Four people sat around a table with boats and the sea in the background
This toolkit has been developed from ESRC-funded research conducted as part of the Generating Older Active Lives Digitally (GOALD) project at the University of Plymouth and University of Stirling.
This toolkit has been created for an intended audience of technology developers to support with the future creation of digital products for older adults with a focus on physical activity. It is made up of three sections: 
  • General recommendations for all technologies designed for older adults.
  • Virtual Reality (VR) sub section for those working with immersive technologies, and including end-user priorities.
  • Physical activity platforms sub section (i.e. websites, apps, games), including end-user priorities.
The recommendations included here are based on the thoughts and input of the GOALD participants and will not form an exhaustive list of potential design requirements for safe, inclusive and accessible technologies.
 
Background information
Research on the GOALD project went through 5 phases to prepare our final toolkit.
Recruitment icon - clipboard
Phase 1 – Recruitment and baseline information phase
184 participants took part from 11 community groups and 7 care homes. From these participants 145 were older adults (60+ years), 6 were younger adults (16–30 years) and 33 were staff/group facilitators. Participants completed baseline information questionnaires to allow us to understand their lifestyles, current technology perceptions/use and levels of activity. 
Ƶ of technology icon - glasses
Phase 2 – Ƶ of technology offerings
Participants were presented with over 20 technologies linked to physical activity, reminiscence and social connectivity to provide familiarisation with technologies and an overview of technology already available. Participants gave initial thoughts and opinions on the technologies, and offered their preference on those they would like to try. Technologies included VR, AI voice technology, mobile applications, websites and more.
Tech try-out and feedback
Phase 3 – Technology sessions and feedback
Participants were invited to try technologies they were interested in from the menu offering. This either took place in person with the researchers, or independently within their own home. Initial reactions were captured during face-to-face interactions. These sessions allowed participants to familiarise themselves with the technology, enabling them to give informed design considerations for future technologies. Each group of participants were then invited to a formal evaluations focus group/interview to give their thoughts on the technology as well as their motivators for use, potential benefits, barriers and improvements.
Formal co-design workshops
Phase 4 – Formal co-design workshops
Based on the results from phase 3, two areas of technology/intervention were identified as priority for co-design: i) VR for physical activity and access to places and spaces, and ii) online physical activity platforms. These sessions involved participants ranking priorities for the technologies, based on feedback throughout phase 3, as well as creative design sessions to capture ideas for future technologies. 
Toolkit creation
Phase 5 – Toolkit creation
Recommendations presented are based on thematic analysis of participant preferences in phase 3 and participant co-design ideas in phase 4. Thematic analysis means the recommendations are based on patterns seen across the data set.
Toolkits were then sent to a selection of SMEs who used them for their own technology design interactions and then provided feedback on toolkit for final improvements. 

Importance of co-design

Co-design involves engaging key stakeholders in the early stages of product design. Stakeholders may include potential end-users (older adults themselves, community groups), those required to procure, implement and facilitate product use (care home staff, activity co-ordinators, managers) and wider organisations (health professionals). Through co-design activities we develop actionable ways to improve a product or design a new meaningful solution together. Research has supported the importance of user-centred design approaches by demonstrating significant differences in design preferences between developers and end-users (Bradwell et al., 2019). Numerous technologies developed in isolation of end-users fail to succeed, while involvement of end-users in the design process enhances likelihood of acceptability and adoption.

Our toolkit

These recommendations have been produced from a full thematic analysis undertaken on audio recordings from participants phase 3 technology perceptions and phase 4 co-design ideas. A thematic analysis is a method of analysing qualitative data (text produced from focus groups/interviews) which involves the systematic reviewing of text for common threads which are identified through familiarisation, initial code forming, collating codes into themes and checking and refining. All data was coded by at least 2 researchers to allow for checking of validity of interpretation.
Within the VR and physical activity platform subsections, you will also find examples of priority feature ranking. To identify these priorities, we produced feature cards (based on the feedback received during interaction sessions) which participants ranked from low priority to high priority. The ranking can be used to help inform the development of your product design to meet the end-user ‘wishlist’. 
Creating a priority feature ranking may be a useful way for you to engage end-users and explore what design features of your product are of most and least importance to them. Our example rankings may be useful if relevant to your specific product, or give you an idea of how to create your own.

General recommendations

Motivation

How will people be motivated to use your product? These are some factors people find motivating:
  • Social connection and fun – providing a community, connecting with friends, family or other community groups/care homes.
  • Gamification principles – competitions, using badges and rewards for achievements.
  • Benefits of technology/product – older adults felt the products increased their levels of activity and confidence. People reported feeling benefits of being more active. People gain a sense of enjoyment, fun and social engagement. The products helped keep the mind and body active, allowing for reminiscence and relaxation. Some technologies provide an educational learning opportunity. Based on these outcomes, older adults had a desire to continue using the technologies. 

Content

Have you thought about what exercise or activity your technology will focus on? Think about:
  • Type of activity – ensure a choice of exercises; GOALD participants had a particular interest in dancing, strength training, swimming and personal training/coaching. 
  • Relatable content for engagement – use older styles of dancing and music for reminiscence, a variety of cultural content and general variety to avoid boredom over longer term engagement. 
  • Intensity – provide choice of intensity with easy and hard versions of the same content, provide progressive exercises, ensure warmups and cool downs are included. 
  • Duration – short sessions (20–30 minutes) are desirable and more manageable, but choice is key. 
  • Variety of content – provide variety of songs and content, singing and music are enjoyable, repetitive content should be avoided.

Barriers

Have you thought about the barriers that may hinder older adults in using your technology? Such barriers can lead to frustration and disengagement. Think about:
  • Injury concerns – how do you make sure people use good form and conduct their movements correctly? What do you do to ensure safety?
  • Accessibility (physical capabilities) – how accessible is your technology? Have you thought about the level of fitness required to start using your technology? Consider previous injuries or mobility issues (e.g. wheelchair users). Consider tremors and dexterity for interaction with the technology.
  • Accessibility (technology) – consider how much technology experience and literacy people will need to use and understand your product. Ensure your product is competitive (affordable or different to currently available technologies). Does your product require internet connection, how easy will it be to connect (e.g. is it as simple to use as a TV)? 
  • Accessibility (space and social context) – will people need access to specific facilities? How much space in people’s own homes or in their care home will they need? How difficult is the physical set-up of the technology?

Design / Inclusivity considerations

What design and inclusivity considerations have you taken into account? Think about: 
  • Infrastructure usability have you ensured the option for login details to be saved for ease of use? Is it possible for your product to learn and remember users’ activities with the product?
  • Tailoring/filtering – could you include filters for people to find relevant content and activities (e.g. filtered by age, date uploaded, activity type, intensity)? Have you considered including the ability to save and re-watch live sessions and content?
  • Suitability of hardware for environment – if your technology is to be used for water-based activities, consider your touch screen sensitivity. 
  • Software – have you considered what platform is most accessible for your target audience (e.g. app or website)? Could you include a digital literacy check for your end users? (e.g. do they have an email address, are they comfortable using web pages or apps?) Have you included audio instructions for your exercises, or voice interaction? Have you considered the image sizes, make sure the pictures and font sizes aren’t too small. Could you include subtitles for people to follow?
  • Ease of use for target audience – seek to understand what is ‘easy to use’ for your target audience, engage end-users (e.g. easy to turn on and start using, no complicated websites, pick up and go). Ensure there is a guide or notes on how to use/navigate your product/platform. Could it be useful to have videos available explaining the technology/equipment needed before people use it?
  • Software adaptations for physical or mental capabilities – think about hearing and sight impairments, could you offer varied audio frequencies, connection to hearing devices, adjustments for sight impairments or subtitles? Work with your target audience on their specific requirements.
  • Physical adaptations of environment of use – what might older adults have at home that could be useful to support engagement with your product and support safe movement? (e.g. a sofa for balance for swivel chair for 360 experiences). Consider the range of mobility issues, will your exercises involve legs, hands, arms? Could a joystick be useful for inclusivity?
  • Accessibility of exercises – does your platform include activities for a range of abilities and considerations for disabilities (e.g. seated exercises)? Make sure any accessibility tools are clear and easy to find (e.g. closed captioning, subtitles, translation, vibrations for hearing loss, adjustable background music volume).
 

Specific to physical activity platforms

Motivation

These following factors might be particularly motivating for online PA platforms.
  • Engaging instructor – make sure instructors are engaging and make the activity fun.
  • Live sessions – consider including live sessions, reminders on live sessions starting and music to move to.
  • Instructor relatability – when designing for older adults, consider including older people in your videos (both for instructors and demonstrators) and not relying only on younger models.

Barriers

Consider the barriers specific to online platforms and websites that may impair use of your technology.
  • Programme design barriers – it can be difficult to motivate participation through a screen, some prefer to go outside or engage in face-to-face classes. How will you motivate people to be more active? Consider how older adults will be able to find your online platform. 
  • Use of social media platforms – we recommend live sessions are hosted on websites as social media can be distracting and requires sign up.

Design / Inclusivity

These are some design and inclusivity factors to consider when designing your platform.
  • Clarity of presentation – make sure all exercises have a visual follow-along. It can be difficult to follow exercises not mirrored by the instructor. 
  • Clarity of instructions – consider instructors accents and how clearly they speak. Make sure instructions are available in written and audio form. Consider limiting chat between instructions/activities.
  • Visual considerations – would it be useful for your exercises to be casted onto larger screens, and is this function easy?
  • Accessibility of exercises – consider including pauses, breaks and slower instructions to allow people to follow along, rest and catch up. We recommend including exercises that do not require specific equipment. Have you included live sessions that allow for questions and checking of form? 

Potential audiences

These are some groups our GOALD participants felt may enjoy and benefit from PA platforms: 
  • Care home residents, community groups, people living alone, those less able or independent, people living without access to outdoors or recreation. Online PA may be more suitable for people who are currently less active, or could provide a physio or rehabilitation tool. Make sure you consider cognitive suitability as well as physical.

Physical activity end-user priorities

High priority

  • Follow-along videos
  • Community of users (hosted in the platform)
  • Group activity in-person
  • Visual follow-on
  • Variety of content
  • Live sessions
  • Filter function on difficulty level
  • Content for range of abilities
  • Variety of songs to move to
  • Assessment on suitable exercises
  • Voice assistive technology 
  • Game scenario – reaching, stretching, moving
  • Armchair activities
  • Warm up and cool down activity
  • Easy to navigate
  • Ability to pause and come back
  • Value for money (affordable)
  • Motivation to exercise
  • Easy to use
  • Easy to search
  • Audio instructions (sight impairment)
  • Easy initial set up (sight impairment)

Medium priority

  • Gamified component – collecting badges
  • Easy screen casting options
  • Indoor cycling
  • Varied cultural content
  • Separate from social media platforms
  • Audio description to nativigate platform (sight impairment)
  • Gradual increase in intensity
  • Individual activity
  • Social forum component
  • Yoga
  • Music content for varied generations
  • Someone to check your exercises
  • Family activity 
  • Adjustable pace of sessions
  • Adaptable video and font sizing
  • Older tutors to match audience
  • Big screen/not a mobile app
  • Appropriate length (<45 mins)
  • Translation options
  • Closed captioning
  • Frequent updates
  • Space needed for activities
  • Clear audio (speaking over music)
  • Dancing
  • Group activity
  • Range of video lengths

Low priority

  • Tutorial to navigate platform
  • Extreme sports (skiing)
  • Reminders to take part (notifications)
  • Needs to be different to what already receiving for free
 

Specific to virtual reality

Acceptability of technology

 Older people demonstrate good acceptance and potential for VR to facilitate exercise.
  • Praise: Older adults generally praised the VR technologies and enjoyed the experiences, felt safe and highlighted their desire for continued use.
  • Facilitation: Consider how the VR is introduced to older adults and how they’re supported in using the technology, developers should consider generational differences in prior experience with VR technology. Consider showing users content before wearing the headset and familiarise with the equipment to prepare them for the experience within VR.

Barriers

Consider the barriers specific to VR that may impair use of your technology.
  • Attitude: Developers should consider any initial attitudes and expectations that could influence use of the technology, such as fear of heights or enclosed spaces, fear or disinterest in wearing a headset or in VR technology. 
  • Mobility: Consider balance and coordination specific to using VR technologies, alongside potential for old injuries or mobility challenges to impact older adults’ potential to perform different types of activity.
  • Content: Ensure the VR experiences are not too repetitive or monotonous over time which can create boredom. Older adults may not enjoy static experiences. Avoid infantilisation, older adults may not enjoy child-like games or content. Consider ensuring movements in VR are smooth and controlled and remember that edges and ledges in VT can create unpleasant feelings.
  • Psychological: Older adults may have concerns around addiction to technology, as well as VR inducing fear, confusion, disconnection between senses, disorientation. These are aspects to consider in your approach. 
  • Physical: Consider any physical effects of the VR and physical movements associated, such as body aches, dizziness, feeling unbalanced and sickness. Can you do anything to negate these effects?
  • Health and safety: Older adults may have worries about the risk of falls, epilepsy, instability in VR and the safety of standing. What can you do to reduce these worries?
  • Unfulfilled purpose: What does your VR product provide that isn’t possible on other devices (such as the TV)? Is it actually providing an effective form of exercise? How will it remain engaging for long-term use? 

Design considerations

Some hardware and software factors to consider that could improve motivation, engagement and overall experience are:
  • Hardware: Consider; comfortable headsets, hygiene with the equipment, storage requirements, required accessories, headphones for audio, projectable from VR to large screen.
  • Software: Consider; tutorials, guidance within the program, easy navigation between content, simplified set-up, avoiding unrealistic content, appropriate warnings (e.g. content could be frightening or cause fear/anxiety), audio is important, customisable avatars, seamless head movements, accurate scale of scenery, consistent and reliable technology.
  • Software for motivation: Consider; gamification principals, motivational rewards, milestones, checkpoints, encouragement to explore more (by ever-changing content), use of social element. 
  • Features to avoid: Older adults may not enjoy teleportation in VR. The disconnect between physical and VR movement can be off putting. Consider the terrain people encounter as hills and steps can feel strange when people are physically on a flat surface.
  • Modes of interaction to consider: Older adults want to be able to interact with the scenery, try to include movement to explore the VR environment, they may enjoy interactive stories or decision trees. Consider any potential for voice interaction. What type of movement will people use to interact with the VR? Interesting options include; walking, skiing, natural movements, seated movements, climbing, horse riding, kayaking, rowing, running, skating, swimming. Ensure physical movements are matched in VR (e.g. speed and direction). 

Motivations to use

These are outcomes that may motivate people to use VR technology:
  • Enhanced access to experiences: Your product could be used for enhancing accessibility to experiences older adults cannot access in real-life, due to cost, mobility or mental health challenges. This could be particularly useful for people in hospital, care homes or with physical and mental health limitations. The VR may mean experiences that would be unsafe ordinarily could be enjoyed safely (e.g. adrenaline sports). Another potential use would be for familiarising to new places. 
  • Expanding experiences: The VR technologies can help older people experience new places and experiences, including historical and rare locations further to opportunities to explore such places.
  • Educational: VR can be used as a learning tool to make learning fun, provide information on dangers or be used as a travel companion. 
  • Wellbeing: Older adults may value the ability to use VR to escape reality, expand their experiences or re-live their old life, as well as providing mental and physical stimulation or relaxation. 
  • Physical activity: VR has potential in facilitating exercise, dependent on their current level of activity. Exercises could include movement of legs and arms, providing interesting content to engage with while achieving additional physical activity.
  • Health: Older adults felt outcomes of use could be therapeutic uses, psychological benefits and distractions from pain.
  • Happiness: VR brought enjoyment and fun.
  • Social experience: Consider the potential of your product to enhance social contact, either with family, care staff or through intergenerational connections. This about including competitions against others in VR. Social experiences in VR will enhance confidence and offer a sense of community. VR can provide a focal point for conversation.

Content

The below provides a list of content suggestions older adults may be interested in enjoying in VR.
  • Nature: Gardens, animals, coastal content, landmarks, space, different seasons and times of day, under the sea.
  • History: Wonders of the world, archelogy, antiques, National Trust sites, architecture, museums, seeing places change over time, archive footage from the past, famous historical events, historical education.
  • Activity: Activity with no consequence (e.g. robbing a bank), cable car journeys, competitions, cooking classes, driving, exploring boats, extreme sports, funfairs, cruise ships, helicopter rides, house design, immersive exercise, jigsaws, meeting lost family members, model building, music events and lessons, plane journeys, playing the part of a movie actor, shopping, train journeys, visiting towns, treasure hunts, watching sports, guided tours, video games, crafts, scary or horror options, visiting zoos, VR sports, different countries, point of view experiences (e.g. jumping from a plane), birds eye views of places, mix of passive and active experience.
  • Personal: Local areas, past holidays, familiar places.
  • Content improvement: Longer content, bigger maps, colourful scenes, soothing audio, realistic imagery (to improve feeling of immersion), continuously interesting, detailed scenes (dynamic environments, realistic, ambient content such as objects on display and people walking around), audio guides, greater variety of content, educational (including physical artefacts alongside the VR).

Potential audiences

These are some groups our GOALD participants felt may enjoy and benefit from VR technology: 
  • Care home residents, people needing more exercise, retired community, people with mobility issues, people experiencing pain, hospital patients, people requiring rehabilitation, house-bound people, people who are less active. Consider peoples capacity, some prefer individual experience and others prefer group activity. 

VR end-user priorities

High priority

  • Peddling
  • People watching
  • Guided tour
  • Audio from the scenes filmed
  • Different eras 
  • Varied content
  • Multi-sensory (artefacts to hold, breeze to feel, sand at beach)
  • Simple set up
  • Historical information on audio
  • Armchair exercise
  • Information on what you're viewing
  • Relaxing visual content
  • Colourful, bright
  • Interact with objects
  • Clear instructions on how to use
  • Natural foot movements (walking not shuffling)
  • Places with memories
  • Safety features on exercise equipment
  • Comfortable headsets
  • Natural movements
  • Places usually expensive to visit
  • Movement With feet
  • Ability to move around in virtual environment 
  • Headset not too heavy
  • New experiences
  • Not colourless
  • Places no longer physically accessible
  • Realistic
  • Affordable price
  • Detailed visuals (fine details e.g. leaves on trees, petals)
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  • Not simplistic models
  • High image quality

Medium priority

  • Rewards (incentives to continue (seeing something new/exciting))
  • Show you locations you may have to go (reduce anxiety hospital appts, shopping trips)
  • Pre-travel knowledge (view where you will go)
  • Group activity on a big screen displaying VR content
  • POV adrenaline experiences (zip lining, roller coasters, horse riding)
  • Not cartoonish
  • Physical activity associated with hobbies i.e. gardening
  • Audio/sounds/music (like Blue Planet)
  • Watch animals
  • Sports matches
  • Social element should be optional
  • Seated movements (tech allows seated interaction)
  • Passive watching of nature
  • 󲹱DZDz
  • Inclusive (mobility)
  • Related to hobbies
  • Local places
  • Dancing
  • Family interaction 
  • Warnings on content (small spaces/heights/sit down/dizziness))
  • Pedals to move around
  • Ƶ self-orientates in front of you
  • Outdoors
  • 𲹲
  • Flowers
  • Heritage sites
  • Movement with hands
  • Haptic feedback tech (gloves)
  • Historical events (Jubilee, reminiscence)
  • Step counter
  • Walking
  • Stable movements (smooth, not teleporting)
  • Has to offer more than TV
  • Feel control over moving
  • Subtitles (for hearing impairment)
  • Headphones for sounds
  • Easy to put on headset
  • Different countries
  • Written cues to sound (for hearing impairment)
  • Concerts
  • Interesting content
  • Nature
  • Countryside
  • Educational aspect
  • Paddling/rowing
  • Audio journey/description (for sight impairment)

Low priority

  • Shopping trips (malls, in stores no longer go to)
  • Treasure hunt (items to find)
  • Garden centres
  • Races
  • Social VR world
  • Transferable/portable
  • Peaceful places
  • Busy environments (more hustle and bustle)
  • Competitions (including with family/grandchildren)
  • Races
  • Audible directions of where to go (sight impairment)
  • Avatar customisable
  • Historal information plaques
  • Calm sounds
  • Directional seated movement
If you would like to collaborate with the Centre for Health Technology, email us at Hannah.Bradwell@plymouth.ac.uk or Leonie.Cooper@plymouth.ac.uk