JMIR Publications

ABSTRACT

Background:

Falls are a major public health concern due to their impact on individuals and the health system. Standing Tall, a digital balance exercise app, has demonstrated strong adherence and fall-reduction effects in Australia. Before considering implementation in Canada, its acceptability must be assessed.

Objective:

To explore the prospective acceptability of the StandingTall app among Canadian community-dwelling adults aged 50 years and older with a variety of physical activity and technological skills.

Methods:

A concurrent mixed methods design was guided by the Theoretical Framework of Acceptability (TFA). Participants completed an online survey rating seven TFA constructs using a 5-point Likert scale after viewing a demonstration video. Participants also reported demographic and health characteristics. A subsample of participants completed interviews, also based on TFA constructs. Convergence between data sources was assessed through overall patterns.

Results:

In total, 314 individuals completed the survey (mean age 61.9 ± 8.0 years; 88.9% female), and 22 completed interviews. The mean acceptability score was 5.8 ± 1.3/7. Participants viewed the Standing Tall app positively, valuing its convenience, flexibility, clear design, and alignment with their health and aging goals. Both sources of data indicated strong acceptability, shaped by high affective attitude and self‑efficacy, and were tempered by burden and opportunity cost-related factors, including technology issues and existing lifestyle commitments. Participants also reported mixed beliefs about its effectiveness, with some skepticism about the mechanisms of the app exercises to improve balance and ultimately reduce the risk of falls.

Conclusions:

Standing Tall was viewed as acceptable overall, with challenges that could be addressed using implementation strategies, co-created with potential users.