Extending Context–Mechanism–Outcome Theory for Digital Dementia Risk-Reduction Education: A Realist-Informed Conceptual Framework for Future Theory Development

Abstract

Peter Carey

Background: Dementia prevention has emerged as a global public health priority, with growing evidence indicating that a substantial proportion of dementia cases may be delayed or prevented through modification of life-course risk factors. Despite this expanding epidemiological evidence base, translating knowledge into sustained behavioural change remains a persistent challenge. Digital dementia risk-reduction education offers unprecedented opportunities to increase public access to evidence-based prevention information; however, existing approaches frequently emphasise information delivery rather than explaining the processes through which individuals interpret, internalise, and act upon that information.

Objective: This paper examines the theoretical foundations of Context–Mechanism–Outcome (CMO) reasoning within realist evaluation and proposes a domain-specific realist-informed conceptual framework to strengthen explanation of how digital dementia risk-reduction education may influence behavioural readiness and preventive action.

Methods: A conceptual synthesis was undertaken drawing upon critical realism, realist evaluation, health literacy, behaviour change theory, implementation science, and contemporary dementia prevention literature. The paper also synthesises an emerging programme of conceptual scholarship on dementia prevention literacy and digital dementia education to develop a coherent programme theory for future empirical investigation [1-5].

Results: The proposed framework extends established CMO reasoning by distinguishing broader contextual influences, digital intervention characteristics, resource availability, and user engagement while proposing interpretative engagement as a potential generative mechanism through which individuals construct meaning from dementia prevention information. Behavioural readiness is positioned as an intermediate outcome linking interpretation with sustained dementia risk-reduction behaviours. The framework integrates complementary theoretical traditions into a single explanatory model capable of informing future realist evaluation of digital dementia interventions.

Conclusions: Rather than replacing established realist evaluation, the proposed framework provides a domain-specific refinement designed to improve theoretical explanation within digital dementia risk-reduction education. By emphasising interpretation, meaning-making, and behavioural readiness, the framework offers a foundation for future empirical testing and contributes to ongoing theory development within realist-informed digital health research.

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