The Challenges in Dementia Three-Level Prevention Services Through Integrated Care Theory: Insights from an Ethnographic Study.

Background: The number of older adults living with dementia is increasing in China and worldwide. Three-level prevention is vital to delay the occurrence and development of dementia. However, the current state of these services remains suboptimal. This study aimed to explore the programs and challenges in providing dementia prevention services. Methods: A one-year ethnographic study, including semi-participatory observations and in-depth interviews, was conducted in nine settings in China from July 2022 to June 2023. Twenty-four service providers and 26 residents or family members were observed, and seventeen of these 50 participants were interviewed. Data collection was guided by the Rainbow Model. A combination of deductive and inductive content analysis was applied to identify the challenges. Results: Dementia-friendly communities, Dementia Screening Program, Medical Consortia, and Long-term care services were the main programs in dementia three-level prevention services. This study identified 32 challenges, including four at system level, ten at organizational level, seven each at professional and clinical levels, and four additional challenges. Conclusions: Enriching the diversity of programs and strengthening primary prevention services will be beneficial for improving the dementia three-level services. The challenges identified in this study can provide valuable insights to guide targeted interventions, inform policy, and optimize service delivery for relevant stakeholders.