Conectar
We aimed to identify the barriers and facilitators to participation in interventions aimed at improving cognitive function among older adults with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) in rural areas.
This study is the qualitative phase of a larger randomised controlled trial and employs a descriptive approach.
We conducted in-depth, semi-structured face-to-face interviews with older adults diagnosed with T2DM and MCI in rural areas of China in November 2023. The interviews were guided by the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). The interview recordings were transcribed and analysed using NVivo V.11 software. Two research assistants independently coded the transcriptions, and the identified barriers and facilitators were mapped to the corresponding domains within the COM-B model and TDF.
A total of 26 older adults, aged 60–87, participated in the interviews. Nine themes were identified, including disease awareness, disease attitude, social interaction, responsibility and health, emotion guidance, organisational management, expertise and benefits, self-perception and role identity crisis. These themes mapped onto the three core components of the COM-B model as well as the nine domains of the TDF, which include: knowledge, environmental context and resources, social influences, intentions, emotions, reinforcement, beliefs about consequences, beliefs about capabilities and social identity.
Addressing barriers and leveraging facilitators can effectively enhance the willingness of elderly patients in rural areas to participate in interventions aimed at improving cognitive function. A multi-layered approach should be adopted, focusing on disease knowledge and attitudes, social interactions, the impact of the disease burden on both family and individuals, emotional state, organisational management, team expertise and timely assessment, individual self-efficacy and role perception.
The study adheres to the COREQ reporting guidelines.
The participants in this study were older adults with T2DM and MCI from rural areas. Participants were involved in the development of the interview guide and were subsequently interviewed regarding the facilitators and barriers to their participation in cognitive function interventions.
This study aims to examine the relationship between alcohol consumption patterns and hypertension in high-altitude populations. Additionally, it seeks to assess the mediating effects of metabolic factors on this association.
Cross-sectional study.
A subproject of a national survey conducted in high-altitude regions of Tibet, China.
A total of 53 460 residents aged 35–75 years were selected using multistage cluster sampling.
Hypertension was defined as a systolic blood pressure ≥140 mm Hg and/or a diastolic blood pressure ≥90 mm Hg, self-reported physician-diagnosed hypertension or current use of antihypertensive medications.
Multivariate logistic regression analyses were used to assess the association between different frequencies of alcohol consumption and hypertension. Simple and parallel multiple multicategorical mediation analyses were performed to estimate the individual and combined mediation effects of dyslipidaemia and obesity.
Finally, 50 044 participants were included in the analysis, with a hypertension prevalence of 42.97%. Among them, 41.3% were males, and the mean age was 51.12 years. Compared with non-drinkers, occasional alcohol consumption was not significantly associated with hypertension in the overall population. However, in subgroup analysis, it was linked to a 12% increase in odds among males (OR 1.12, 95% CI 1.02 to 1.24) and an 11% decrease among females (OR 0.89, 95% CI 0.81 to 0.97). The odds of hypertension rose significantly by 1.25 (95% CI 1.15 to 1.36), 1.23 (95% CI 1.12 to 1.36) and 1.51 (95% CI 1.37 to 1.65) times in the groups consuming alcohol two to four times a month, two to three times a week and ≥4 times a week, respectively. The indirect effects of these mediators were evident in the light-to-moderate alcohol consumption group but not in the heavy drinking group, a pattern that was also confirmed in sensitivity analyses.
This large-scale study underscores that the impact of occasional drinking on hypertension varies by gender, while consistent associations between frequent alcohol consumption and a higher prevalence of hypertension were observed. Given the differing mediating effects of metabolic abnormalities across individuals with varying alcohol consumption patterns, tailored interventions should be implemented. These findings provide valuable evidence to inform public health strategies to prevent hypertension.
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