What Health Topics Older Adults Want to Track: A Participatory Design Study
Jennifer L. Davidson, Carlos Jensen · 2013 · Proceedings of the 15th International ACM SIGACCESS Conference on Computers and Accessibility (Assets '13) · doi:10.1145/2513383.2513451
Summary
This paper presents a participatory design study investigating what health topics older adults (aged 65+) want to track using mobile health (mHealth) applications. The authors argue that most mHealth app developers fail to conduct needs assessments with older adult end users, creating a "viscous cycle" of technology exclusion that leads to lower adoption rates and potentially contributes to cognitive decline. Eighteen participants (12 female, median age 71, range 65-88) with no programming experience were recruited from a registry of Oregon residents aged 50+ and from senior centers. They participated in 2.5-hour sessions involving individual interviews about technology use, group participatory design sessions where 5 groups of 3-4 participants sketched application designs, and post-session questionnaires. Three groups critiqued existing iPhone health apps before sketching; two groups sketched first and then critiqued. The study took a user-centric rather than patient-centric approach, focusing on what individuals personally want to track rather than what doctors or insurers want them to track. A market analysis compared participants' identified health topics against offerings in the iPhone App Store and Google Play Store.
Key findings
The five groups produced designs covering 22 distinct health topics, with remarkable diversity — only 4 topics appeared in more than one design, and none appeared in more than two. Thirteen health topics from the designs were not included in the researchers' questionnaire, demonstrating that participatory design surfaces ideas that traditional survey methods miss. The most popular health topic from the questionnaire was "health appointments" (93.75%), which appeared in none of the designs — illustrating that design sessions and questionnaires capture complementary information. Four of the five groups identified at least one health metric not currently available in either app store. Five topics were absent from both stores: rest tracking (beyond sleep — including meditation, yoga, gardening), social interaction tracking, personalized healthy eating suggestions based on desired outcomes, local stress relief activity suggestions, and hematocrit. The most creative design ("RxMedApp") came from the group with no prior smartphone experience that did not critique existing apps first, suggesting that exposure to existing solutions may constrain creative thinking. Seventeen of eighteen participants expressed interest in tracking health metrics via smartphone despite limited device experience. Participants defined health broadly to include mind, body, and soul — encompassing social interactions, mood, stress relief, and restful activities alongside clinical metrics like blood pressure and cholesterol.
Relevance
This paper demonstrates the value of including older adults in the technology design process rather than designing for them based on assumptions. The finding that the most creative design came from participants with no smartphone experience challenges the common practice of recruiting "lead users" and suggests that novice users may bring fresher perspectives. For accessibility practitioners, the study highlights several important points: older adults are willing and eager to use health technology even without experience; their health tracking needs extend well beyond clinical metrics into social, emotional, and lifestyle domains that remain underserved by the app market; and participatory design and questionnaires are complementary methods that surface different needs. The "viscous cycle" concept — where excluding older adults from design leads to products they don't adopt, which is then used to justify continued exclusion — is a powerful framing applicable to disability and accessibility more broadly. The recommendation to continue involving older adults throughout the development process, not just at the initial design stage, supports the principle of "nothing about us without us" in accessible technology development.
Tags: older adults · aging · participatory design · mHealth · mobile accessibility · health technology · smartphone applications · aging in place · user-centered design · digital health