Development and exploratory feasibility of a social cognitive theory-based family intergenerational support intervention for rural older adults with cognitive impairment

Guided by Social Cognitive Theory (SCT) as the theoretical framework and family-based intergenerational support as the implementation pathway, this study developed a family-based intergenerational support intervention for rural older adults with cognitive impairment. An exploratory feasibility pilot study was subsequently conducted. It described recruitment and retention, completion of assessment procedures, family participation, and implementation challenges.

The findings were used to inform further protocol refinement and future feasibility research. The intervention was developed based on the core mechanisms of Social Cognitive Theory, including self-efficacy, observational learning, behavioral reinforcement, and environmental support, through a literature review, research team discussions, and two rounds of Delphi expert consultation. The intervention comprised three modules: self-management, psychological intervention, and cognitive training.

Representative activities included walking, looking at old photographs, everyday-life calculation tasks, and memory training. Under the guidance of healthcare professionals, younger-generation family members were intended to support patients’ participation in the planned activities through companionship, reminders, demonstrations, joint activities, and feedback recording. From June to July 2026, eight rural older adults with cognitive impairment admitted to Fuyang Third People’s Hospital were recruited using purposive sampling.

Each participant was enrolled together with one younger-generation family member who was primarily involved in their care, and all dyads took part in a 2-week pilot study. Two nurses documented patient participation, available information on task implementation, and family-member feedback through WeChat communication, observations during intervention delivery, and follow-up. A researcher-developed four-item family feedback form was used to assess overall satisfaction, understanding and implementation of the intervention content, willingness to participate in future research, and satisfaction with the research staff’s service attitude.

Open-ended questions were used to collect family-reported patient activity preferences and suggestions for intervention refinement. The Montreal Cognitive Assessment (MoCA), 15-item Geriatric Depression Scale (GDS-15), and Pittsburgh Sleep Quality Index (PSQI) were administered to document completion of the assessment procedures, and the data were analyzed descriptively. The effective response rates of the two rounds of expert consultation were 100.0% and 94.4%, respectively, and the coefficients of expert authority were 0.79 and 0.85, respectively.

In the second round, the mean importance scores of items at all levels ranged from 4.53 to 4.94, and the mean operability scores of tertiary-level items ranged from 4.18 to 4.82. Kendall’s coefficients of concordance for the importance ratings of items at all levels and the operability ratings of tertiary-level items were 0.591 and 0.617, respectively (both P