Physical activity (PA) is defined as “any bodily movement produced by skeletal muscles that results in energy expenditure” [1
]. PA has several health benefits for the population in general [2
]. The health benefits of regular PA for older adults are extensive and include cardiovascular, musculoskeletal, and psycho–social health [3
]. Moreover, PA can contribute to preventing falls in community-dwelling seniors, especially exercise programs that challenge balance and are of higher dose (at least three hours of exercise per week) [4
]. International recommendations on the types and amount of PA needed to improve and maintain health have been formulated [5
]. Recommendations for persons aged 65+ are the same as for adults in general with the addition that: (1) persons with poor mobility should perform PA to enhance balance and prevent falls three or more days per week; (2) when older adults cannot do the recommended amounts of PA due to the presence of health conditions, they should be as physically active as their abilities and conditions allow. Examples of activities to enhance balance and to prevent falls include group and home-based exercise programs and tai-chi [6
]. Approximately one-third of adults worldwide fail to reach public health guidelines for recommended levels of PA, and the proportion of persons with insufficient PA in relation to guidelines increases with age [7
]. Moreover, seniors’ uptake and adherence to fall-prevention PA is low [8
]. Increased and long-term maintenance of seniors’ PA (in general and related to fall prevention) is, therefore, highly important for public health.
A review of the effectiveness of PA interventions among adults aged 60+ concluded that PA interventions for seniors were more effective when containing cognitive-based and cognitive-behavioral approaches than behavioral-only approaches [10
]. Moreover, it has been recommended that interventions for promoting older people’s engagement in PAs to prevent falls should be tailored to the specific values and situation of the individual [11
]. In addition, a systematic review and thematic synthesis of qualitative studies on perspectives on PA among people aged 60+ concludes that strategies to enhance seniors’ PA should include raising awareness of the benefits and minimizing the perceived risks of PA as well as improving the environmental and financial access to PA opportunities [12
]. Digital technology-based applications can be used to deliver more efficient and effective fall prevention exercise and PA interventions among seniors [13
]. For example, the potential of wearable activity monitors for promotion of seniors’ PA has been investigated [14
Technology-based solutions need to be accepted and used by the intended users. In order to design new digital applications users are interested in and willing to use, user-centered design processes are often used [18
]. Here, the users’ needs, requirements, and perceptions are used in the design process. Moreover, new technical applications supporting PA should be designed in accordance with relevant theory [19
]. It is, therefore, relevant to relate needs, requirements, and perceptions gathered from users to relevant theories for technology use and for changing and sustaining PA behavior. In particular, the degree to which the users are willing to use technical applications is described by the unified theory of acceptance and use of technology (UTAUT) [20
]. According to UTAUT, four constructs (performance expectancy; effort expectancy; social influence and facilitating conditions, respectively) are determinants of users’ intent and usage of a system. Rhodes et al. [19
] have given an overview of PA behavior theories and their key constructs. For example, the behavioral change wheel [21
] and taxonomy of behavioral change techniques (BCTs) [22
] provide systematic approaches for designing, characterizing, evaluating, reporting, and implementing behavioral change interventions. The taxonomy is particularly relevant for defining content and evaluating behavioral effects of PA interventions. In addition, autonomous motivation has been proven as a determinant of sustained PA behavior [24
]. Autonomous motivation is a central construct of the self-determination theory (SDT) [26
], which comprises five complementary mini-theories and provides a viable framework for explaining motivation quality and PA behavior [19
]. A systematic literature review made by Teixeira et al. [28
] concluded that there is good evidence for the value of SDT in understanding exercise behavior.
The study reported in this article was conducted as a first step in a user-centered design process [18
] of digital technology supporting and motivating seniors to perform PA. The main aim was to investigate seniors’ and health care professionals’ (HCPs) perceptions on possible contributions and qualities needed/required from technology in supporting and motivating seniors to perform PA. The HCPs’ perspective was considered relevant here, since they also could be users of the technology when coaching seniors to perform PA. In order to be able to design and develop a solution that is useful for both user groups, it is important to gain an understanding of the differences and similarities among the two user groups’ views. Hence, seniors and HCPs were essential for the feasibility of the study by representing two different potential user groups of the technology, while the role of the researchers was to investigate the users’ views and perspectives on the technology and use the results in the user-centered process. A secondary aim was to discuss whether the views expressed were in accordance with the SDT [26
], UTAUT [20
] or reflected elements in the BCT taxonomy for PA behavioral change [23
]. The following research questions were addressed:
Q1: What are seniors’ and HCPs’ views on needs and requirements on digital technology for supporting and motivating seniors to increase PA?
Q2: Which similarities and differences can be found between seniors’ and HCPs’ views?
Principal conclusions from the study are:
(1) Both seniors and HCPs saw that technology should support PA and make it more enjoyable while strengthening the seniors’ control and well-being. However, the seniors’ opinions were related to social aspects, enjoyment, and how the technology could contribute to making seniors feel better, whereas HCPs highlighted how the technology could contribute to their role as professional coaches and described how the technology could facilitate the dialogue between the senior and coaching HPC as well as providing information. Both seniors’ and HCPs’ views can be supported by SDT. Also, BCTs relevant for increasing seniors’ PA can be identified in the results.
(2) Seniors and HPCs had similar views on qualities that the technology should have in order to be useful and attractive. Views expressed were mainly in accordance with UTAUT.
This study illustrates the views of seniors and HCPs on digital technology-based motivation support for increasing seniors’ PA. Results from the study showed that both seniors and HCPs see several possible contributions from technical support and have similar views on which qualities the technology must have to be attractive and useful. Both seniors and HCPs saw that technology should support PA and make it more enjoyable while strengthening the seniors’ control and well-being. However, the seniors´ opinions were related to social aspects, enjoyment, and how the technology could contribute to making them feel better. The HCPs views also included aspects on how the technology could contribute to their role as professional coaches and how the technology could facilitate the dialogue between the senior and coaching HCP as well as providing information. Both seniors’ and HCPs’ views can be supported by the SDT. Also, BCTs relevant for increasing seniors’ PA can be identified in the results. Four main contributions of the technology were identified in supporting and motivating seniors to increase PA; they are discussed in the following section both from a theoretical perspective and in relation to previous research in the area.
Firstly, seniors and HCPs perceived that the digital technology should make PA more enjoyable. This can be seen as a way of raising the seniors’ intrinsic interest for PA, which is in accordance with SDT, and especially, its sub-theory cognitive evaluation theory (CET) [26
]. Examples provided on how to raise intrinsic interest were to include playful and competitive elements in the technical applications and to make the technology support social interactions. Especially, the seniors emphasized social interaction as a main motivator for PA. Social support has also been found to improve the effectiveness of PA interventions [34
]. Concretely, social interaction, such as group activities that include PA, could contribute to satisfying the psychological need of relatedness which, according to SDT, can contribute to intrinsic motivation and to autonomous motivation for PA. The importance of social interaction for behavioral change is also in accordance with the social cognitive theory which emphasizes the importance of social interaction and model learning [35
]. However, this theory also describes that personal, behavioral, and environmental factors interact with each other in behavioral change. All three factors are, therefore, necessary for behavioral change [35
]. In addition, the technical support could contribute to reducing loneliness among seniors. It is also postulated in SDT that satisfaction of the psychological needs of competence and autonomy is important for a person’s autonomous motivation. It should be emphasized that the senior participants in the focus group were physically active, some of them were also used to PA in a social setting. For persons that do not feel competent and autonomous in a PA group setting, technical applications can contribute to satisfying their need for relatedness, for example, by providing different social features. Social interaction could also be relevant for introducing new users to the technology. For example, UTAUT describes that a system is perceived more attractive to new users when used by other persons they have confidence in, and that access to help from other users with the usage of the system can strengthen personal motivation for using the system.
Secondly, both seniors and HCPs described that the digital technical applications should provide support for PA. Here, the HCPs described how technology could facilitate their role as professional coaches. However, the seniors expressed a broader view on coaching and saw that coaching could be provided from the technology itself, from senior organizations, as well as from health care. The seniors thought that some inactive persons could become motivated to increase their PA after prescription by a physician and follow-up meetings. Some of the HCPs gave similar descriptions of their work procedures together with patients. Provision by a professional can, according to SDT (particularly its sub-theory organismic integration theory (OIT), which describes the process through which a person can become more intrinsically motivated to a behavior that he/she initially was amotivated) be seen as the least autonomous form of extrinsically motivated behaviors performed to satisfy an external demand or obtain external reward or avoid external punishment. According to SDT, contextual factors can support internalization and integration of regulations, which are important processes for intrinsic motivation, which in turn, contributes to long-term behavior maintenance. Also, coaching can contribute to satisfying the senior’s need of relatedness while gradually increasing satisfaction of personal needs for competence and autonomy. According to SDT, this process contributes to autonomous motivation and sustained behavior.
Thirdly, it was expressed that the digital technology should contribute to strengthening the seniors’ own control in changing PA behavior. This view is supported by SDT which states that satisfying the personal need for autonomy is important for strengthening autonomous motivation and sustained behavior. The HCPs perceived that seniors’ motivation for PA could be strengthened if the technology informed and raised the seniors’ awareness of the importance of PA. According to OIT, being physically active in order to avoid health risks is the least autonomous form of extrinsically motivated behaviors. Organismic integration theory states that, in order to strengthen the individual’s autonomous motivation for PA, promotion of internalization of values and behavior related to being physically active is needed. This was illustrated by the HCPs statement that results need to be communicated by the applications in a suitable way. Moreover, the refined taxonomy of BCT to help people change their PA includes two BCTs on providing information on consequences of behavior (in general or behavior to the individual) [23
]. However, providing information of consequences on behavior has not been identified as among the most efficient BCTs for increasing seniors’ PA [36
]. The HCPs also perceived that the technology should provide visual guidance. This is interesting since two previous studies have pointed out that, although being effective for increasing PA, BCTs related to practice, planning, problem solving, and providing instructions are scarce in current activity monitoring applications [37
]. Also, the HCPs described different ways by which they wanted the technology to support seniors’ self-monitoring. Previous studies have shown that BCTs related to self-monitoring and self-regulation are most frequently found in activity monitor systems [37
]. However, BCTs related to self-regulation have not been identified among the most efficient BCTs for increasing seniors’ PA [36
]. On the contrary, there is evidence that later in life, people tend to prioritize present-oriented goals related to emotional meaning over future-oriented goals [39
]. Therefore, it might be important in information aiming at increasing seniors’ motivation for PA, to focus on the short-term benefits of PA and to include suggestions for emotionally meaningful activities to seniors. The seniors perceived that motivation for PA could be strengthened by personal awareness of insufficient PA in their daily life and acknowledgement of progress. The latter is interesting since rewards for successful behavior have been identified as one of the three most effective BCTs for increasing older adults’ PA [40
]. Moreover, the seniors perceived that the technical support should motivate the user to perform PA by providing feedback. The feedback can be seen as support for the users’ internalization and integration of regulations, which, according to SDT, can increase the degree of self-determination in PA behavior and thereby enhance persistence and adherence.
Fourthly, it was expressed that the digital technology should contribute to strengthening well-being. The seniors described that the technology must be perceived supportive, non-demanding, and must not provoke fear of making mistakes (for ruining something, and for needing help). The described aspects relate to key constructs of UTAUT (expectancy of the system’s performance, effort needed for using the system, and degree of ease to use a system) which are important for technology acceptance and use according to UTAUT [20
]. The seniors’ view that the technology should be perceived safe and supportive is also in accordance with SDT, which states that fulfilment of psychological needs for competence and autonomy is relevant for increasing the seniors’ autonomous motivation for technology use and for PA. Moreover, the HCPs perceived that the technology should contribute to decrease seniors’ fear and doubt for PA. This view is both in accordance with SDT, which describes that satisfying the psychological need of competence can contribute to strengthening autonomous motivation, and with a study by French et al. [40
] which identified BCTs related to problem solving as one of most effective BCTs for increasing older adults’ PA.
Both HCPs and seniors expressed that the digital technology should make seniors feel better. The HCPs also perceived that the technology should provoke feelings that could increase the seniors’ intrinsic interest for the technical applications, for example, feelings of enjoyment and being modern. According to SDT, this is relevant for strengthening seniors’ intrinsic motivation to use the devices. Finally, the HCPs described that users must feel confident in the technology. For example, they described that technical applications must communicate results to seniors in a suitable way, which is in accordance with SDT, describing that satisfying the needs of relatedness is important for autonomous motivation. The HCPs also emphasized that, as professionals, they need to feel they can truly recommend the technical support to patients. This view is supported by UTAUT describing that users’ expectancy on system performance is important for technology acceptance and use.
Seniors and HCPs had similar views on what qualities the digital technology must have to be attractive and useful: both user groups expressed that the technical applications should be user friendly, reliable, customizable, interoperable, and effective for the purpose. All mentioned aspects are relevant for satisfying the users’ needs of autonomy and competence, and therefore in accordance with SDT which states that this is important for autonomous motivation to use the devices [26
]. Moreover, the mentioned qualities are also supported by UTAUT as determinants for technology acceptance and use [20
]. The HCPs also described that price and distribution channels could be relevant for the seniors’ motivation to use the support. This view is in accordance with UTAUT, which describes facilitating conditions as having a positive effect on users’ willingness to accept and use technology.
To summarize, the identified requested contributions of the digital technology are relevant for strengthening motivation according to SDT [41
], since they reflect needs and requirements on a system that can be intrinsically interesting for users and that can increase the users’ motivation quality for PA. Moreover, it illustrates how the system can contribute to the satisfaction of seniors’ psychological needs for relatedness, autonomy, and competence, which according to SDT, can increase intrinsic motivation for PA and thereby strengthen adherence and persistence. The results also contain examples of BCTs that are relevant for increasing PA behavior as well as needs and requirements important for technology acceptance and use according to UTAUT [20
The results from this study are in accordance with empirical studies on requirements on technology supporting PA. For example, the contributions and qualities identified in this study overlap with the design requirements (giving users proper credits for activities; providing personal awareness of activity levels; supporting social influence; and considering the practical constraints of users’ life styles) identified by Consolvo et al. [42
]; core features (identified up-to-date and evidence-based information and instructions, self-regulation tools, social interaction, personalized set-up, attractive design and content, and access to the internet service) according to people with rheumatoid arthritis identified by Revenäs [43
]; requirements expressed by HCPs and person’s with cardiovascular disease (patient tailoring, simplicity within the platform, technology-augmented care, enabling or increasing individual self-management, and capitalizing on an appropriate time to intervene in the rehabilitation) identified by Walsh et al. [44
]; and with design considerations (functional exercises, behavior change and blended technology delivering programs through interactive video) and requirements (comprehensiveness, effectiveness, adaptability, and remote guidance) for an intervention supporting seniors’ exercise at home with help of technology identified from scientific literature and consultancy from experts from health and behavior science, respectively, in a study by Mehra et al. [45
Results from this study can be used for further exploration of seniors’ and HCPs’ views on hindrances and motivators for PA and for designing interventions for increasing seniors’ PA as well as for technical systems supporting and delivering interventions. In addition, this study also aimed to relate seniors’ and HCPs’ views on theory for personal motivation for PA (SDT) and technology acceptance and use (UTAUT). Thereby, the study might contribute to increased understanding on concrete ways to build technology-based motivation support for seniors’ PA based on theory for personal motivation. Moreover, areas where seniors and HCPs expressed different views on approaches for increasing seniors’ motivation for PA were identified. Further research is needed on potential differences between HCPs’ and seniors’ views on how to strengthen seniors’ motivation for PA. In particular, the third contribution identified in this study (i.e., strengthening the seniors’ own control) is relevant for further exploration, especially since the HCPs’ view (that increasing seniors’ awareness of risks associated with low PA and how active they need to be) according to SDT will contribute to the least autonomous form of extrinsically motivated behaviors. Here, it might be relevant to relate the results to complementary theories for PA and health behavior. For example, theories including the key construct of self-efficacy [46
] such as the social cognitive theory [35
] and the health belief model [47
]. Exploration of individual barriers and facilitators for participation in fall prevention programs have been suggested to improve HCPs’ possibilities to build partnerships and develop person-centered care [48
]. Further research is also needed on how technical support can contribute to seniors’ internalizing and regulating of integration. For example, how can technology facilitate the dialogue between HCP and senior, as requested by the HCPs in this study. Further investigations on how new types of BCTs can be integrated into PA support systems is also needed. For example, BCTs for relapse prevention and prompt barrier identification are most often not included in mobile applications [49
The strengths of this study include the representation of two different potential user groups (seniors and HCPs) in early phases of a user-centered design process. Investigating both user groups’ needs prior to technology development is important since it enables the design and development of a system that is usable for both groups. Furthermore, potential conflicts between the two user groups’ needs can be identified. Moreover, HCPs represented different organizations, different professions, and professional roles. In addition, to ensure the trustworthiness of the result, the analysis was performed by two researchers and read by a third researcher with previous experience in qualitative research and seniors’ PA. Accordingly, the papers discussion section has been reviewed by an external researcher with deep knowledge in SDT. The paper provides a detailed description of how data was collected and analyzed. Moreover, the transparency of the analysis has been strengthened by citations from the interviews and description the participants groups and research team.
The main limitations of the study included the rather limited sample due to the fact that only one focus group was conducted with seniors and one with HCPs. Another limitation was the selection bias since the senior participants were active persons in independent living. Therefore, the results of the study might not be transferable to inactive seniors, persons with transportation barriers, persons living in special housing or in rural communities. The technology might be helpful also for those persons and further investigation is needed in this area. However, future work will also involve inactive seniors in the development process, where needs and requirements for technology supporting seniors’ PA will be further explored. Also, some of our senior participants had experiences from leading and arranging social activities and training activities for seniors. Some of their views described needs and requirements that they perceived important for other seniors that they had met in those roles. Moreover, the analysis of similarities and differences among the two user groups was performed on sub-categories from the two analyzed focus group interviews. Hence, the data subjected to the second analysis were sub-categories from the first step of qualitative analysis containing interpretation by the researchers. Therefore, the researchers’ perceptions might have influenced the data used for the second analysis and this might affect the results. However, interpretation is always a part in qualitative analysis, for example, as described in Silverman [50