The goal of this clinical trial is to learn if a digital health literacy program using mobile phone chat-based application called WISDOM (WhatsApp Intervention for Seniors' Digital and cOgnitive Management) can help older adults in Singapore with fewer resources improve their digital health skills and support brain health. The main questions it aims to answer are: * Is it feasible to run WISDOM in senior centres, and will participants join and stay in the program? * Does WISDOM help older adults find and use online health information? * Does WISDOM help older adults make health decisions and impact brain functions? * What do participants think about WISDOM, and how can it be improved? Researchers will compare two groups: * WISDOM group: Participants will join a 6-week program with face-to-face learning sessions and WhatsApp activities about digital health skills. Extra support will be given if needed. * Control group: Participants will continue with their usual activities at the senior centres. Participants in the WISDOM group will: * Join weekly face-to-face sessions for 6 weeks * Use WhatsApp to complete learning activities
Promoting lifelong learning and digital usage are forms of cognitive stimulation that foster cognitive flexibility and connectivity with information and social networks. Functional imaging research has shown that older adults who were previously internet naïve demonstrated increased brain neural activity after learning to search online. Other studies reported that older adults who underwent in-person digital literacy programs involving internet searches, messaging, photography, and mobile application use showed improvements in overall cognition, episodic memory, and processing speed. Knowledge and skills gained through learning also promoted empowerment, psychosocial well-being, and improved quality of life. In Singapore, formal and non-formal learning among older adults remains low, with only 13.2% participating, and those who do often have higher socioeconomic status. Socially disadvantaged older adults rarely take part, even though learning engagement has been found to improve subjective well-being more strongly in this group. Volunteer-led, one-to-one digital literacy programs for older adults with low socioeconomic status have shown promise but were resource-intensive. Thus, innovative, accessible, and affordable approaches are needed. Chat-based applications offer a potential platform for informal learning among older adults, as they support multimedia attachments, real-time messaging, and videoconferencing. WhatsApp is a common chat-based application widely used by older adults in Singapore. Previous studies have reported positive health and behavioral outcomes of chat-based interventions in areas such as smoking cessation, diabetes, breastfeeding, and depression. However, evidence for digital health literacy interventions using mobile-based chat-based platform to promote digital health literacy skills among older adults. This study will pilot WISDOM (WhatsApp Intervention for Seniors' Digital and cOgnitive Management) to assess feasibility and explore its potential benefits among socially disadvantaged older adults. A mixed methods design will be adopted. Four active ageing centres will be randomized into two WISDOM and two control groups. About 140 older adults with low socioeconomic status will be recruited. The WISDOM program will last 6 weeks and include face-to-face sessions and WhatsApp-based learning. Weekly topics include, but not limited, to basics of operating search engines, websites, and mobile applications, searching online health information using Google and YouTube, evaluating the reliability of health information and applying online health information. Participants in the WISDOM group may receive additional support where needed. A subset of participants will join qualitative interviews to share their experiences and provide feedback. Data will be collected at three timepoints: baseline (pre-test), post-test 1 (week 7), and post-test 2 (3 months after completion) to monitor changes in digital health literacy and cognitive outcomes. Quantitative analyses will include repeated measures approaches, and qualitative data will be analyzed thematically. This pilot study will provide insights into feasibility, acceptability, and preliminary effectiveness of WISDOM as a potentially scalable, low-resource intervention to improve digital health literacy and cognition among socially disadvantaged older adults in the community.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
140
A 6-week digital health literacy program delivered through weekly face-to-face training sessions and WhatsApp activities. Additional support may be provided if needed.
NTUC Health Active Ageing Centre (West Cluster)
Singapore, Singapore, Singapore
Digital health literacy competency
Competency in digital health literacy will be measured using the 21-item Digital Health Literacy Instrument (DHLI). The DHLI includes seven domains: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Internal consistency for the tool is α=0.87. In addition to the self-reported items, seven performance-based items will also be included for objective evaluation.
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Perceived usefulness of online health information
Measured using a 4-item adapted subscale from the Technology Acceptance Model 3 tool (α=0.92).
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Perceived ease of using online health information
Measured using a 4-item adapted subscale from the Technology Acceptance Model 3 tool (α=0.93).
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Attitudes towards online health information
Measured using a 5-item subscale of the Health Impact Questionnaire (α=0.77).
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Use of online health information
Measured using a 4-item validated scale (α=0.82).
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Changes in health behaviour and decision-making using internet-based health information
Measured using a modified 9-item scale assessing health behaviour change related to online health information.
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Cognitive function
Measured using the Montreal Cognitive Assessment (MoCA), a 30-point validated screening tool for global cognition.
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Cognitive domains (working memory, executive function, visuospatial coordination, psychomotor speed, attention)
Measured using Thinc-it, a validated computerized battery of cognitive tests. Thinc-it is not used for screening or diagnostic purposes but to explore cognition in detail.
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
Social support networks
Measured using the 6-item Abbreviated Lubben Social Network Scale, which assesses family and friend support (α=0.83).
Time frame: Baseline, week 7 (post-test 1), and 3 months after intervention (post-test 2).
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