Dyadic Management Intervention in Older People With Co-occurring Cognitive Impairment and Diabetes as a Supplementary Approach to Chronic Diseases Self-Management Program

Glycated hemoglobin (HbA1c) measures average blood sugar levels over the past 2-3 months, acting as a crucial diagnostic and management tool for diabetes. A level below 7% is recommended for patients with diabetes.

Subjective Cognitive Decline Questionnaire 21 (SCD-Q21) is a reliable, validated 21-item tool designed to detect self-reported cognitive changes, helping distinguish Mild Cognitive Impairment (MCI) from healthy people. The score is from 0 to 21, with a higher score corresponding to a greater likelihood of MCI.

Montreal Cognitive Assessment (MoCA) is a widely used screening scale designed to detect mild cognitive impairment, with scores from 0 to a maximum of 30 points. A higher score on MoCA indicates better cognitive function and less impairment.

Caregiver Contribution to Self-Care of Diabetes Inventory (CC-SCODI) is a validated scale measuring caregiver efforts in diabetes maintenance, monitoring, and management. The score is from 0 to 100 points, with a higher score indicating higher caregiver involvement.

Caregiver Burden Inventory (CBI) is a scale measuring multidimensional caregiver burden. Score is from 0 to 96 points, with a higher score indicating higher perceived caregiver burden.

Acceptability of Intervention Measure (AIM) is a questionnaire assesses how acceptable the intervention is perceived to be by the participants. The total score ranges from 4 to 20, with higher scores indicating greater acceptability of the intervention. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

Intervention Appropriateness Measure (IAM) is a questionnaire evaluates how suitable or relevant the intervention is for the intended purpose or context. The total score ranges from 4 to 20, with higher scores indicating the intervention is perceived as more appropriate. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

Implementation Outcome: Feasibility of Intervention Measure (FIM) is a questionnaire examines how practical and implementable the intervention is in real-world settings. The total score ranges from 4 to 20, with higher scores indicating greater feasibility of implementing the intervention. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

This Adoption questionnaire is derived from the Measuring the Use of the RE-AIM Model Dimension Items Checklist and is designed to assess the adoption of an intervention at both the setting and staff levels. It evaluates factors such as participation rates, reasons for exclusion, and characteristics of participating versus non-participating settings and staff. The measure does not use a specific scoring system; instead, it relies on qualitative and descriptive insights to explore adoption. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

This Fidelity questionnaire is derived from the Fidelity Checklist for Chronic Disease Self-Management Education Programs and is designed to evaluate the consistency and quality of program implementation. It uses a performance checklist to ensure that the intervention is delivered as intended. The measure does not use a specific scoring system; instead, it relies on qualitative and descriptive insights to explore adoption. If more items on the Fidelity Checklist are met, it indicates better fidelity to the program's design. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

This cost outcome focuses on evaluating the economic aspects of the intervention by measuring health-related quality of life using the EQ-5D-5L questionnaire (EuroQol 5-Dimension 5-Level questionnaire), collecting expenditures associated with delivering the intervention (e.g., material costs, staff training, and technical support), and assessing patients' health utilization costs, such as medical expenses, follow-up time, and related financial costs (e.g., transportation). It also considers indirect costs, such as income loss for patients or caregivers, long-term healthcare savings from improved outcomes, and time costs for participants and staff. The collected data will support a cost-effectiveness analysis, providing a comprehensive evaluation of the intervention's value relative to its costs. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

This Penetration questionnaire is derived from the RE-AIM Model Dimension Items Checklist and is designed to evaluate how representative the enrolled patients are of the target population by counting and comparing the number of patients with co-occurring diabetes and MCI who are eligible, invited, excluded, and enrolled to receive CDSMP within participating organizations. Comparisons will be made to non-participants based on key demographic data, including age, diabetes type, MOCA scores and duration, and the number of follow-up attendances. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.

This Sustainability questionnaire is derived from the RE-AIM Model Dimension Items Checklist and is designed to assess the sustainability of an intervention over time. It includes three key components: Maintenance, which evaluates the long-term impact and continuation of the intervention; Individual Level, which focuses on the persistence of individual behavior changes and health outcomes (e.g., maintaining improvements in quality of life or clinical outcomes at 6 months or more post-intervention); and Setting Level, which examines whether the intervention is institutionalized within the organization, including alignment with the organization's mission, resource allocation, and adaptation for long-term implementation. The measure relies on qualitative and descriptive insights rather than a specific scoring system. Additionally, qualitative interviews with patients and relevant stakeholders are conducted to further evaluate this outcome.