gms | German Medical Science

Background: Cognitive impairments as well as depression are prevalent among elderly individuals residing in long-term care facilities. However, the implementation of intervention measures aimed at enhancing psychosocial well-being and cognitive abilities in this population remains limited. Participatory intervention development with this target group is rare and design decisions and processes for generating ideas about intervention content, format, and delivery are often not well-documented.

Objective: 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 analogue and digitally delivered mindfulness-informed health promotion intervention in elderly care homes (silBERN).

Methods: The PBCD process for the intervention involved multiple stakeholders, including the target audience, their relatives, experts from nursing facilities, caregivers, health insurance representatives and app developers. The reiterative process comprised several key steps: selection of theory-based mindfulness 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 and colleagues (n=15); online survey with project partners, nursing facility experts, caregivers, and the general public (n=12). Qualitative feedback was assessed through content-structuring analysis. For the online version, the app developer 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: Health promotion intervention (silBERN) based on mindfulness-based and mindfulness-informed elements comprising preparatory elements (welcoming, general information), 22 exercises and 13 exercise repetitions in 8 modules. 11 exercises were adopted and 8 exercises were excluded based on feedback from different stakeholders. User experience was incorporated in the online version. The main feedback referred to the complexity/comprehension of exercises.

Conclusion: Stakeholder participation has led to interventions that fit the needs of the target audience. The process of engaging all stakeholders in the PBCD process can be time-consuming and intensive. Experimental testing of the silBERN intervention is required to evaluate to what extent this approach ultimately leads to improved usability as well as patient outcomes.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.