A Self-Guided E-Learning Program Improves Metamemory Outcomes in Healthy Older Adults: A Randomized Controlled Trial

The majority of older adults will experience normal age-related memory changes. Memory programs offer a promising solution to mitigate decline and promote brain health. Memory programs have evolved over time, progressing from single mnemonic techniques to the combination of mnemonics, then to multicomponent programs offering participants a more holistic approach to enhancing their memory and brain health. A large body of literature demonstrates that in-person memory interventions can increase knowledge, support the acquisition of memory strategies, improve metamemory outcomes, and promote healthy lifestyle behaviors among participants. With the advancement of technology and the goal of attaining scalable and accessible solutions, researchers and clinicians are developing online memory programs. Our team developed a self-guided, e-learning program based on the well-validated, in-person Memory and Aging Program®. The objective of this dissertation was to evaluate efficacy of the e-learning program compared to a waitlisted control group through a randomized controlled trial. The trial was registered at clinicaltrials.gov (identifier: NCT03602768). As part of a larger, multi-arm, controlled trial, 115 healthy older adults (ages 60-84, 71% female) were randomized into an intervention or a delayed-start control condition. Team members involved in data collection were masked to participant grouping. Outcome measures were completed by telephone interviews (assessing memory knowledge) and online questionnaires (assessing metamemory and health-promoting lifestyle behaviors) at three time points (pre-program, post-program, and 6- to 8-week follow-up). Reasons for attrition were explored with a brief feedback survey. Improvements over time in memory knowledge, the acquisition of memory strategies and their use in daily life, and memory satisfaction and ability were larger in the group that completed the intervention than the control group. There was no interaction effect for health-promoting lifestyle changes. Attrition was 43%, and the most common participant-reported reasons for attrition included a breakdown in communication, personal circumstances, dissatisfaction with the e-learning program, and technical/instructional issues. Overall, this self-guided, e-learning memory program may be an effective, accessible, flexible, and potentially cost-effective intervention that has the potential to achieve similar metamemory outcomes as the original in-person version in participants that complete the program. This research identified opportunities to design e-learning interventions to better support healthy lifestyle changes and potentially improve participant retention. Findings are discussed in relation to evidence-based practice in psychology.