4.4. Limitations and Future Directions
memory complaints, MKN, ADRD
RECRUITMENT
There are some important limitations to acknowledge when interpreting the findings from this pilot. First, given the relatively small sample size, it is necessary to emphasize that participant attrition may limit generalizability and interpretation of the clinical outcomes reported. Our study was not powered to evaluate moderation effects, which may be an important next step for better understanding for whom and under what conditions MKN is most beneficial. Importantly, however, our results are consistent with the indicators of success based on the NIH ORBIT model for Phase II development and provide a green light for moving forward with intervention development in Phase III.Second, our inclusion criteria primarily focused on memory complaints and objective scores on a brief cognitive screening tool administered via telephone. As previously noted, this screening protocol may have led to recruitment of a sample with few cardiometabolic risks and relatively normal cognitive functioning, which may have limited our ability to detect clinically important changes on these factors. Protocols recruiting based on multiple risk factors for ADRDs (e.g., demographics, memory, and cardiometabolic) may provide a stronger participant pool for understanding risks and benefits of MKN for high-risk individuals. Further, it may be necessary to increase the number of long-term data collection assessments in order to better evaluate long-term effects of the program and MKN.Poor racial and ethnic representation in the current sample is another significant limitation that potentially limits the generalizability of our findings. An important future step in the refinement of the MKNA program will involve the use of community engaged research methods and recruitment strategies to increase the diversity of our sample. This issue is especially important in the context of ADRD and related risks, as there is strong evidence that black and Latino individuals [Finally, in order to address scalability of the MKNA program, an important next step in intervention development will involve increasing the structure and simplicity of presentation materials. Currently, the program is led by a clinical psychologist and nurse practitioner, which may not be feasible in many low-resource settings. For example, recorded videos of the nutrition education content, incorporating stop-points, and additional slides for leading guided discussions could provide a straight-forward format without need for extensive specialized training. This modification may be necessary to ensure that the program can be sustainably administered with high fidelity in a community setting by a community health worker.