The experiences of community dwelling older people using Nymbl : a digital health intervention to prevent falls : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health, Massey University, , New Zealand

Abstract

Falls present a major public health challenge globally, causing significant injury, disability, and increasing economic strain as populations age. Although traditional strength and balance programs are highly effective, they are limited by low long-term adherence and accessibility barriers. Digital health interventions (mHealth), such as the Nymbl balance training app, represent an innovative, scalable approach, but engagement metrics show user participation often diminishes following initial uptake. This qualitative study aimed to deepen the understanding of how community-dwelling older people in New Zealand experience, adopt, and sustain use of the Nymbl app. In-depth, semi-structured interviews were conducted with older Nymbl users, and data were analysed via Template Analysis framed by the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). The findings reveal that participants engaged successfully when the app satisfied two main conditions: being clearly useful (Performance Expectancy) and easy to use (Effort Expectancy). Users reported measurable gains in balance confidence and daily functioning and appreciated the app's short, simple sessions. Initial adoption was heavily influenced by social factors. However, sustaining engagement was a major challenge, limited by waning motivation, perceived monotony, and occasional technical or content-related frustrations. These findings suggest that the future success of mHealth for fall prevention depends on incorporating user-centred design, ensuring cultural relevance, and integrating digital tools into a comprehensive, supportive community and healthcare ecosystem to promote long-term adherence and equitable access.