Toward Inclusive Design Heuristics for Digital Health Interventions for the Aging Population: Scoping Review

Digital health interventions (DHI) deliver health-related services in a digital manner. Meant for older adults, they must be tailored to address their needs. This may be by applying inclusive design principles. Inclusive design is an approach that aims to accommodate the needs of a broad spectrum of users, taking into account health-related factors, socioeconomic status, age, cultural background, language diversity, and other factors.

This review aims to collect best practices on the inclusive design of DHIs for older adults and aggregate them into a set of design guidelines.

We examined peer-reviewed papers from 3 databases that described a design and development process of a DHI specifically designed for users aged 60 years or older, and used inclusivity to design the solution. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) checklist. Information on the DHIs and their design process, as well as facilitators and barriers for adopting DHIs by older adults, was extracted.

Of 1276 records, 40 papers were included and considered for data synthesis. DHIs are provided through a broad range of technical platforms (mobile apps [20/40], web-based platforms and web apps [6/40], voice and virtual assistant technology [2/40], telehealth and remote monitoring systems [4/40], and tablet-based and specialized systems [8/40]). Sometimes, their design process included older adults (2/40) but also clinicians (1/40), designers and developers (3/40), and researchers (3/40), as well as other community stakeholders (3/40). The derived design heuristics to be considered for inclusive design comprise 11 aspects covering multiple dimensions: visual design and readability, navigation, accessibility, customization and personalization, social engagement and support, learnability, multiplatforms and device compatibility, motivation, feedback and user engagement, security and privacy, inclusive language, and costs. Barriers range from age-related health issues to technical hurdles related to access or connectivity.

The inclusive design of DHIs for older adults extends beyond usability and user interface design. This study highlights the critical role of co-designed DHIs in addressing persistent challenges of isolation, limited mobility, and access to care among older adults. Older adults must be placed at the center of development, with their needs and challenges identified and addressed in the solution. By enabling tailored, locally relevant digital experiences, co-design empowers older adults to engage meaningfully with health services despite infrastructural and socioeconomic barriers. The list of inclusive design aspects and recommendations provides a starting point for DHI developers to create functionality that supports many needs and goals of older adults. Future work must validate our results from a practical perspective. The adoption of our heuristics in practice could be fostered by developing concrete methods that implement them.