Impact of an mHealth App on Digital Transformation: Randomized Clinical Trial on Strengthening Digital Skills in...

The rapid growth of digital technologies has transformed daily activities, health management, and social interaction. Older adults, however, continue to face challenges in adopting and using these tools due to limited previous exposure, age-related sensory or cognitive decline, and low digital confidence. In Brazil, internet access among adults aged  60 years or older has increased, yet digital exclusion persists, worsening health disparities. Mobile health (mHealth) apps offer a potential strategy to promote digital inclusion, strengthen digital competencies, and support healthy aging. Nonetheless, studies show that culturally adapted, multidisciplinary interventions for this group remain scarce and are rarely assessed through both quantitative and qualitative methods.

This study aimed to evaluate the impact of a lifestyle mHealth app on improving digital skills, as well as to analyze the level of satisfaction and usability of the app.

In this mixed methods study, a 14-week randomized clinical trial was conducted in Ribeirão Preto, São Paulo, Brazil. A total of 40 older adult women were randomized into an intervention group (n=21), who used the mobile app, and a control group (n=19). Digital competencies were measured before and after the intervention using a semistructured questionnaire based on the Modelo de Competências Digitais para M-learning com foco em idosos (MCDMSênior; Digital Competency Model for M-learning with a focus on older adults) framework, covering 6 domains-basic technology use, internet navigation, mobile app use, online research, digital communication, and usage of digital resources. Additionally, satisfaction with the educational content was evaluated using the suitability assessment of materials, and system usability was assessed using the System Usability Scale. Qualitative data were collected through semistructured, in-person interviews conducted immediately after the intervention with all intervention participants. Interviews explored perceptions of the app's usability, satisfaction with its content, barriers, and facilitators to engagement, and perceived changes in digital skills. All interviews were audio-recorded, transcribed, and analyzed thematically by 2 independent researchers using an inductive coding approach.

Postintervention analyses revealed significant differences in specific digital competencies. The intervention group demonstrated a moderate improvement in internet navigation skills, while gains in basic technology use and digital communication were minimal. Conversely, the control group exhibited moderate improvement in basic technology skills and lower effects in online research and digital communication. Overall, satisfaction with the educational content was low, and usability was rated as average. Qualitative findings indicated that, although participants valued the clarity of navigation and cultural relevance, persistent age-related fears and insecurities in using digital technologies were reported. Participants highlighted the need for more personalized guidance, ongoing motivational support, and technical adjustments to improve usability and engagement.

mHealth apps can effectively enhance certain digital competencies in older women, particularly internet navigation, but improvements in content suitability and usability are needed. Refinements in design and tailored support are essential to overcome age-related barriers and foster digital inclusion.