JMIR Publications

ABSTRACT

Background:

Multidomain dementia-prevention interventions delivered via apps have the potential to reach large populations. However, existing trials have tended to recruit more socioeconomically advantaged participants, raising concerns that the resulting interventions may be less usable or engaging for some groups of older adults, particularly those from minority ethnic, lower educational, or lower socioeconomic backgrounds, who are at higher risk of dementia. ENHANCE was designed to address this by prioritising accessibility and engagement across diverse user groups, with the goal of developing an intervention that is acceptable and effective for all.

Objective:

This study evaluated the usability and user experience of the ENHANCE prototype during a one-week at-home supported-use test and explored factors influencing engagement among older adults.

Methods:

We purposively recruited 10 adults aged 60–80 years without dementia for a one-week mixed-methods usability evaluation, consistent with recommended sample sizes for identifying major usability issues. Participants were recruited through community settings including groups underrepresented in dementia-prevention trials and had at least one of 10 pre-specified dementia risk factors. They attended a face-to-face onboarding session with a coach, used the ENHANCE app at home for seven days with ongoing coach support, and completed a post-test interview and an eight-item satisfaction survey. We analysed quantitative data, including app usage metrics against prespecified minimum use targets and satisfaction survey responses descriptively, alongside reflexive thematic analysis of qualitative data from onboarding sessions, post-test interviews, coaching calls, and in-app message.

Results:

Participants represented a wide range of neighbourhood deprivation (Index of Multiple Deprivation deciles 1–8), with four from ethnic minority backgrounds. All met prespecified minimum-use targets (watching a module video, completing a check-in, and playing assigned games at least once), and many demonstrated additional voluntary engagement (e.g., repeated gameplay, video rewatching, and use of messaging or phone support). Survey responses indicated high satisfaction, perceived usefulness, and ease of use; 90% intended to continue using the app and 80% would recommend it to peers. Qualitative analysis identified engagement facilitators, including rewarding game design supporting trial-and-error learning, familiar interfaces and game conventions, appropriately challenging gameplay, consistent virtual rewards, trusted expert information combined with peer stories, and coach support with hands-on practice and follow-up. Barriers included unclear visual cues, limited accommodation of motor or sensory impairments, and visual discomfort in some games, highlighting targets for refinement.

Conclusions:

Older adults recruited via community settings serving underrepresented groups found the ENHANCE prototype usable, acceptable, and engaging over one week of supported at-home use. Participants highlighted human coaching, inclusive design, and integration of expert and peer narratives as key drivers of engagement. These findings support further feasibility testing to examine longer term engagement and provide design insights to inform development of more inclusive digital health interventions. Clinical Trial: ISRCTN17060879