JMIR Publications

ABSTRACT

Background:

Older adults face substantial burdens from common mental disorders, yet they are less likely to seek professional help than younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the Theory of Planned Behavior (TPB) and nudge theory, suggesting that norm-based messages, especially when visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions.

Objective:

This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (Descriptive Norm Nudge [DNN]) or pictorial forms (Pictorial Norm Nudge [PNN]), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control.

Methods:

This three-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily smartphone messages for 14 days, allocated to PNN (descriptive text plus pictorial cultural games evoking social support), DNN (descriptive text only), or control (mental health service information). Assessments are conducted at baseline (T0), post-intervention (T1), and a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A three-level linear mixed model will be used in intention-to-treat analyses to examine the intervention’s effectiveness.

Results:

The study commenced on December 1, 2024. As of April 30, 2026, 520 participants have been enrolled, with 464 completing the final assessment. Data collection for the follow-up is ongoing. Full report of findings is expected by October 2026, with publication anticipated in early 2027.

Conclusions:

This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach offers a scalable, culturally adaptive, and low-intensity strategy to improve mental health service utilization among older adults. Clinical Trial: ClinicalTrials.gov NCT06707935 (November 27, 2024).