A municipality implemented behavioural intervention to improve quality of life among older adults: protocol for a...

Ageing is associated with circadian rhythm sleep disorders, poor sleep at night, less physical activity and more time spent indoors, affecting the wellbeing of older adults. Their sleep and mood could benefit from daytime outdoor physical activity, exposure to daylight, better indoor lighting and sleep routines. However, changes to routines can be challenging depending on individual behavioural conditions (e.g. having the physical and cognitive capacity) and a supportive social and physical environment, such as a walk-friendly environment. To address these challenges, we have developed a complex behavioural intervention, delivered as a web-based course ('Light, activity and sleep in my daily life') that targets light-related behaviour, outdoor walking and sleep behaviour among community-dwelling older adults. The study aims to evaluate the usability, usefulness and acceptance of the intervention, the intervention outcomes and whether changes to routines are sustained. In addition, perceived enablers and inhibitors to daytime outdoor walking will be identified.

We use a case study design and mixed methods because a deeper understanding of the real-world context is critical for a successfully implemented complex behavioural intervention. Eligible intervention participants (target N = 40) are Swedish-speaking adults (≥ 70 years), living in one-person households in apartments in four municipalities. Participants complete questionnaires assessing intervention outcome measures (e.g. quality of life), are interviewed about their daily routines, and wear an accelerometer which tracks activity and rest at the baseline. They then enrol in a 9-week course, including self-studies at home and four physical meetings at the senior citizen meeting point. Baseline measures are repeated directly after the course, at 3 and 10 months. In addition, participants evaluate the intervention's usability and usefulness after the course and are interviewed at three months about perceived enablers and inhibitors to daytime outdoor walking. Staff from the municipality (a potential future service provider) assess their acceptance of the intervention delivery and discuss future implementation in focus groups (N = 4).

Results will inform a subsequent randomised study including a control group focused on optimising the intervention's content and delivery procedures to enable an intervention better integrated into municipal health promotion services/strategies. An anticipated long-term outcome is continued independence.

ClinicalTrials.gov Identifier: NCT06807060. Registered on 3 February 2025-retrospectively registered.