JMIR Publications

ABSTRACT

Background:

People aged 60 years and over represent the fastest growing population segment worldwide. Aging is associated with complex health and social challenges, and quality of life is influenced by multiple factors, including access to healthcare services, caregiver support, social participation, and community engagement. In this context, digital health interventions (DHIs), such as mobile applications and wearables, may meet these needs in older adults. However, their adoption among older adults remains low, partly due to limited usability, inadequate accessibility, and a lack of inclusive design principles.

Objective:

This study aimed to validate a novel set of inclusive design guidelines for DHIs targeting older adults. To achieve this objective, we convened an expert panel in digital health, user experience, design, and geriatrics.

Methods:

The initial version of the guidelines was created using a multi-method approach in previous work and comprised 13 guideline elements. A three-round eDelphi study was conducted with experts from academia, industry, and public and private health sectors. Participants rated each guideline item in terms of utility, clarity, and ease of use on a 7-point Likert scale, which was transformed into a fuzzy scale for analysis. The eDelphi process and reporting followed the Guidance on Conducting and Reporting Delphi Studies (CREDES) guidelines. Consensus criteria were predefined. After the eDelphi rounds, experts also contributed practical examples to support guideline implementation.

Results:

A total of 28 experts from a range of disciplines participated in round 1, 20 in round 2, and 19 in round 3. Consensus was reached on more than 75% of the evaluated items related to the guidelines’ utility, clarity, and ease of use (33/42 items). All guideline items achieved consensus regarding their utility and clarity. However, approximately 65% of guideline items (9/14 guideline items) did not reach consensus with respect to their ease of use. According to the panel, this was primarily due to the lack of concrete examples supporting the practical implementation of the guidelines. Therefore, such examples were subsequently added to the final version of the guideline.

Conclusions:

The eDelphi panel confirmed that inclusive design of DHIs for older adults should address not only user interface elements but also broader healthcare, organizational, and contextual factors. The validated guideline provide evidence-based support for the development of DHIs intended for older adults. The findings highlight the importance of complementing theoretical guidelines with practical examples to enhance the ease of use for designers and developers.