Preparation for Future Care in Community-Dwelling Older Adults With Prefrailty and Frailty: Development and Pilot Test of a Digital Intervention.

Abstract

China's rapidly aging population and high burden of frailty make proactive preparation for future care increasingly urgent, yet few older adults engage in such preparation. Existing interventions often overlook the heterogeneity between prefrail and frail populations and lack precision-oriented digital strategies. Building on a series of prior empirical studies, this study aimed to develop and pilot-test a digital intervention to support preparation for future care among community-dwelling older adults with prefrailty and frailty. The "Yi Yang Plan," a WeChat mini-program, was developed through a rigorous multiphase process, including a scoping review, a convergent mixed methods study, and a structural equation model. These findings informed the design of a tailored, stage-specific intervention targeting the distinct needs of prefrail and frail older adults. An interdisciplinary team subsequently refined the intervention using an iterative design approach. The intervention modules comprised 4 processes: Awareness Enhancement, Care Resources, Care Decision-Making, and Care Planning. Pilot testing involved expert panel consultations and think-aloud tests. Expert characteristics, engagement, and authority coefficients were assessed, and feedback was synthesized using content analysis. Feasibility and acceptability among older adults and their family members were evaluated through task completion metrics, satisfaction surveys, think-aloud protocols, and semistructured interviews. Seven experts participated in the consultation, with an engagement coefficient of 100% and an authority coefficient of 0.88. Recommendations were synthesized into four key themes: (1) establishing mechanisms for care plan updating and review, (2) strengthening user-centered design, (3) implementing dynamic resource management and robust data security measures, and (4) enhancing integration with community care systems and policy frameworks. A total of 20 older adults and 20 family members were recruited. All participants successfully completed the assigned tasks, with a mean completion time of 20.7 (SD 5.2) minutes. Satisfaction ratings were generally favorable. The qualitative findings indicated that the intervention was perceived as useful and professionally designed, while also identifying several challenges, including variability in preparation for future care readiness and educational levels, limited interactivity, insufficient practical content, and reliance on support from adult children. Suggested improvements included enhanced personalization, additional supportive tools, improved usability, greater involvement of adult children, and stronger integration with offline services. The "Yi Yang Plan" demonstrated preliminary scientific validity, feasibility, and acceptability as a multidisciplinary, collaboratively developed digital intervention to support preparation for future care among older adults with prefrailty and frailty. By translating prior empirical and theoretical findings into a differentiated, precision-oriented digital strategy, this study advances interventions beyond conventional one-size-fits-all approaches. Future iterations should focus on optimizing system architecture, user interface design, platform functionality, and implementation strategies. Further research should conduct higher-quality randomized controlled trials to evaluate the platform's effectiveness.