Nurse-led mobile health-based nudging intervention program to support exercise behavior among community-dwelling frail older adults: A multiphase intervention development study.

BACKGROUND: Multicomponent exercise is widely recommended to prevent and delay frailty. Despite the health benefits of exercise, participation in and adherence to exercise among community-dwelling frail older adults remain suboptimal.

AIM: To develop a nurse-led mobile health-based nudging intervention program to support exercise behavior among community-dwelling frail older adults.

METHODS: This intervention development study was informed by the Guidance for Reporting Intervention Development Studies in Health Research checklist. The study comprised four sequential development phases followed by digital translation for delivery: scoping review, semi-structured interviews, theory-informed development, and structured expert consultation. The finalized intervention program was then translated into digital delivery.

RESULTS: A 12-week nurse-led mobile health-based nudging intervention was developed. The intervention program was grounded in the Capability, Opportunity, Motivation-Behavior model and targeted frail older adults' physical and psychological capability, physical and social opportunity, and reflective and automatic motivation for exercise. Fourteen nudge strategies were mapped to intervention components, including priming, information support, simplification, default options, emotional anchoring, feedback, expert authority, environmental cues, social norms, precommitment, framing, reminders, peer comparison, and gamification. These strategies were operationalized into intervention components, including technical guidance, health education, exercise lessons, future self-visualization, psychological adaptation, environmental modification, professional support, peer support, self-monitoring, goal setting, framing reminders, role modeling, and gamification. The final program specifies behavioral targets, nudge strategies, intervention content, delivery stages, and delivery platforms.

CONCLUSION: The program was developed through a theory-, evidence-, participant-, and expert-informed process and may provide a structured intervention prototype for supporting exercise behavior among community-dwelling frail older adults. As this was a multiphase intervention development study, future pilot studies and randomized controlled trials are needed to evaluate implementation feasibility, user acceptability, intervention effectiveness, and optimal combinations of nudge strategies.