A Mixed-Methods Study on Collaborative Health Governance for Older Adults with Mild Cognitive Impairment in Hangzhou, China

Yiqi Kong¹Zihan Xu¹Zhiyou Zhu¹Lan Ye²Siyu Zhou^1*

• ¹Hangzhou Normal University, Hangzhou, China
• ²Party School of Shanghai Municipal Committee of the Chinese Communist Party, Shanghai, China

Introduction: Mild cognitive impairment (MCI), a prodromal stage of Alzheimer's disease, poses a critical public health challenge in aging populations. Current community-based MCI interventions are often fragmented, lacking effective collaboration among families, community workers, and physicians. This study aimed to construct a multi-agent collaborative governance model and propose optimization strategies for community-based MCI management. Methods: A mixed-methods design was employed in Hangzhou, China. Quantitatively, 373 community-dwelling older adults with MCI completed the Family APGAR Index, Social Isolation Scale, and Mini-Mental State Examination (MMSE). Structural equation modeling (SEM) was used to analyze the pathways linking social isolation, family support, and cognitive domains. Qualitatively, thematic analysis was conducted on in-depth interviews with four community workers and four family physicians to delineate stakeholder responsibilities and collaboration challenges. Results: The quantitative results revealed a dual effect of family support: it was positively associated with memory and calculation ability (path coefficient = 0.176, P < 0.05) but negatively associated with reading and praxis ability (path coefficient = -0.164, P < 0.05). Reduced social isolation significantly enhanced family support (β = 0.405, P < 0.001). Furthermore, positive feedback loops were identified among cognitive domains (orientation, reading/praxis, memory/calculation). Qualitatively, key barriers included the absence of structured collaboration mechanisms, passive information-sharing, and insufficiently trained family caregivers. Discussion and Conclusion: This study underscores the complex role of family support and the necessity of integrated care. We propose a tripartite "Social Worker–Physician–Family" collaborative framework, featuring skill-building curricula, psychological support, and cross-sectoral data linkage protocols to optimize health outcomes. However, due to the cross-sectional design, causal inferences are limited, and longitudinal studies are needed to validate the pathways. The findings offer empirical evidence and practical insights for designing community-based interventions for early-stage cognitive impairment in aging societies.