Appreciating the complexity of frailty and user context in digital health intervention design: A qualitative study with personas

Frailty is a complex and dynamic process that is becoming increasingly common as the population ages. Early intervention has been shown to reverse or slow progression, but requires support from increasingly limited healthcare resources. Digital health interventions could potentially assist, but first it is vital to understand older adults' experiences and perspectives. This study describes feedback from older adults with symptoms of pre or early frailty on the design concept of a digital device intended to function as an adjunct to physiotherapy and occupational therapy by increasing frequency and quality of safe movement at home. Objectives were to better understand experiences of frailty, and to identify potential influencing factors on adoption and adherence. In-person audio-recorded qualitative interviews were conducted with 17 older adults and 5 carers recruited from community settings. Reflexive thematic analysis generated two themes: 'autonomy and prompts: importance of personalisation'; and 'digital interfaces and accountability: importance of usability and purpose'. In addition, three personas were generated from the data, each describing different needs and preferences for such a device. Situating the results of analysis in the context of current literature, a set of Guiding Principles was created to support future design development in this area. These highlight important factors for consideration when designing for this population, and provide key design feature suggestions and implementation strategies to address these factors including: ensuring the device has clear purpose; is adaptable to the diversity of needs within this clinical population; any form of feedback is safe, relevant, useful and rewarding to multiple users; and technical support is accessible and ongoing. It is recommended that the target population, and clinical purpose be more clearly defined within the healthcare context to encourage personal rehabilitation through enhancing the therapeutic alliance rather than focussing on individual behaviour change of diverse older adults.