The Challenges in Dementia Three-Level Prevention Services Through Integrated Care Theory: Insights from an Ethnographic Study
By: Taomei Zhang, Yueju Wang, Lili Li, Liping Tan, Lanshu Zhou, Huiling Li and Fengmei Tian
References
- Alzheimer’s Disease International. Dementia statistics. 2020. [cited 2024 Jan]. Available from:
https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/ . - Jia L, Du Y, Chu L, Zhang Z, Li F, Lyu D, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health. 2020;5(12):e661–e671. DOI: 10.1016/S2468-2667(20)30185-7
- Yu EY. Chinese Guideline of the Prevention and Treatment of Elderly Dementia. Beijing: People’s Medical Publishing House; 2021. [in Chinese].
- Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. DOI: 10.1016/S0140-6736(20)30367-6
- Zhang TM, Ye QQ, Zhang LX, Wen X, Meng WY, Li HL.
A Survey Report on the Current Status of Cognitive Impairment Awareness among Community Population in the Yangtze River Delta Region . Shanghai: China Association of Gerontology and Geriatrics; 2023. - Lian Y, Xiao LD, Zeng F, Wu X, Wang Z, Ren H. The Experiences of People with Dementia and Their Caregivers in Dementia Diagnosis. Journal of Alzheimer’s Disease. 2017;59(4):1203–1211. DOI: 10.3233/JAD-170370
- Dupuis S, McAiney C, Loiselle L, Hounam B, Mann J, Wiersma EC. Use of participatory action research approach to develop a self-management resource for persons living with dementia. Dementia. 2021;20(7):2393–2411. DOI: 10.1177/1471301221997281
- Zhao W, Wu MW, Petsky H, Moyle W. Family carers’ expectations regarding dementia care services and support in China: A qualitative study. Dementia. 2022;21(6):2004–2019. DOI: 10.1177/14713012221106817
- Enthoven AC. Integrated delivery systems: the cure for fragmentation. Am J Manag Care. 2009;15(10 Suppl):S284–S290.
- World Health Organization. Framework on integrated, people-centred health services. 2015. [cited 2024 Jan]. Available from:
https://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf . - Draper B, Low LF, Brodaty H. Integrated care for adults with dementia and other cognitive disorders. Int Rev Psychiatr. 2018;30(6):272–291. DOI: 10.1080/09540261.2018.1564021
- Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affair. 2008;27(3):759–769. DOI: 10.1377/hlthaff.27.3.759
- World Health Organization. WHO global strategy on people-centred and integrated health services: Interim report. Geneva; 2015. [cited 2024 Jan]. Available from:
https://iris.who.int/bitstream/handle/10665/155002/WHO_HIS_SDS_2015.6_eng.pdf . - Amelung V, Stein V, Goodwin N, Balicer R, Nolte E, Suter E. Handbook Integrated Care. Gewerbestrasse 11, 6330 Cham, Switzerland: Springer International Publishing AG; 2017. DOI: 10.1007/978-3-319-56103-5
- Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13:
e10 . DOI: 10.5334/ijic.886 - Government of the People’s Republic of China. Notice of the National Health Commission and 14 Other Departments on Jointly Issuing the National Action Plan for Addressing Dementia in Older Adults (2024–2030). 2025. [cited 2025 Nov] Available from:
https://www.gov.cn/zhengce/zhengceku/202501/content_6996231.htm . 2025. - Fetterman DM. Ethnography: Step-by-Step (3rd Edition). Thousand Oaks, CA: SAGE Publications; 2010.
- Morse JM. “Data were saturated…”. Qual Health Res. 2015;25(5):587–588. DOI: 10.1177/1049732315576699
- Valentijn PP, Vrijhoef HJ, Ruwaard D, Boesveld I, Arends RY, Bruijnzeels MA. Towards an international taxonomy of integrated primary care: a Delphi consensus approach. Bmc Fam Pract. 2015;16:64. DOI: 10.1186/s12875-015-0278-x
- Briggs AM, Valentijn PP, Thiyagarajan JA, Araujo De Carvalho I. Elements of integrated care approaches for older people: a review of reviews. Bmj Open. 2018;8(4):
e21194 . DOI: 10.1136/bmjopen-2017-021194 - Chen ZR, Zheng Y, Dai T, Wang QB. Study on evaluation framework of integrated health care system. Chinese Journal of Health Policy. 2018;11(4):29–35. DOI: 10.3969/j.issn.1674-2982.2018.04.006 [in Chinese].
- Bylund HB, Denzin NK. The Research Act: A Theoretical Introduction to Sociological Methods. Contemporary Sociology. 1972;1(4):322. DOI: 10.2307/2063497
- Department of Health and Care. Challenge on dementia 2020: implementation plan. 2016. [cited 2025 Nov]. Available from:
https://assets.publishing.service.gov.uk/media/5a816d6040f0b62305b8ee55/PM_Dementia-main_acc.pdf . 2025. - Gong N, Yang D, Zou J, He Q, Hu L, Chen W, et al. Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model. Bmc Geriatr. 2023;23(1):55. DOI: 10.1186/s12877-023-03756-x
- Shanghai Civil Affairs Bureau. Notice from the Shanghai Civil Affairs Bureau on Launching the Fifth Batch of Pilot Projects for the Construction of Elderly Cognitive Impairment Friendly Communities in the City. 2023. [cited 2025 Jan]. Available from:
https://www.shanghai.gov.cn/cmsres/fb/fb4a0caa638544d6b4a7aa1eb95ffb8f/9c8ad3b3e6b9e1d210e7e1a9f7a5d0ab.pdf . [in Chinese]. - Alzheimer’s Disease International. Dementia friendly communities key principles. 2015. [cited 2025 Jan]. Available from:
https://www.alzint.org/u/dfc-principles.pdf . - Yuan S, Wang F, Li X, Jia M, Tian M. Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study. Bmj Open. 2019;9(10):
e32444 . DOI: 10.1136/bmjopen-2019-032444 - Wu S, Lei Z, Liu T, Chen L, Qin Y. The analysis of factors influencing patient choice of healthcare providers between tertiary hospitals and community clinics. Front Public Health. 2025;13:1510311. DOI: 10.3389/fpubh.2025.1510311
- Ayeno HD, Atee M, Kassie GM, Nguyen TA. Knowledge, Attitude, and Practice of Care Providers Toward Non-Pharmacological Intervention for Managing Behavioural and Psychological Symptoms in Australian Aged Care Residents with Dementia: A Cross-Sectional Survey. Clin Gerontologist. 2025;48(5):1038–1056. DOI: 10.1080/07317115.2024.2419929
- Zhang T, Wen X, Jin Y, Lin L, Li H. Integrated Care Services for Dementia and Their Challenges from a Nursing Home Perspective: An Ethnographic Study. Int J Integr Care. 2024;24(4):12. DOI: 10.5334/ijic.8592
- Van Eck M, Ettema R, Cloin M, Van Regenmortel T. Facilitators and Barriers in Integrated Social Care for Families Facing Multiple and Complex Problems: A Scoping Review. Int J Integr Care. 2024;24:13. DOI: 10.5334/ijic.7768
- Zhang HN, Li J, Chen XL, Du J. Investigation on dementia management capabilities of general practitioners in urban district of Beijing. Chin J Gen Pract. 2022;(11):1043–1049. DOI: 10.3760/cma.j.cn114798-20220527-00537. [in Chinese].
- Subramaniam M, Ong HL, Abdin E, Chua BY, Shafie S, Siva KF, et al. General Practitioner’s Attitudes and Confidence in Managing Patients with Dementia in Singapore. Ann Acad Med Singap. 2018;47(3):108–118. DOI: 10.47102/annals-acadmedsg.V47N3p108
- Lin L, Lv S, Liang J, Li H, Xu Y. Level of Knowledge About Alzheimer’s Disease Among Nursing Staff in Suzhou and its Influencing Factors. Curr Alzheimer Res. 2019;16(7):650–658. DOI: 10.2174/1567205016666190726102935
- Haave RO, Skinner MS, Obstfelder A, Melby L. ‘See Me as a Person’: A Qualitative Study of Long-Term Care Recipients Perceptions of High-Quality Care. J Clin Nurs. 2025;34(5):1889–1899. DOI: 10.1111/jocn.17646
- Gorostiaga A, Etxeberria I, Salaberria K, Kortabitarte I. Primary and Secondary Caregivers of People with Dementia (PwD): Differential Patterns and Implications for Psychological Support. Healthcare-Basel. 2022;10(6):1102. DOI: 10.3390/healthcare10061102
- Pierse T, Keogh F, O’Shea E, Cullinan J. Geographic availability and accessibility of day care services for people with dementia in Ireland. Bmc Health Serv Res. 2020;20(1):476. DOI: 10.1186/s12913-020-05341-z.
DOI: https://doi.org/10.5334/ijic.9106 | Journal eISSN: 1568-4156
Language: English
Page range: 8 - 8
Submitted on: Jan 11, 2025
Accepted on: Jun 15, 2026
Published on: Aug 10, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Taomei Zhang, Yueju Wang, Lili Li, Liping Tan, Lanshu Zhou, Huiling Li, Fengmei Tian, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.