Introduction
Dementia is the most common cognitive disorder with a significant prevalence in the elderly, and is mostly occur due to Alzheimer’s disease (AD) [6]. Given the drug resistance in many older people with dementia, cognitive and non-pharmacological rehabilitation interventions are recommended [5]. Rather than passively absorbing knowledge from the environment, social-cognitive theory (SCT) argues that individuals actively influence learning by interpreting the outcomes of their actions, which in turn influence their environment and personal factors, informing and modifying subsequent behaviors [18]. Given the increase in cognitive disorders such as AD and evidence that group poetry therapy can be effective in creating awareness, cognition, and changing attitudes in different groups with different disorders [19-21], the present study aimed to determine the effect of group poetry therapy based on the SCT on the cognitive status of older people with mild AD.

Methods & Materials
This is a quasi-experimental study with a pretest/posttest design. Participants were 60 older people with mild AD who were referred to elderly day care centers in Tehran, Iran, who were randomly assigned to two control (n=30) and intervention (n=30) groups. The inclusion criteria were age 60 years and older, a mild AD with an mini-mental state examination (MMSE) score of less than 23, confirmed by a geriatrician after a brain MRI, willingness to participate in the study, and being a resident of Tehran. The exclusion criteria were restlessness, lack of cooperation, and non-attendance or absence from more than two sessions.
The SCT-based educational program (group poetry therapy) was provided to intervention group at 12 45-minute sessions for 6 weeks. Based on the constructs of SCT, materials were provided to them to increase their knowledge of cognition and memory, the possible benefits of engaging the brain by memorizing poetry, improving social relationships, and believing in the ability of older people to remember and recall. The intervention was presented by the following methods: lectures, questions and answers, brainstorming, role-playing, and discussions in small and focused groups.
The data collection tools included a demographic form, a researcher-made questionnaire based on the SCT constructs, and the MMSE test. The data obtained before and after the intervention were analyzed in SPSS software, version 20 using the chi-square test, Kolmogorov-Smirnov test, Paired t-test, and Wilcoxon test. The normality of the data was examined with the Kolmogorov-Smirnov test. If normal, the comparison of scores between the two groups before and after the intervention would be done using the t-test; if not normal, the nonparametric Mann-Whitney U test would be used. The comparison of scores within the groups would be done using the paired t-test, if normal, or the Wilcoxon test if not normal.

Results
The chi-square test results showed no significant difference in the demographic characteristics between the two groups (P>0.05). 
In comparing the mean scores of SCT constructs within groups using paired t-analysis, it was shown that there was no significant difference in the control group (P>0.05), but in the intervention group, the mean score significantly increased after the education in all constructs, compared to the pretest phase (P<0.001). The mean total scores of SCT in the intervention group increased from 62.76 before the intervention to 83.73 after the intervention.
In comparing the mean MMSE score within groups using paired t-analysis, it was shown that there was no significant difference in the control group (P=0.173), but in the intervention group, the mean score significantly increased after the education, compared to the pretest phase. The mean MMSE score of the intervention group increased from 21.93 before the intervention to 25.20 after the intervention.
There was a significant and direct correlation between the MMSE score and all SCT constructs (P<0.001). With the increase in each of the SCT constructs, the mean MMSE score increases (Table 1).



Conclusion
The SLT-based educational intervention to learn and memorize poems for memory rehabilitation can significantly improve the cognitive status of older adults with mild AD. The SLT can be an effective theory for teaching older adults about memory rehabilitation. These results may be useful in developing interventions to improve cognitive status in older adults with dementia caused by other diseases other than AD. Therefore, educating older adults about cognition, memory, and non-pharmacological methods of memory improvement through poetry therapy is very important and can significantly improve the quality of life of these people. This needs the collaboration between health educators and geriatric medicine specialists.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Science and Research Branch (Code: IR.IAU.SRB.REC.1402.053). Written informed consent was obtained from all participants.

Funding
This article is taken from Arefeh Azadsir's master's thesis in health education and health promotion from Islamic Azad University, Science and Research Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors' contributions
Conceptualization, investigation, resources, initial draft preparation, editing & review, visualization: Arefeh Azadsiyar; Methodology, validation, supervision: Zahra Jalili and Azadeh Sadat Zendehbad; Project administration: Zahra Jalili.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank Dr. Jalili and Dr. Zendeyad for their consultations, the management and staff of Yas and Arman Pouya elderly day care centers for their assistance, and all seniors who participated in this study for their cooperation.

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