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Using Co-Designed Norm-Based Nudges to Promote Mental Health Help-Seeking Intentions Among Older Adults: Protocol for
Tianyin Liu1, Ken Ho Kan Liu1, Dara Kiu Yi Leung2
1Department of Applied Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, 999077, China (Hong Kong), 852 27665015.
JMIR Research Protocols
|July 21, 2026
Summary
Norm-based nudges, especially pictorial ones, may increase mental health help-seeking intentions in older adults. This study tested visual and text-based nudges to improve social norms and encourage older adults to seek support.
Area of Science:
- Gerontology
- Mental Health Research
- Behavioral Science
Background:
- Older adults experience high rates of mental health issues but are less likely to seek help.
- Collectivist values and stigma in Chinese contexts can impede mental health help-seeking.
- Norm-based messaging, particularly visual, can influence social approval and help-seeking intentions.
Purpose of the Study:
- To assess the effectiveness of co-designed norm-based nudges in enhancing subjective norms and mental health help-seeking intentions among older adults.
- To compare pictorial and descriptive norm nudges against an information-only control group.
Main Methods:
- A 3-arm randomized controlled trial involving adults aged 60 and above in Hong Kong.
- Participants received daily text messages for 14 days, allocated to pictorial norm nudge, descriptive norm nudge, or control groups.
- Primary outcomes (subjective norms, help-seeking intentions) and secondary outcomes were assessed at baseline, post-intervention, and 3-month follow-up using the Theory of Planned Behavior (TPB) questionnaire.
Main Results:
- Recruitment involved 532 eligible participants, with high completion rates for post-intervention (88.34%) and 3-month follow-up (76.69%) assessments.
- Data collection and follow-ups are ongoing, with a full report expected by October 2026.
Conclusions:
- Brief, co-designed nudges show potential for promoting mental health help-seeking intentions in older adults.
- This approach offers a scalable, culturally adaptable, and low-intensity strategy to improve mental health service utilization among the elderly.
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