Ambivalence in decision making for outdoor mobility among adult child carers of people with dementia: a study protocol for a randomized vignette study with message framing and eye-tracking

Background: Independent outdoor mobility is crucial for the quality of life and well-being of people with dementia. However, adult child carers of older adults with dementia often face ambivalence when making decisions about restricting their parents' independent outdoor mobility, due to concerns for their parents and the need to balance autonomy and safety. This study aims to explore the influence mechanism of person-centered care values and reasons for/against independent outdoor mobility on ambivalence in decision-making regarding independent outdoor mobility, as well as the role of message framing in shaping caregivers' decision-making processes. Methods: A randomized vignette study with eye-tracking will be conducted among 260 adult child carers of people with dementia (stage 3/4 dementia). Participants will be exposed to vignettes varying in lineage, dementia stage, message framing (gain/loss), and the outside environment (high/low ambivalence). Eye-tracking will objectively measure ambivalence during decision-making by recording the frequency of eye gaze and total gaze duration of participants. This study will also assess person-centered care values, reasons for/against independent outdoor mobility, and intentions of carers to allow people with dementia to go out alone by self-constructed scale from our previous modified Delphi study. Data will be analyzed using eye movement analysis with hidden Markov models and partial least squares structural equation modeling to test hypotheses. Discussion: This study aims to develop a biopsychosocial model to explain ambivalence in independent outdoor mobility decision-making among caregivers. Findings will provide insights into how person-centered care values and message framing influence decisions, offering practical guidance for caregivers and healthcare professionals. The results may inform interventions to support caregivers in balancing autonomy and safety for people with dementia.