Mobile health-based nudging intervention program to promote exercise behavior among pre-frail and frail older adults in the community: A mixed-methods pilot study
Ruotong Peng, Yishu Zhu, Jing Chang, Hui Feng, Yinan Zhao · International Journal of Nursing Sciences · 2026
Objectives: This study aimed to evaluate a mobile health (mHealth)-based nudging intervention program to promote exercise behavior among community-dwelling pre-frail and frail older adults, focusing on feasibility, usability, safety, preliminary changes in physical outcomes, and implementation barriers and facilitators.
Methods: An explanatory sequential mixed-
methods pilot study was conducted among 12 community-dwelling pre-frail and frail older adults. In the quantitative phase, participants received a 12-week mHealth-based nudging intervention, and feasibility, usability, safety, and pre-post changes in physical outcomes were assessed. In the subsequent qualitative phase, follow-up interviews explored barriers and facilitators related to participants’ intervention experiences. Quantitative and qualitative
Findings: were integrated through side-by-side comparison and a joint display.
Results: In the quantitative phase, the recruitment, completion, and adherence rates were 71%, 100%, and 91.7%, respectively. The mean System Usability Scale score was 70.00 ± 9.05, and no intervention-related adverse events were reported. Exploratory pre-post comparisons showed improvements in Fried Frailty Phenotype score, 4-meter walk time, 5-time sit-to-stand time, and Short Physical Performance Battery total score (all P < 0.05), while grip strength and balance scores remained unchanged. In the qualitative phase, interviews with nine participants identified four barriers (technical operation issues, network instability, insufficient movement feedback, and limited exercise variety) and five facilitators (flexible access, health benefits, social value, exercise program professionalism, and rewards and incentives). Integration showed convergence and complementarity for feasibility and usability, complementarity for safety, and additional qualitative insights into the preliminary physical outcome
findings.
Conclusions: The mHealth-based nudging intervention demonstrated favorable feasibility, usability, and safety among community-dwelling pre-frail and frail older adults, with preliminary improvements in physical outcomes. Future studies with larger samples are warranted to further validate these
findings.