Developing hybrid nudges to promote mental health help-seeking in Chinese older adults: A co-design approach

Abstract Background and Objectives Older adults often face significant barriers to mental health help-seeking. This study integrated participatory co-design with behavioural science principles to develop culturally meaningful hybrid nudges to normalise mental health help-seeking among older adults in Hong Kong. Research Design and Methods Twelve older adults with mental health volunteering experience participated in eight researcher-facilitated co-design workshops structured by design thinking principles. A graphic designer assisted in visualising the prototypes. Workshop artefacts, design outputs, structured summaries, and focus group recordings were analysed using thematic analysis. The study was primarily an intervention development study; focus group data were used as an embedded process evaluation to understand participants’ experiences of co-design. Results Co-designers were 75% female with a mean age of 63.83 years. The co-design process produced a set of hybrid nudge prototypes with two design orientations: (1) reminiscence-oriented using metaphors from childhood games to cue autonomy and peer support, and (2) psychoeducation-oriented using relatable vignettes to model perspective taking. Although the project initially aimed to create social norms and visual nudges, co-designers preferred integrating brief psychoeducational and general well-being content to increase acceptability. The embedded process evaluation highlighted perceived learning, ownership, and collaboration, as well as challenges such as self-doubt. Discussion and Implications Participatory co-design can support the development of theory-informed and culturally attuned hybrid nudges to address motivational barriers to mental health help-seeking. Future research should test acceptability and behavioural outcomes through randomized or pragmatic trials, and examine how to balance theoretical fidelity with participant agency in co-designed behavioural interventions.