Currently submitted to: JMIR Aging
Date Submitted: Jul 15, 2026
Open Peer Review Period: Jul 16, 2026 - Sep 10, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited.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.
Co-validation of AtiVida, a Digital Nursing Intervention for Healthy Aging: An e-Delphi Study
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.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.