Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Apr 23, 2026
Open Peer Review Period: Apr 28, 2026 - Jun 23, 2026
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Co-Design of a Digitally Enabled Habit-Formation Intervention for Community-Dwelling Older Adults with Pre-Frailty or Mild Frailty: A Mixed-Methods Feasibility Study
ABSTRACT
Background:
Frailty prevalence among older adults is rising globally, with significant implications for quality of life, healthcare costs, and economic productivity. While multicomponent lifestyle interventions can reverse frailty, existing programmes such as Vivifrail and the Otago Exercise Programme are limited by poor long-term adherence. Digital technologies combined with behavioural science principles offer a potential solution, yet few interventions have been developed with meaningful input from older adults themselves.
Objective:
To co-design a digitally-enabled intervention and to evaluate its feasibility, acceptability, and preliminary effects on health behaviours and frailty status in community-dwelling older adults.
Methods:
A mixed-methods feasibility study was conducted with 30 community-dwelling adults aged 65 and over (mean age 72.6 years; 45% men, 55% women) scoring 0-4 on the Fried Frailty Scale at enrolment. The "Healthy Habits" intervention was iteratively developed through four co-design cycles, incorporating wearable sensors (smartwatch, smart scale, sleep analyser), and a custom mobile application providing personalised feedback on seven habit domains. Participants engaged for a minimum of six weeks, with optional extended participation. Outcomes included retention, engagement metrics, changes in daily step count and sedentary time, grip strength, and frailty scores (Fried and Edmonton scales).
Results:
Retention was 97% (29/30) at six weeks, with 83% of completers electing to continue participation up to a maximum of 54 weeks. Smartwatch adherence was high (80% wear time). Among participants, 79% (22/28) demonstrated greater than 10% improvement in either daily step count or sedentary time. In the subgroup receiving the digital application (n=7), 71% increased daily steps by more than 10% within six weeks. Mean grip strength improved by 8% (p=0.013) and Edmonton Frailty Scale scores decreased by 48% (p=0.015).
Conclusions:
A co-designed, digitally enabled intervention based on habit formation principles is feasible and acceptable to older adults, with high retention and preliminary evidence of improvements in physical activity, sedentary behaviour, and frailty markers. These findings support progression to a randomised controlled trial to evaluate efficacy. Clinical Trial: N/A
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