Co-Designing a Web-Based, Gamified, Auditory–Cognitive  Dual-Task Training System for Older Adults with Hearing Loss

<b>Background:</b> Age-related hearing loss (ARHL) is associated with decreased communication, reduced social engagement, cognitive decline and an increased risk of dementia globally. Although increasing studies report the benefits of combing auditory and cognitive training for older adults with ARHL, more evidence is needed to examine its effects. Moreover, existing training programs have been developed with minimal end-user involvement leading to low adherence rates. This study aimed to investigate the role of co-design in the development of an auditory-cognitive training system for older adults with ARHL. <b>Methods:</b> A co-design methodology was employed. Digital recordings of the co-design workshops were transcribed verbatim. An established reflexive thematic analysis methodology was used. <b>Results</b>: Fifteen older adults with ARHL, referred to as "co-researchers", participated in three co-design workshops until data saturation was achieved. Consultations were held with two key service providers. Three key themes emerged: (1) older adults with ARHL prefer a user-friendly auditory-cognitive training system; (2) clear, localized and colloquial instructions for the training tasks are necessary; and (3) diversified, tailor-made and dual-task training tasks, performed in an interactive and game-like mode, can motivate and sustain usage of the training system. As a result, a prototype of a web-based, gamified, and adaptive auditory-cognitive dual-task training system was co-designed. <b>Conclusions</b>: Our findings affirmed the importance of genuinely listening to the voices of end-users and creating a system that is responsive to their needs and preferences. Future study is recommended to examine the effects of this system on older adults with ARHL.