A hybrid type 1 trial of a digital behaviour change intervention for frailty prevention in community-dwelling older adults aged 60 years and older

Aims This hybrid type 1 randomised controlled trial evaluated the effectiveness and implementation of a digital behaviour change intervention (DBCI) designed to empower older adults (60+) who are nonfrail and community-dwelling to adopt activity, vaccination, optimising medication, interaction and socialisation, diet and nutrition (AVOID) behaviours to prevent frailty. Methods Sixty adults, from one South Australian local council, were randomised to receive the DBCI (n = 31) or wait (control; n = 29) for 6 months to receive limited DBCI access. Repeated-measures mixed models were used to assess between-group differences in changes in the primary outcome, the frailty index (FI), and the secondary outcome, quality-of-life (QoL; EQ-5D-5L) scores, from baseline to 6 months. Content analysis of survey and focus group data from the intervention group assessed technology acceptance, perceived knowledge and behaviour change. DBCI behaviour change techniques included baseline health and three-month behaviour change reports, education, a library of community resources, goal-setting and action planning and gamification and nudging. Participants in the intervention group received newsletters and were invited to face-to-face expert talks. Results The median age was 75.4 years, and 63.3% of participants were female. In the intervention group, the mean FI score decreased from 0.135 (SD 0.053) to 0.115 (SD 0.071) over 6 months, while in the control group it increased from 0.134 (SD 0.048) to 0.160 (SD 0.087). The intervention group had a mean FI change of −0.044 [95% confidence interval (CI) −0.076 to −0.012] and a mean QoL change of 0.032 (95% CI 0.016 to 0.058) compared with the control group. Qualitative feedback indicated that the DBCI was acceptable, improved knowledge and supported behaviour change across AVOID behaviours. Conclusion A DBCI promoting the adoption of AVOID behaviours among nonfrail, community-dwelling older people is effective in preventing frailty and improving QoL when implemented. Solving technical barriers and incorporating intelligent technologies could enhance impact.