Barriers to the behavioral conversion of dementia screening intentions among high-risk individuals: a qualitative study in an urban Chinese setting.

backgroundAs dementia prevention increasingly shifts toward community settings, early screening can help identify individuals who may benefit from timely assessment, referral, and support. Although many individuals at high risk of dementia express willingness to undergo screening, actual participation remains low, indicating an intention-behavior gap. This study explored barriers that prevented individuals with documented screening willingness from completing dementia screening.

methodsThis descriptive phenomenological qualitative study drew on a preliminary survey conducted in two urban communities in Guangzhou, China, from November 16, 2021, to April 2, 2022. Among 439 individuals at high risk of dementia, 272 expressed willingness to undergo dementia screening. At the six-month follow-up, 156 individuals were successfully contacted; 19 had completed screening. Fifteen individuals with documented screening willingness but no subsequent screening behavior were purposively selected for semi-structured interviews between June and December 2022. Data were analyzed using Colaizzi's seven-step method.

resultsThree themes and nine sub-themes were identified. Theme 1, post-intentional hesitation in initiating screening, included low perceived urgency after initial willingness, fear- and stigma-driven postponement, and delayed self-initiation pending trusted confirmation. Theme 2, individual and familial constraints to intention enactment, included limited understanding of dementia screening, economic constraints and competing responsibilities, and insufficient instrumental support for screening attendance. Theme 3, service-level barriers to intention enactment, included fragmented and restricted access to screening services, perceived low credibility of community-based screening, and lack of follow-up or continuity of care. Overall, screening willingness was often postponed or remained unacted upon when screening was perceived as non-urgent, emotionally threatening, difficult to arrange, or insufficiently connected to a trustworthy care pathway.

conclusionAmong individuals at high risk of dementia who were willing to be screened, non-participation was shaped by delayed action, limited screening knowledge, fear and stigma, practical constraints, and service-level barriers. Community-based services should help willing older adults move from intention to action through clear information, emotional reassurance, practical assistance, credible screening procedures, and visible referral and follow-up support.