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국문

1. 연구의 목적과 배경
고령사회로 진입한 한국 상황에 대비하여 다수의 지역사회에서는 치매 예방 중재 프로그램들을 시행하고 있으나, 시·공간 및 인적자원의 부족으로 인해 소수의 노인만이 혜택을 받고 있다. 그러므로 치매 예방을 위한 서비스의 혜택을 최대한 재가에서 받을 수 있도록 실질적인 여건을 마련하는 것이 중요하다. 이러한 상황에 맞추어 다양한 분야의 치매 전문가들은 한국형 치매 예방 다중영역 중재프로그램(이하 슈퍼브레인)을 개발하고 적용가능성을 조사하기 위한 연구를 진행하였다. 고위험군 비치매 노인들을 대상으로 기관 및 재가에서 6개월 동안 혈관, 인지, 운동, 영양, 동기의 다중영역 중재를 실시한 결과, 슈퍼브레인 프로그램이 치매 예방에 효과적임을 밝혔다. 그러나 해당 연구에서는 치매 예방 행동을 실천하도록 돕는 동기강화 개입의 독립적인 효과를 확인하기 어렵다는 제한점이 있다. 따라서 본 연구에서는 스마트폰 앱을 활용하여 강화된 실천동기가 인지, 운동, 영양의 3가지 영역에서 행동변화를 이끄는 데 효과적인지 알아보는 것이 목표이다.

2. 연구대상자 및 중재방법, 측정변수
본 연구는 만 60-79세의 치매예방에 관심이 있고, 인터넷 연결이 가능한 안드로이드 스마트폰을 소지한 비치매 노인들을 대상으로 진행한다. 연구대상자들은 아주대병원 정신건강의학과에 내원하여 1회의 치매 예방 활동에 대한 교육 및 교육자료를 받은 후 8주간 재가에서 개별적으로 인지, 운동, 영양 영역의 치매 예방 활동을 실시한다. 그러나 중재군은 대조군과 달리, 재가에서 치매 예방 활동을 실시하는 동안 동기강화 스마트폰 앱을 활용하여 주 1회의 가족응원영상 및 금/은메달평가를 통한 자가 모니터링을 실시한다.  
* 연구 측정변수 : K-MMSE, 성격5요인, 시간적 할인율, 노인우울척도, 인지활동점수, 국제신체활동설문지, MIND 식사 점수, 변화준비단계, 상황적 동기유형, 계획된 행동이론(치매 예방에 대한 태도, 주관적 규범, 지각된 행동통제력), 치매 예방 행동의도, 만족도 설문지 

3. 연구 가설
8주의 중재 이후 대조군과 중재군의 치매예방 활동 수준에 차이가 있을 것이다.

4. 연구 결과로 인한 기대효과
본 연구를 통해 스마트폰을 활용한 동기강화 개입이 동기를 유발하고 강화하는 데 효과적임을 밝힘으로써 의료, 보건, 복지서비스를 최대한 재가에서 받을 수 있도록 실질적인 여건을 마련할 수 있을 것이다. 또한 지역사회에서 동기강화 스마트폰 앱을 사용하여 노인들의 프로그램 참여를 쉽게 유도할 수 있으며, 환자, 가족, 사례관리자 및 의료진 간의 사회적 지지체계를 강화할 수 있을 것이라 기대한다.

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1. The Purpose and Background of the Study
In preparation for the situation in Korea, which has entered the aged society, many communities have been implementing cognitive impairment prevention or brain health intervention programs. However, only a small number of the senior population benefit from those programs due to the lack of time, space, and human resources. Thus, it is important to establish practical conditions in which senior citizens can benefit from such services at home as much as possible. In line with this situation, experts in various fields of dementia have conducted a study to develop and investigate the applicability of Korean multidomain intervention program to prevent cognitive impairment, referred to as SUPERBRAIN. After six months of a multidomain intervention at institutions and homes for at-risk elderly people, the SUPERBRAIN program has been shown to be effective in preventing cognitive impairment. But there is a limitation in this study that it is difficult to identify the independent effects of the motivational enhancement intervention. Therefore, this study aims to verify whether the motivation enhancement intervention delivered through a mobile application is effective in driving behavioral changes in three areas: cognition, exercise, and nutrition.

2. Participants, Methods, and Measurements
This study is conducted on elderly people aged 60 to 79 years who are interested in preventing cognitive impairment and have an Android smartphone with a Wi-Fi connection. The subjects of the study will visit the Department of Psychiatry at Ajou University Hospital for a session of brain health-related education and will individually practice various activities based on the education manual at home for 8 weeks. Unlike the control group, however, the experimental group will utilize the mobile application to receive videos from their family members supporting them and to self-monitor their activities through a medal evaluation once a week.
*Measurements: K-MMSE (Korean Mini-Mental State Examination), BFI-K (Big Five Inventory-Korean version), Temporal discounting, GDS-15 (Geriatric Depression Scale-15 items), Cognitive Activity Score, GPAQ (Global Physical Activity Questionnaire), MIND Diet Score, Readiness to Change Questionnaire, SIMS (Situational Motivational Scale), Theory of Planned Behavior Questionnaire, Behavioral intention for brain health, Satisfaction questionnaire

3. Hypotheses
There will be statistically significant differences in the level of brain health activities between the control group and the experimental group after 8 weeks of intervention.

4. Expected Utility
From this study, we expect to identify the effects of the motivation enhancement intervention through a smartphone application, establishing practical conditions in which senior people could receive medical, health and welfare services at home. Also, it is expected that the use of the motivation enhancement application in communities will make it easier for the elderly to participate in various intervention programs and will strengthen the social support system among patients, families, and medical staffs.

국문

아주대병원 정신건강의학과에 내원하여 1회의 치매예방 활동 교육을 받은 후 교육자료를 바탕으로 8주간 자택에서 개별적으로 치매예방 활동을 실시한다. 시험군의 경우, 치매예방 활동 교육과 더불어 스마트폰 동기강화 앱 사용법에 대한 교육을 받은 후 재가 치매예방 활동을 실시하는 동안 동기강화 앱을 활용한다. 시험군은 동기강화 앱을 통하여 가족, 친구, 의료진 등의 지지와 응원이 담긴 영상을 시청하고, 한 주간 치매예방 활동에 대한 자신의 노력 정도를 금메달 또는 은메달로 평가하며 자신의 성취 수준을 확인할 수 있다.

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The subjects of the study will visit the Department of Psychiatry at Ajou University Hospital for a session of brain health-related education and will individually practice various activities based on the education manual at home for 8 weeks. Unlike the control group, however, the experimental group will utilize the mobile application to receive videos from their family members supporting them and to self-monitor their activities through a medal evaluation once a week.

상세내용 영문

The subjects in the experimental group will visit the Department of Psychiatry at Ajou University Hospital for a session of brain health-related education and will individually practice various activities based on the education manual at home for 8 weeks. Unlike the control group, however, the experimental group will utilize the mobile application to receive videos from their family members supporting them and to self-monitor their activities through a medal evaluation once a week.

상세내용 영문

The subjects in the control group will visit the Department of Psychiatry at Ajou University Hospital for a session of brain health-related education and will individually practice various activities based on the education manual at home for 8 weeks without the mobile application.

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The subjects of this study are the elderly without dementia who are interested in brain health (including the elderly with subjective memory impairment or mild cognitive impairment).

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Adherence rate

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Every week

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Brain health activities(Cognitive Activity Score, Global Physical Activity Questionnaire, MIND Diet Score)

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1st visit, the end of the study

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Behavioral intention for brain health

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The end of the study

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Motivation(Readiness to Change Questionnaire, Situational Motivational Scale)

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1st visit, the end of the study

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Key variables of the theory of planned behavior(Attitude toward the behavior, subjective norm, perceived behavioral control)

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1st visit, the end of the study

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The purpose of this study was to confirm the effectiveness of the motivation-enhancing smartphone application on the brain health activity level of cognition, exercise, and nutrition. For this purpose, random assignment was conducted for the elderly people aged 60 to 79 years who agreed to the study, and finally 40 people (20 in the intervention group, 20 in the control group) completed the study. For 8 weeks, both the intervention group and the control group performed cognitive, exercise, and nutritional brain health activities autonomously, but the intervention group additionally watched support videos from family, friends, and medical staff through a smartphone application and conducted self-evaluating.  As a result, it was found that the intervention group had a positive (+) relationship with intrinsic motivation and moderate-intensity physical activity compared to the control group. In addition, as a result of examining adherence to the intervention program through the brain health activity diary, it was found that the intervention group maintained the activity performance longer than the control group. We suggest that the motivation enhancement application could be an efficient option for maintaining and promoting psychosocial health behavior. Also, as our smartphone application is not restricted to dementia, it can be applicable on many other diseases that need behavioral change. Further research is required to evaluate effectiveness of the smartphone application in other diseases.