Currently submitted to: JMIR mHealth and uHealth
Date Submitted: May 24, 2026
Open Peer Review Period: May 26, 2026 - Jul 21, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Exploring multi-stakeholder needs for gamified nutrition education among frail older adults in mountainous areas: A qualitative study
ABSTRACT
Background:
In many resource-limited mountainous settings, frail older adults face substantial barriers to accessing health services. Although multiple stakeholders play important roles in supporting their nutritional health, they often lack structured and engaging tools to promote evidence-based dietary practices, contributing to persistent nutritional deficits and frailty progression. Previous studies have examined the feasibility of digital nutrition interventions for older adults; however, multi-stakeholder perspectives and context-specific requirements for gamified nutrition education remain insufficiently understood, limiting the development of sustainable and locally adapted interventions.
Objective:
To explore the nutrition education needs of frail older adults in mountainous areas from a multi-stakeholder perspective, including their expectations regarding system functions and usage patterns, in order to inform the development of a practical and sustainable gamified nutrition education intervention.
Methods:
Participants were recruited using purposive and snowball sampling strategies. From November to December 2025, semistructured interviews were conducted with 33 participants, including frail older adults in mountainous areas, family caregivers, and primary health care workers, recruited from key counties targeted for national rural revitalization and former poverty-alleviation counties in Guizhou Province. Data were analyzed using directed content analysis guided by the Dynamics-Mechanics-Components gamified design theoretical model.
Results:
Three interrelated themes were identified. Older adults demonstrated limited nutritional knowledge and unhealthy dietary behaviors. Stakeholders also described unclear caregiving roles and weak communication between families and primary health care workers. Participants further emphasized the importance of simple functions, age-friendly sensory design, and localized interface features in gamified nutrition education.
Conclusions:
Gamified nutrition education for frail older adults in mountainous areas should incorporate multi-stakeholder collaboration, age-friendly design, and locally adapted content to improve acceptability and engagement.
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