Principle Investigator: Professor Jane Murphy

Team members: Dr Euan Sadler, Dr Michele Board, Dr Kat Bradbury, Professor Mike Vassallo, Dr Simone Yule, Dr Dawn-Marie Walker, Crystal Dennis, Matt Sait, Jim McMahon (Patient and Public Involvement Lead)

Partners: Bournemouth University, University of Southampton, University Hospitals Dorset NHS Foundation Trust, The Adam Practice, Dorset CCG, Wessex AHSN, Southern Health NHS Foundation Trust

Start Date: 1/4/2022

End Date: 30/9/2024 

Bournemouth University web page

Lay Summary

Frailty is a condition that affects one in ten people over the age of 65. It means people are at higher risk of falls, disability and poorer quality of life. Some may struggle with decreased energy levels, poor appetite, lower strength and having difficulty with household tasks such as shopping and cooking. As the population ages, frailty also impacts on health and social care services because of more GP appointments and increased hospital and care homes admissions. More people own a smartphone with applications (apps) and have access to the internet. This technology can help people to live well by enabling access to person-centred advice and care. It can help share in decision making to meet well-being and health needs and reduce the burden on health and social care systems. However little research has been done, particularly for people with frailty, living at home.

Aims

This study aims to explore whether a digital approach could be used alongside support from health coaches to help the lifestyle management of frailty (in its early stages). The approach has been used across the NHS in people with long term conditions which we think will transfer to people with frailty. We will work together with people living with frailty, their carers, health coaches and health care professionals (key stakeholders).

Design and methods

We will do this through two work-packages (WPs) with people from 2 areas in Wessex (Dorset and Hampshire). WP1 will develop and test a new digital approach. It will include interviews with 10 people with frailty and family carers, 20 health care professionals and health coaches. In WP2, we will train health coaches to use the digital approach and measure how well it works in people with frailty.

We will collect data including physical activity, eating and drinking, social engagement, quality of life, frailty status, costs of the approach. We will also ask people about their experiences of using it. We aim to recruit 20 people with frailty and their carers, 20 health coaches, 20 health care professionals and commissioners of care services from both areas to do this. This information will help us plan for carrying out a larger study to implement the approach wider across Wessex. We will regularly seek advice from doctors, nurses, commissioners of services during the project.

Patient and public involvement (PPI)

A group of family carers and health coaches will support the project by membership of a group to support project design, delivery, analysis and reporting and advise on how we share the findings.

NOTE: DIALOR was previously known as DONOR and the name changed in consultation with Public contributors

Dissemination

We aim to share the findings in academic and professional publications, social media, a website, conferences as well as deliver an end of project stakeholder event.

What did we find out?

As the population ages frailty is increasing, affecting one in ten people over 65 in the UK. Frailty increases the risk of disabilities, falls, and hospital stays, leading to a greater need for long-term care. Early actions like improving physical activity, nutrition, mental health, and social interaction can help reduce or reverse frailty and lower healthcare costs.

NIHR Applied Research Collaboration Wessex funded a study to test a new digital health coaching programme called 'DIALOR' for people with frailty. This programme, developed with input from healthcare professionals and patients, provides a digital app and a health coach to help users with exercises, nutrition, and wellbeing plans.

Older people using the digital health coaching programme saw improvements in frailty, physical activity, diet, quality of life, social engagement, and mental wellbeing. Most found the experience positive and helpful in meeting their health goals, although some found the digital component difficult and did not like the term frail. Healthcare professionals said this approach could help older people manage their health better and reduce pressure on primary care services.

DIALOR helps older people with frailty manage their health independently, reducing frailty progression and easing the burden on NHS healthcare by drawing on existing allied services such as health coaching.

What Next?

A meeting was held on 25th June 2025 with attendees from the healthcare professions, academia, digital healthcare and healthcare charities to learn about the outcomes from DIALOR and discuss the way forward.

They concluded that DIALOR has a strong alignment with NHS health priorities as it supports preventative care goals and a shift into more community-based care. There is potential to scale up and roll out regionally and nationally, with support from organisations like Health Innovation Wessex, Help & Care and alignment with the NHS 10-year plan.

More research needs to be done to discover how DIALOR can work across different regional systems, technology platforms, and wider social contexts to discover how it can be effective and cost-efficient for a wider range of people, especially those from ethnic and socially deprived communities. This will support its broader use across the UK.

Publications

DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care

https://doi.org/10.1136/bmjopen-2023-080480

Digital empowerment in long-term condition management: A systematic review and narrative synthesis of the experiences and perceptions of home-based digital health coaching interventions

https://doi.org/10.1177/20552076241302230