Applying the Health Belief Model to Quantify and Investigate Expectations for Computerized Cognitive Training

Abstract

Despite the demonstrated benefits of computerized cognitive training for older adults, little is known about the determinants of training behavior. We developed and tested scales to quantify expectations about such training, examine whether expectations predicted training adherence, and explore if training expectations changed from pre- to post-training. Participants ( N \u2009=\u2009219) were healthy older adults aged 55–96\xa0years ( M \u2009=\u200975.36, SD\u2009=\u20099.39), enrolled in four studies investigating Dakim, InSight, or Posit Science Brain Fitness computerized cognitive training programs. Instruments were adapted from existing health behavior scales: Self-Efficacy for Cognitive Training; Outcome Expectations for Cognitive Training; Perceived Susceptibility to Cognitive Decline, Dementia, or Alzheimer’s Disease; and Perceived Severity of Cognitive Decline, Dementia, or Alzheimer’s Disease. Participants completed scales at baseline ( N \u2009=\u2009219) and post-training ( n \u2009=\u2009173). Eight composites were derived from factor analyses. Adherence rates were high ( M \u2009=\u200981%), but none of the composites predicted training adherence. There was an overall significant effect of time, Wilks’ λ \u2009=\u20090.843, F (8, 114)\u2009=\u20092.65, p \u2009=\u20090.010, partial η 2 \u2009=\u20090.157; a significant overall effect of training group, Wilks’ λ \u2009=\u20090.770, F (16, 228)\u2009=\u20091.99, p \u2009=\u20090.015, partial η 2 \u2009=\u20090.123; and an overall significant group\u2009×\u2009time interaction, Wilks’ λ \u2009=\u20090.728, F (16, 226)\u2009=\u20092.44, p \u2009=\u20090.002, partial η 2 \u2009=\u20090.147. Significant effects of time were found for e xpected psychological outcomes and self-efficacy . Post-training, participants more strongly agreed that training was enjoyable and increased their sense of accomplishment. Changes in s elf-efficacy for cognitive training varied by program, improving for Dakim, and declining for the more challenging Brain Fitness and InSight participants. These newly devised scales may be useful for examining cognitive training behaviors. However, more work is needed to understand factors that influence older adults’ enrollment in and adherence to cognitive training.