Older adults' acceptability and perceived barriers to digital health tools integrating nutrition and physical activity: a focus group study

Introduction: The rapid ageing of the population presents significant public health challenges, particularly in countries with high life expectancy such as Italy. Although nutrition and physical activity are key determinants of healthy ageing, many older adults do not meet recommended guidelines. Mobile health (mHealth) technologies may support healthy behaviors; however, evidence on older adults' perspectives remains limited, especially in the Italian context. This study aimed to explore experiences, perceptions, and expectations regarding mHealth tools for nutrition and physical activity. Methods: A total of three in-person focus groups were conducted with older adults in Italy, recruited regardless of prior experience with mobile health technologies. Data were analyzed using reflexive thematic analysis. Results: Reflexive thematic analysis generated three themes: digital health as a "robotic friend", digital health as an emotional barrier and digital health to increase awareness. The findings demonstrated that participants had good mHealth literacy. Nevertheless, they described digital health technologies as low in engagement and external motivation, highlighting the emotional distance, a strong preference for in-person interactions, and a general mistrust toward digital health. While there were some concerns related to privacy and fear of injury, older adults expressed their interest in digital tools as sources of guidance, education, and supervision. Discussion: Fully automated digital interventions may not meet the needs and preferences of this population. Findings suggest that hybrid models combining both digital technologies and human interaction might be more acceptable and feasible for promoting physical activity and healthy nutrition in later life.