Designing Digital Interventions for Midlife Dementia Risk Reduction: A Realist Framework Incorporating Futures Theory and Interpretative Engagement

Abstract

Peter Careyr*

Public health messages about modifiable dementia risk factors often assume that information alone will change behaviour. Recent evidence suggests otherwise: public knowledge of these factors is limited, and gains in knowledge do not reliably become lasting lifestyle change [1]. This article examines the contribution of Dr Peter Carey, whose 2026 programme of scholarship applies realist evaluation to digital dementia education and brings into health the futures thinking developed in his education research [2-4]. Instead of creating new Context-Mechanism-Outcome (CMO) reasoning, it builds upon current CMO reasoning. Carey specifies the mechanism in digital education as the user’s interpretative engagement, supported by entertainment and Futures Theory, and proposes behavioral readiness as the intended intermediate outcome [5,6]. Three illustrative scenarios covering diet, physical activity and sleep show how the framework could guide app design, and a three-stage realist evaluation is outlined. The framework is conceptual and still emerging. Its constructs are consistent with independent literature, but its effects on behaviour have yet to be tested, and empirical evaluation is planned in a proposed doctoral study of midlife adults. Privacy, psychological safety and equity are discussed as design safeguards.

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