JMIR Publications

ABSTRACT

Background:

Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to few randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions but is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research fully remotely.

Objective:

This paper describes a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming application to facilitate meaningful social interactions in older adults.

Methods:

To evaluate recruitment and onboarding, intervention adherence, and intervention acceptability, we quantitatively analyzed the questionnaire and game data of the RCT participants and conducted post-RCT evaluation interviews and a focus group with 4 RCT participants and 5 welfare organizations that aided RCT recruitment.

Results:

In total, 371 people signed up for the RCT, of which 20% (76/371) installed the app and signed informed consent, showing a large drop-out during onboarding. The baseline questionnaires were completed by 36% (27/76), rapidly declining during follow-up. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence was low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires.

Conclusions:

Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires.