Facilitators and Barriers to Digital Self-Management in Older Adults With Depression: COM-B and Theoretical Domain Framework Qualitative Study

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: 13 barriers and 11 facilitators identified

• Primary Outcome: Six themes identified: illness perception/experience; cognitive/physical challenges; digital technology integration; social influences/support; environmental constraints; beliefs/emotions/motivation

• Nnt Or Sensitivity: Not applicable - qualitative exploration of experiences

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Findings can inform mHealth app design but implementation requires consideration of individual cognitive, social, and technological contexts Relevant to Australian aged care and mental health services, particularly given increasing focus on digital health solutions and PBS-subsidised mental health interventions for older adults Older adults with depression considering or using digital self-management tools

Abstract

BACKGROUND: Depression in older adults presents unique challenges in self-management. Digital tools, such as mobile health (mHealth) apps, have the potential to support this population. This study explored the facilitators and barriers to digital self-management in older adults with depression to inform the design of effective mHealth apps. OBJECTIVE: This study aims to explore the facilitators and barriers to digital self-management in older patients with depression with the aim of informing the design and development of mHealth apps for older adults. METHODS: A purposive sampling method was used to recruit 25 older patients with depression from July to September 2024. Semistructured interviews were conducted to capture real-life experiences. Directed content analysis ensured objective and accurate data interpretation, and the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the Theoretical Domains Framework were applied to identify facilitators and barriers related to behavior. RESULTS: Six themes were identified based on the COM-B model and the Theoretical Domains Framework: perception of illness and accumulation of personal experience; dual challenges of cognitive abilities and physical limitations; integration of digital technologies and acceptance differences; social influences and access to and utilization of support resources; environmental constraints and accommodations; and intertwined influences of beliefs, emotions, and motivation. A total of 13 barriers and 11 facilitators were identified. CONCLUSIONS: Digital self-management in older adults with depression is complex and influenced by multiple interrelated factors. Effective mHealth apps must integrate the cognitive, emotional, and social contexts of patients to provide user-friendly, personalized solutions.

References

1. 1.Zhu, Z., Lin, X., Chen, Z., Li, H., & Lin, R. (2026). Facilitators and barriers to digital self-management in older adults with depression: COM-B and theoretical domain framework qualitative study. JMIR Aging, 9, e79253. https://doi.org/10.2196/79253