Using Co-Designed Norm-Based Nudges to Promote Mental Health Help-Seeking Intentions Among Older Adults: Protocol for...

Older adults face a substantial burden of common mental disorders, yet they are less likely to seek professional help compared to younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the theory of planned behavior (TPB) and nudge theory, suggesting that norm-based messages, especially those that are visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions.

This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (descriptive norm nudge) or pictorial forms (pictorial norm nudge), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control.

This 3-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily texting for 14 days and are allocated to the pictorial norm nudge (descriptive text combined with pictorial cultural games that evoke social support), the descriptive norm nudge (descriptive text only), or the control (mental health service information) groups. Assessments are conducted at baseline (T0), after intervention (T1), and at a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese version of the TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A 2-level linear mixed model will be used in intention-to-treat analyses to examine the intervention's effectiveness.

The study grant was awarded in June 2023, with recruitment of participants to the randomized controlled trial starting in December 2024 and concluding in June 2026. As of June 30, 2026, a total of 532 eligible participants had completed the baseline assessment. Among them, 470 (88.34%) completed the postintervention, and 408 (76.69%) completed the 3-month follow-up assessment assessments. Data collection and follow-ups are ongoing. A full report of the findings is expected by October 2026, with publication anticipated in early 2027.

This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach will offer a scalable, culturally adaptive, and low-intensity strategy to improve mental health service use among older adults.