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.
Keywords: digital health; frailty; healthy ageing; older people; primary prevention.
© The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society.