A 12-week application-based group conversation intervention on cognitive health and psychosocial well-being among older adults during the COVID-19 pandemic: a randomized controlled trial

TL;DR

A 12-week app-based group conversation program for older adults in Japan did not significantly improve cognitive or psychological health, but showed smartphone familiarity may affect outcomes.

Contribution

This study evaluates an application-based conversation intervention for cognitive and psychosocial health in older adults during the pandemic, highlighting the moderating role of digital literacy.

Findings

No significant cognitive or psychological improvements were observed in the intervention group compared to the control group.

Participants unfamiliar with smartphones showed a significant decline in categorical fluency performance during the intervention.

The study highlights the importance of digital literacy in the effectiveness of app-based interventions for older adults.

Abstract

Following empirical evidence suggesting a strong connection between social activities and longevity/well-being, this topic has now entered an intervention phase, which evaluates the effectiveness of social activity interventions and accumulates practical knowledge. Among these interventions, conversation—as a core component of social activity—has emerged as a promising target for cognitive, social, and psychological health.

This study examined the effects of “Photo-Integrated Conversation Moderated by Application” (PICMOA), an application-based remote conversational intervention, on the cognitive function and psychological and social well-being, as reflected by selected indicators, among community-dwelling older adults with subjective cognitive concerns in Japan.

The PICMOA trial is a randomized controlled trial introducing an open-label, two parallel group trial design with a 1:1 allocation. In this trial, the effects of the PICMOA intervention, a weekly application-based group conversation, were compared with weekly health education videos. The participants included community dwellers aged 65 years and older with subjective cognitive concerns. The main outcomes included cognitive function assessed through the Telephone Interview for Cognitive Status in Japanese, verbal fluency test, and Digit Span Forward and Backward tests. The secondary outcomes included indicators related to psychological and social well-being, assessed using the Multidimensional Scale of Perceived Social Support, the UCLA Loneliness Scale-10 item version, the 5-item World Health Organization Well-Being Index, and the Health Utilities Index Mark 3.

In total, 81 participants were randomized and divided into two groups (intervention: n = 41; control: n = 40). A total of 75 participants who completed the intervention and evaluations were analyzed (intervention: n = 35; control: n = 40). There were no significant improvements associated with cognitive function and psychological metrics in the intervention group compared with the control group during the 12-week intervention. However, the ancillary analysis showed significant decline in the categorical fluency performance for those who were unfamiliar with smartphones at baseline (b = -5.47, SE = 2.04, P = 0.009), suggesting a moderating effect of participants’ familiarity with smartphones at baseline.

This trial showed no significant improvements in cognitive and psychological outcomes after the PICMOA intervention. However, the findings raise important considerations regarding participants’ familiarity with digital devices and intervention setting. Further research is needed to accumulate evidence on the duration and intensity of intervention and individual support for improving digital literacy.

UMIN000047247 (http://www.umin.ac.jp/ctr/), registered on March 22, 2022.

The online version contains supplementary material available at 10.1186/s12877-025-06444-0.

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