for people with dementia is an important process to ensure that patient preferences are respected throughout disease progression. However, the complexity of advance care planning and the challenges in effective communication hinder its implementation. The lack of clear procedural guidance for health care teams and the limited research on practical issues such as building trust and resolving conflicts further complicate this process.
To explore the key components of and processes for advance care planning for people with dementia.
The authors conducted a comprehensive search of databases, including PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, NICE, Open Grey, CNKI, and Wanfang. The inclusion criteria focused on studies reporting advance care planning practices and stakeholder perspectives related to dementia.
The review included 45 studies and identified key components and processes for successfully implementing advance care planning in dementia care. These components include enhancing readiness, capturing patient wishes, and executing those wishes. The implementation processes cover assessing participation capacity, selecting surrogate decision-makers, and identifying healthcare providers who implement advance care planning. As the condition of people with dementia progresses, the role of healthcare providers who implement advance care planning becomes increasingly important in advance care planning practices.
The success of advance care planning depends on the interconnection of multiple components, and the findings offer practical insights for improving the advance care planning process to ensure that the care preferences of people with dementia are respected throughout the progression of the disease.
PRISMA-ScR.
This is a review without patient and public contribution.
This study investigates how observed workplace ostracism affects nurses' helping behaviour from a bystander's perspective, examining the mediating roles of moral courage and employee resilience to inform strategies for fostering workplace harmony in nursing settings.
A cross-sectional study design was adopted.
A survey of 346 nurses from two Grade III, Level A hospitals in Henan, China, utilised scales measuring workplace ostracism, moral courage, helping behaviour and employee resilience. SPSS Statistics 26.0, Mplus 8.3 and the SPSS macro program Process 4.1 plugin were used to test the associations among variables.
Observed workplace ostracism positively correlated with nurses' helping behaviour, with moral courage partially mediating this relationship. Employee resilience moderated both the link between observed workplace ostracism and moral courage, and the indirect effect of observed workplace ostracism on helping behaviour through moral courage.
Nurses with high levels of resilience demonstrate moral courage when observing workplace ostracism and engage in helping behaviours towards those ostracised.
This study examines how workplace ostracism undermines nursing team cohesion and individual well-being. It highlights that bolstering nurses' resilience and moral courage can alleviate these adverse effects, thereby improving patient care quality. Nursing managers are advised to adopt targeted strategies, such as resilience training, to mitigate workplace ostracism.
This study employs a questionnaire to explore nurses' views of workplace ostracism and helping behaviours, aiming to inform strategies for fostering nursing team harmony and improving care quality.
This study strictly follows the STROBE reporting guidelines to ensure the clarity and credibility of the research findings.
Data were collected from hospital nurses through electronic questionnaires.
Cognitive decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia, significantly affects social participation, leading to social isolation and reduced quality of life. Enhancing social participation through interventions may mitigate these effects, yet evidence on intervention effectiveness and mechanisms remains inconsistent.
To evaluate the effectiveness of social participation interventions for individuals with cognitive decline and identify effective behavior change techniques (BCTs) supporting social participation.
Our search using the following databases—PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, and Wanfang—was conducted until October 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.4 and Stata18, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Sixteen RCTs involving 2190 participants were included. Music therapy (SMD = 0.62, 95% CI [0.15, 1.10]) and reminiscence therapy (SMD = 0.34, 95% CI [0.02, 0.66]) demonstrated significant positive effects on social participation. Group-based interventions were particularly effective (SMD = 0.23, 95% CI [0.04, 0.43]). Commonly used BCTs included goal setting, behavioral practice/rehearsal, and social support. However, substantial heterogeneity and limited data on SCD and MCI restricted generalizability.
Interventions promoting social participation may enhance engagement for individuals with cognitive decline, particularly through music therapy, reminiscence therapy, and group-based formats. The complexity and dynamic nature of social interaction require individuals to engage and integrate various cognitive functions and skills, which can present significant challenges for older adults with cognitive impairments in their daily social participation. Further research is needed to optimize intervention components and address gaps in targeting early cognitive decline stages.
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