{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:29:41Z","timestamp":1786375781143,"version":"build-2736575974"},"reference-count":37,"publisher":"Ubiquity Press, Ltd.","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Integr Care"],"abstract":"<jats:p>Background: The number of older adults living with dementia is increasing in China and worldwide. Three-level prevention is vital to delay the occurrence and development of dementia. However, the current state of these services remains suboptimal. This study aimed to explore the programs and challenges in providing dementia prevention services.\nMethods: A one-year ethnographic study, including semi-participatory observations and in-depth interviews, was conducted in nine settings in China from July 2022 to June 2023. Twenty-four service providers and 26 residents or family members were observed, and seventeen of these 50 participants were interviewed. Data collection was guided by the Rainbow Model. A combination of deductive and inductive content analysis was applied to identify the challenges.\nResults: Dementia-friendly communities, Dementia Screening Program, Medical Consortia, and Long-term care services were the main programs in dementia three-level prevention services. This study identified 32 challenges, including four at the system level, ten at the organizational level, seven each at the professional and clinical levels, and four additional challenges.\nConclusions: Enriching the diversity of programs and strengthening primary prevention services will be beneficial for improving the dementia three-level services. The challenges identified in this study can provide valuable insights to guide targeted interventions, inform policy, and optimize service delivery for relevant stakeholders.<\/jats:p>","DOI":"10.5334\/ijic.9106","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:50:41Z","timestamp":1786373441000},"page":"8","source":"Crossref","is-referenced-by-count":0,"title":["The Challenges in Dementia Three-Level Prevention Services Through Integrated Care Theory: Insights from an Ethnographic Study"],"prefix":"10.5334","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-0275","authenticated-orcid":false,"given":"Taomei","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8862-4341","authenticated-orcid":false,"given":"Yueju","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5914-9727","authenticated-orcid":false,"given":"Lili","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-0435","authenticated-orcid":false,"given":"Liping","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-3972","authenticated-orcid":false,"given":"Lanshu","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9025-436X","authenticated-orcid":false,"given":"Huiling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6575-3929","authenticated-orcid":false,"given":"Fengmei","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"key20260810145038_B1","unstructured":"Alzheimer\u2019s Disease International. Dementia statistics. 2020. [cited 2024 Jan]. 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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."},{"issue":"6","key":"key20260810145038_B11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/09540261.2018.1564021","article-title":"Integrated care for adults with dementia and other cognitive disorders","volume":"30","year":"2018","journal-title":"Int Rev Psychiatr"},{"issue":"3","key":"key20260810145038_B12","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1377\/hlthaff.27.3.759","article-title":"The triple aim: care, health, and cost","volume":"27","year":"2008","journal-title":"Health Affair"},{"key":"key20260810145038_B13","unstructured":"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."},{"key":"key20260810145038_B14","volume-title":"Handbook Integrated Care","year":"2017"},{"key":"key20260810145038_B15","article-title":"Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care","volume":"13","year":"2013","journal-title":"Int J Integr Care"},{"key":"key20260810145038_B16","unstructured":"Government of the People\u2019s 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\u20132030). 2025. [cited 2025 Nov] Available from: https:\/\/www.gov.cn\/zhengce\/zhengceku\/202501\/content_6996231.htm. 2025."},{"key":"key20260810145038_B17","volume-title":"Ethnography: Step-by-Step","year":"2010","edition":"3rd"},{"issue":"5","key":"key20260810145038_B18","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/1049732315576699","article-title":"\u201cData were saturated\u2026\u201d","volume":"25","year":"2015","journal-title":"Qual Health Res"},{"key":"key20260810145038_B19","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12875-015-0278-x","article-title":"Towards an international taxonomy of integrated primary care: a Delphi consensus approach","volume":"16","year":"2015","journal-title":"Bmc Fam Pract"},{"issue":"4","key":"key20260810145038_B20","article-title":"Elements of integrated care approaches for older people: a review of reviews","volume":"8","year":"2018","journal-title":"Bmj Open"},{"issue":"4","key":"key20260810145038_B21","first-page":"29","article-title":"Study on evaluation framework of integrated health care system","volume":"11","year":"2018","journal-title":"Chinese Journal of Health Policy"},{"issue":"4","key":"key20260810145038_B22","doi-asserted-by":"crossref","first-page":"322","DOI":"10.2307\/2063497","article-title":"The Research Act: A Theoretical Introduction to Sociological Methods","volume":"1","year":"1972","journal-title":"Contemporary Sociology"},{"key":"key20260810145038_B23","unstructured":"Department of Health and Care. 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