Original Articles

Collective efficacy and community readiness for dementia prevention: a spatial spillover analysis

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 8 June 2026
0
Views
0
Downloads

Authors

Dementia represents a growing public health challenge in Taiwan, particularly within its rapidly aging population. This study employed the Community Readiness Model (CRM) to systematically assess community readiness for dementia prevention across multiple domains. It further examined whether collective efficacy, defined as shared social cohesion and a community’s capacity for collective action, is associated with greater readiness for dementia-related prevention efforts. A cross-sectional survey was conducted from March to June 2021 among 3,129 community leaders in 456 communities in Taipei City. A total of 447 valid responses were analyzed, representing 288 communities (63.2% of all communities). A spatial lag regression model was conducted, and spatial spillover effects were further assessed. Spatial lag regressions revealed that willingness to intervene (B=0.256, p<0.0001), social cohesion (B=0.375, p<0.0001), and prior dementia prevention programs (B=1.036, p=0.01) were significantly associated with higher community readiness for dementia prevention. Spill-over patterns — particularly for social cohesion and prior programs — appeared to play a potential, though not fully conclusive, role in shaping readiness across neighbouring communities. Those with higher proportions of residents aged 85+ showed lower readiness, while average income was not a significant predictor. Collective efficacy and prior dementia efforts were associated with higher community readiness. Tailored, community-based strategies that foster social cohesion and proactive engagement while accounting for spatial disparities are considered essential for effective dementia prevention.

Downloads

Download data is not yet available.

Citations

Adane D, Yeshaneh A, Wassihun B, Gasheneit A, 2021. Level of community readiness for the prevention of covid-19 pandemic and associated factors among residents of Awi Zone, Ethiopia: A community-based cross-sectional study. Risk Manag Healthc Policy 14:1509–24. DOI: https://doi.org/10.2147/RMHP.S302974
Anselin L, Moreno R, 2003. Properties of tests for spatial error components. Reg Sci Urban Econ 33:595–618. DOI: https://doi.org/10.1016/S0166-0462(03)00008-5
Backhouse A, Ukoumunne OC, Richards DA, McCabe R, Watkins R, Dickens C, 2017. The effectiveness of community-based coordinating interventions in dementia care: A meta-analysis and subgroup analysis of intervention components. BMC Health Serv Res 17:717. DOI: https://doi.org/10.1186/s12913-017-2677-2
Baller RD, Anselin L, Messner SF, Deane G, Hawkins DF, 2001. Structural covariates of U.S. county homicide rates: Incorporating spatial effects. Criminology 39:561–88. DOI: https://doi.org/10.1111/j.1745-9125.2001.tb00933.x
Bivand R, Piras G, 2015. Comparing implementations of estimation methods for spatial econometrics. J Stat Softw 63:1–36. DOI: https://doi.org/10.18637/jss.v063.i18
Chen DR, Liu PH, Kuo CT, 2025. Cluster analysis of community readiness for dementia prevention in Taipei City. Taiwan J Public Health 44:364–80.
Chuang YC, Chuang KY, Yang TH, 2013. Social cohesion matters in health. Int J Equity Health 12:87. DOI: https://doi.org/10.1186/1475-9276-12-87
Cureton JL, Clemens EV, Henninger J, Couch C, 2020. Pre-professional suicide training for counselors: Results of a readiness assessment. Int J Ment Health Addiction 18:27–40. DOI: https://doi.org/10.1007/s11469-018-9898-4
Darmofal D, 2015. Spatial analysis for the social sciences. Cambridge: Cambridge University Press. DOI: https://doi.org/10.1017/CBO9781139051293
Donnermeyer JF, Plested BA, Edwards RW, Oetting G, Littlethunder L, 1997. Community readiness and prevention programs. J Community Dev Soc 28:65–83. DOI: https://doi.org/10.1080/15575339709489795
Gagne MH, Drapeau S, Clement ME, 2020. Community readiness for child maltreatment prevention: The challenge of a brief assessment. J Prim Prev 41:299–316. DOI: https://doi.org/10.1007/s10935-020-00591-3
Gan DR, Chaudhury H, Mann J, Wister AV, 2022. Dementia-friendly neighborhood and the built environment: A scoping review. Gerontologist 62:e340–56. DOI: https://doi.org/10.1093/geront/gnab019
Gansefort D, Brand T, Princk C, Zeeb H, 2018. Community readiness for the promotion of physical activity in older adults—A cross-sectional comparison of rural and urban communities. Int J Environ Res Public Health 15:453. DOI: https://doi.org/10.3390/ijerph15030453
Gleditsch K, Ward MD, 2008. Spatial regression models. Thousand Oaks: Sage Publications.
Groff ER, 2015. Informal social control and crime events. J Contemp Crim Justice 31:90–106. DOI: https://doi.org/10.1177/1043986214552619
Hung L, Hudson A, Gregorio M, Jackson L, Mann J, Horne N, Berndt A, Wallsworth C, Wong L, Phinney A, 2021. Creating Dementia-Friendly Communities for Social Inclusion: A Scoping Review. Gerontol Geriatr Med 7:23337214211013596. DOI: https://doi.org/10.1177/23337214211013596
Ickes MJ, Wiggins A, Hahn EJ, 2018. Online readiness assessment for Smoke- and Tobacco-free campus policies. J Am Coll Health 66:817–20. DOI: https://doi.org/10.1080/07448481.2018.1440570
Islam S, Small N, Bryant M, Bridges S, Hancock N, Dickerson J, 2019. Assessing community readiness for early intervention programmes to promote social and emotional health in children. Health Expect 22:575–84. DOI: https://doi.org/10.1111/hex.12887
Islam S, Small N, Bryant M, Yang T, Cronin de Chavez A, Saville F, Dickerson J, 2019. Addressing obesity in Roma communities: A community readiness approach. Int J Hum Rights Healthc 12:79–90. DOI: https://doi.org/10.1108/IJHRH-06-2018-0038
Jiang S, Wang J, Lambert E, 2010. Correlates of informal social control in Guangzhou, China neighborhoods. J Crim Justice 38:460–9. DOI: https://doi.org/10.1016/j.jcrimjus.2010.04.015
Kelly KJ, Edwards RW, Comello MLG, Plested BA, Thurman PJ, Slater MD, 2003. The Community Readiness Model: A Complementary Approach to Social Marketing. Mark Theory 3:411–26. DOI: https://doi.org/10.1177/1470593103042006
Kostadinov I, Daniel M, Stanley L, Gancia A, Cargo M, 2015. A systematic review of community readiness tool applications: Implications for reporting. Int J Environ Res Public Health 12:3453–68. DOI: https://doi.org/10.3390/ijerph120403453
Lambert EG, Jaishankar K, Jiang S, Pasupuleti S, Bhimarasetty JV, 2012. Correlates of formal and informal social control on crime prevention: An exploratory study among university students, Andhra Pradesh, India. Asian J Criminol 7:239–50. DOI: https://doi.org/10.1007/s11417-011-9108-9
Markowitz FE, Bellair PE, Liska AE, Liu J, 2001. Extending social disorganization theory: Modeling the relationships between cohesion, disorder, and fear. Criminology 39:293–319. DOI: https://doi.org/10.1111/j.1745-9125.2001.tb00924.x
Millar L, Robertson N, Allender S, Nichols M, Bennett C, Swinburn B, 2013. Increasing community capacity and decreasing prevalence of overweight and obesity in a community based intervention among Australian adolescents. Prev Med 56:379–84. DOI: https://doi.org/10.1016/j.ypmed.2013.02.020
Ministry of Health and Welfare, 2018. Dementia prevention and care policy and action plan 2.0 (2018–2025). Taipei: Ministry of Health and Welfare. Available from: https://www.mohw.gov.tw/cp-139-541-2.html
Ministry of Health and Welfare, 2024. The results of the epidemiological survey on dementia in Taiwan’s communities. Taipei: Ministry of Health and Welfare. Available from: https://www.mohw.gov.tw/cp-16-78102-1.html
Minkler M, 2005. Community organizing and community building for health. New Brunswick: Rutgers University Press.
Moss RH, Hussain J, Islam S, Small N, Dickerson J, 2023. Applying the community readiness model to identify and address inequity in end-of-life care in South Asian communities. Palliat Med 37:567–74. DOI: https://doi.org/10.1177/02692163221146587
Murayama H, Sugiyama M, Inagaki H, Okamura T, Miyamae F, Ura C, Edahiro A, Motokawa K, Awata S, 2018. Is community social capital associated with subjective symptoms of dementia among older people? A cross‐sectional study in Japan. Geriatr Gerontol Int 18:1537–42. DOI: https://doi.org/10.1111/ggi.13519
Nunnally JC, Bernstein IH, 1994. Psychometric Theory. 3rd ed. New York: McGraw-Hill.
Paúl C, Teixeira L, Duarte N, Pires CL, Ribeiro O, 2019. Effects of a community intervention program for dementia on mental health: The importance of secondary caregivers in promoting positive aspects and reducing strain. Community Mental Health J 55:296–303. DOI: https://doi.org/10.1007/s10597-018-0345-6
Plested BA, Edwards RW, Jumper-Thurman P, 2006. A Handbook for Successful Change. Fort Collins: Tri-Ethnic Center for Prevention Research.
Plested BA, Jumper-Thurman P, Edwards RW, Oetting ER, 1998. Community readiness: A tool for effective community-based prevention. Prev Res 5:5–7.
Qin W, Wang Y, Cho S, 2021. Neighborhood social cohesion, physical disorder, and daily activity limitations among community-dwelling older adults. Arch Gerontol Geriatr 93:104295. DOI: https://doi.org/10.1016/j.archger.2020.104295
Rice LJ, Hughes B, Briggs V, Delmoor E, Jefferson M, Johnson JC, Halbert CH, 2016. Perceived efficacy and control for neighborhood change: The cross-cutting role of collective efficacy. J Racial Ethn Health Disparities 3:667–75. h DOI: https://doi.org/10.1007/s40615-015-0185-9
Sampson RJ, 1985. Neighborhood and crime: the structural determinants of personal victimization. J Res Crime Delinq 22:7–40. DOI: https://doi.org/10.1177/0022427885022001002
Sampson RJ, 2003. The neighborhood context of well-being. Perspect Biol Med 46:S53–S64. DOI: https://doi.org/10.1353/pbm.2003.0059
Sampson RJ, Raudenbush SW, Earls F, 1997. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 277:918–24. DOI: https://doi.org/10.1126/science.277.5328.918
Sanders ML, Stuckenschneider T, Devenney KE, Lawlor B, Schneider S, Olde Rikkert MGM, 2018. Real World Recruiting of Older Subjects with Mild Cognitive Impairment for Exercise Trials: Community Readiness is Pivotal. J Alzheimers Dis 62:579–81. DOI: https://doi.org/10.3233/JAD-171083
Schiefer D, Van der Noll J, 2017. The essentials of social cohesion: A literature review. Soc Indic Res 132:579–603. DOI: https://doi.org/10.1007/s11205-016-1314-5
Shannon K, Bail K, Neville S, 2019. Dementia‐friendly community initiatives: An integrative review. J Clin Nurs 28:2035–45. DOI: https://doi.org/10.1111/jocn.14746
Silver E, Miller LL, 2004. Sources of informal social control in Chicago neighborhoods. Criminology 42:551–84. DOI: https://doi.org/10.1111/j.1745-9125.2004.tb00529.x
Taber, KS, 2018. The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ 48:1273–96. DOI: https://doi.org/10.1007/s11165-016-9602-2
Vassilev I, Band R, Kennedy A, James E, Rogers A, 2019. The role of collective efficacy in long‐term condition management: A metasynthesis. Health Soc Care Community 27:e588–603. DOI: https://doi.org/10.1111/hsc.12779
Wu YT, Ali GC, Guerchet M, Prina AM, Chan KY, Prince M, Brayne C, 2018. Prevalence of dementia in mainland China, Hong Kong and Taiwan: An updated systematic review and meta-analysis. Int J Epidemiol 47:709–19. DOI: https://doi.org/10.1093/ije/dyy007
York NL, Hahn EJ, 2007. The community readiness model: evaluating local smoke-free policy development. Policy Polit Nurs Pract 8:184–200. DOI: https://doi.org/10.1177/1527154407308409

Supporting Agencies

Funding: The National Science and Technology Council, Taiwan, supported this study (grant numbers MOST 108-2410-H-002-209).

How to Cite



Collective efficacy and community readiness for dementia prevention: a spatial spillover analysis. (2026). Geospatial Health, 21(1). https://doi.org/10.4081/gh.2026.1476