User acceptance and continuance intention of the BeSt age mHealth application for physical activity promotion and fall prevention in nursing homes

$\textbf{Background:}$ Falls pose a major threat to nursing home residents, highlighting urgent prevention needs. Mobile health applications offer promising solutions, but their effectiveness depends on acceptance and sustained use. Despite increasing attention to digital care technologies, adherence remains low and integration into care practice limited. This study aimed to examine acceptance of the BeSt Age App, a fall prevention mobile application for nursing homes, and to analyze the influence of perceived usefulness and usability on continuance intention.

$\textbf{Methods:}$ A cluster-randomized controlled trial was conducted in nursing homes in Southern Germany. Over 12 weeks, trained nursing home employees used the BeSt Age App to provide individualized exercise sessions to nursing home residents. User acceptance data and related usage constructs were collected from nursing home employees (adherence, usability, user experience, perceived usefulness, engagement, continuance intention) and residents (continuance intention, motivation). Multiple regression was conducted to examine factors influencing continuance intention.

... mehr$\textbf{Results:}$ Eleven nursing homes with 37 employees and 137 residents participated. Residents (mean age 85.0 ± 7.6 years, 81% female) showed moderate cognitive impairment and low digital competence (1.9 ± 1.1; scale: 1–5). Employees (mean age 51.7 ± 11.5 years, 84% female, digital competence 3.54 ± 0.8) rated usability with 87.1 ± 15 points and reported positive continuance intention (4.03 ± 1.22; scale: 1–5). Employee adherence was 85.6%, resident adherence 75.1%. Perceived usefulness (β = .39, p = .020) and usability (β = .46, p = .047) significantly predicted continuance intention (R² = .377).

$\textbf{Discussion:}$ Nursing home employees evaluated the BeSt Age App positively, particularly with respect to usability, which, alongside perceived usefulness, predicted continuance intention. The digital divide between employees and residents emphasizes the critical role of employee-mediated technology interventions for successful implementation in long-term care. Future research should examine longer-term adoption patterns and investigate the relationship between sustained app usage and clinical outcomes in nursing home settings.