Development of a (digital) mindfulness-informed intervention for older adults in nursing homes: description and reflection of a person-based co-design approach.

Background: Mindfulness and Positive Psychology interventions have proven effective in enhancing psychosocial well-being and cognitive abilities among older adults residing in long-term care facilities. However, the implementation of health promotion measures in this population remains limited. Participatory intervention development with this target group is rare and processes of generating intervention content, format, and delivery as well as design decisions are often not well-documented. Our research aim was to use person-based co-design (PBCD) methods to facilitate the translation of meaningful stakeholder experiences into the design of an on-site and digitally delivered mindfulness-informed intervention (MII) for health promotion in nursing homes.

Methods: The PBCD process involved multiple stakeholders, including the target group, their relatives, nurses and other experts from nursing homes, health insurance representatives and app developers. The iterative process comprised several key steps: theory-based selection of mind-body exercises by the project team, informal discussions with intervention experts, semi-structured interviews with the target audience (n = 3) during 12 sessions, pre-test of the exercises through an online survey with researchers (n = 15), online survey with project partners, nursing facility experts, caregivers, and the general public (n = 12). Qualitative feedback was assessed through deductive-inductive content-structuring analysis. For the digital version, the app developers created two front-end application examples, of which one was further refined based on regular feedback from the target audience and the research team.

Results: MII (named silBERN) for health promotion comprising preparatory elements (welcoming, general information), 22 exercises and 13 exercise repetitions in 8 modules with a delivery plan over 8 weeks. 11 exercises were adopted and 8 exercises were excluded based on feedback from different stakeholders. User experience was incorporated in the app version. The main feedback referred to the complexity/comprehension of exercises. A resource-oriented view of the target group was implemented. The PBCD process proved valuable despite its time-intensive nature.

Conclusion: Stakeholder participation has led to interventions that fit the needs of the target group. The process of engaging all stakeholders in the PBCD process can be time-consuming and intensive. Careful reflection on the development process indicates that a preliminary phase of participation was carried out. A randomized controlled trial of the silBERN intervention is required to evaluate usability and effectiveness.