JMIR Publications

ABSTRACT

Background:

Digital health interventions have emerged as promising strategies to promote healthy aging by supporting health literacy, self-management, cognitive stimulation, and social participation among older adults. However, many interventions continue to be developed from technology-centered perspectives, with limited stakeholder involvement during the intervention-development process. Structured co-validation processes prior to pilot study remain insufficiently described, particularly within nursing-led digital interventions grounded in health-promotion frameworks.

Objective:

This study aimed to co-validate the contents, structure, and implementation strategies of the AtiVida digital nursing intervention for healthy aging through a stakeholder-based e-Delphi study.

Methods:

An e-Delphi study was conducted as part of the co-validation phase of the AtiVida intervention. A purposive sample of 10 participants, including rehabilitation nurses, policymakers, and older adults involved in healthy-aging initiatives, participated in two online Delphi rounds. Participants evaluated the intervention components using a 5-point Likert scale. Consensus was predefined as at least 75% agreement, corresponding to ratings of 4 or 5. Quantitative data were analyzed using descriptive statistics and the item-level Content Validity Index (I-CVI). Qualitative feedback from open-ended responses was analyzed using content analysis to support intervention refinement between rounds.

Results:

All 10 participants completed both Delphi rounds, resulting in a retention rate of 100%. In the first round, mean scores ranged from 4.4 to 4.9, and I-CVI values ranged from 90% to 100%, with all items achieving the predefined consensus threshold. Participants highlighted the need for shorter sessions, more frequent follow-up contacts, and greater thematic flexibility. Following qualitative refinement, the second round demonstrated high agreement across all revised items, with mean scores ranging from 4.7 to 4.9 and I-CVI values of 100% for all components. The final version of the intervention incorporated reduced session duration, biweekly online follow-up, a shorter follow-up period, and participant-selected themes for later sessions.

Conclusions:

The findings support the content validity, perceived usability, contextual relevance, and implementation readiness of the AtiVida intervention prior to pilot implementation. The study reinforces the importance of participatory and theory-informed approaches in the development of digital nursing interventions for healthy aging. The stakeholder-based e-Delphi process contributed to improving implementation readiness and refining intervention components before feasibility study in community settings.