Principal Findings
anxiety
RECRUITMENT, ATTRITION
OPTIMiSE—a 6-week web-based memory strategy training program—was shown to be feasible, acceptable, and efficacious for older adults with cognitive concerns. In terms of feasibility, a strong demand for the program was evident in the quick and relatively effortless recruitment. More than 600 people registered interest in OPTIMiSE over only 28 days, well exceeding our recruitment goal of 153, even though recruitment was only conducted through 2 organizations (U3A and Probus). Attrition was evenly distributed across the main course period, suggesting that there were no specific modules that were associated with greater attrition. Although the attrition rate is greater than that usually observed for in-person interventions [The program was acceptable to the target group, with 97.4% (150/154) of participants reporting that they would recommend it to someone else and 83.1% (128/154) of participants providing positive evaluations across all aspects of the program evaluated. This was similar to the end-of-course ratings in another web-based memory program for older adults [OPTIMiSE was also efficacious, with postintervention improvements seen across all outcome measures, including knowledge of memory and aging, memory strategy knowledge and use, self-reported memory ability, achievement of personal memory goals, contentment with memory, and mood symptoms, and effect sizes similar to or larger than those observed after in-person interventions [After OPTIMiSE, an additional theme of learning specific strategies was identified, whereas the theme of shared experiences, present after in-person interventions, was missing. This likely reflects the connections between individuals who are in the same room at the same time, compared with completing a course asynchronously with the only interaction via discussion boards. When developing OPTIMiSE, we aimed to balance increased access, cost-effectiveness, and resource effectiveness through web-based asynchronous delivery with ensuring that participants could communicate with peers, given the importance of peer comparison and interaction to foster the normalization of memory concerns [The themes of reduced anxiety and increased confidence in memory were also seen in responses during the booster session regarding the application of knowledge and strategies from OPTIMiSE into everyday life. Many participants reported that they had been able to select strategies from OPTIMiSE that worked for them and applied these beneficially in their everyday lives. Some participants noted that although they had used the strategies throughout the course, they had not been applying them after the course ended. Most participants did not provide reasons for not maintaining the use of the strategies, although some mentioned being busy during the summer months between course completion and the booster session. Further exploration of potential barriers to maintaining the application of strategies, perhaps using in-depth qualitative interviews, would be helpful in understanding what does and does not facilitate the implementation of these strategies in everyday life.There was no consensus regarding which strategies were the most or least useful. Increased confidence and paying attention or focusing on information were reported commonly, but all the strategies discussed in OPTIMiSE were mentioned by at least one participant, reflecting the diversity of needs even within this relatively homogenous cohort. Thus, teaching a wide range of different strategies is important, as different techniques will suit different individuals and different settings, as previously noted [