Digital interventions addressing the unmet needs of older adults with multimorbidity: a mixed-methods Persona design approach

Vincenzo De Luca^1*Michele Virgolesi¹Alessandra Cuomo²Daniela Lemmo³Mariangela Perillo⁴Federica Canfora⁵Sara Aprano⁶Fabrizio Mezza⁷Claudia Vetrani⁸Maria Francesca Freda⁷Daniela Adamo⁵Teresa Rea¹Lorenzo Mercurio¹Erminia Attaianese⁴Enrica Menditto⁹Annamaria Anita Livia Colao²Guido Iaccarino²Maddalena Illario¹

• ¹Department of Public Health, Universita degli Studi di Napoli Federico II, Naples, Italy
• ²Department of Clinical Medicine and Surgery, Universita degli Studi di Napoli Federico II, Naples, Italy
• ³Department of Human Studies, Universita degli Studi di Napoli Federico II, Naples, Italy
• ⁴Department of Architecture, Universita degli Studi di Napoli Federico II, Naples, Italy
• ⁵Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita degli Studi di Napoli Federico II, Naples, Italy
• ⁶Italian Center for Wellbeing and Care of Obese Patients, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
• ⁷Department of Human Sciences, Universita degli Studi di Napoli Federico II, Naples, Italy
• ⁸Department of Wellbeing, Nutrition and Sport, Universita Telematica Pegaso, Naples, Italy
• ⁹Department of Pharmacy, Universita degli Studi di Napoli Federico II, Naples, Italy

Frailty and multimorbidity in older adults require integrated, multidomain care models. Digital health solutions offer potential for improving self-management, but a structured methodology to translate the complex unmet needs of this population into tailored digital interventions is still lacking. The study aims to propose and illustrate a mixed-methods, persona-based approach for mapping unmet needs of older adults with multimorbidity to candidate digital interventions. This study employed an explanatory sequential mixed-methods design. First, quantitative data from the SUNFRAIL+ frailty screening tool were analyzed for a sub-cohort of community-dwelling older adults with polypharmacy (n=54). These findings informed a qualitative phase conducted through a multidisciplinary Focus Group (FG) of 15 healthcare and social care experts. FG transcripts were thematically analyzed to identify unmet needs across clinical, psychological, social, and environmental domains. These insights were synthesized using the European Commission's Blueprint methodology to create a realistic persona, "Gennaro," representing common challenges. Finally, the FG systematically mapped potential digital solutions to address the identified needs. We descriptively profiled a polypharmacy subgroup (n = 54) from the F2UH site of the multicentre SUNFRAIL+ study; no hypothesis testing was performed. SUNFRAIL+ data revealed a high prevalence of perceived memory loss (44.4%), reduced physical activity (40.7%), loneliness (29.6%), and gaps in primary care access (25.9%). Thematic analysis highlighted unmet needs in medication management, motivation for lifestyle change, social isolation, and environmental barriers. The persona "Gennaro" This is a provisional file, not the final typeset article embodied these challenges, facilitating the identification of targeted digital solutions, including Shared Care Plans, Telemonitoring, smart pillboxes for Medication Adherence, Adapted Physical Activity programs, Motivational Interviewing apps, and Ambient Assisted Living (AAL) systems. A foundational dataset and interoperability requirements for implementation were also defined. This descriptive, hypothesis-generating study integrates quantitative screening and multidisciplinary expert insights to propose a structured, persona-guided approach for profiling the multifaceted unmet needs of older adults with multimorbidity. We outline candidate digital options mapped to specific challenges as a preliminary framework to hypothesize person-centered, digitally supported care models. End-user co-design and validation are planned next to evaluate feasibility, usability, acceptability, and potential impact on self-management and adherence.