Co-designing a culturally appropriate mHealth physical activity intervention for midlife women experiencing menopause...

Promoting Physical activity (PA) is a public health priority, with regular engagement associated with improved psychosocial and physical outcomes during menopause. Despite these benefits, adherence to PA guidelines among midlife women remains low globally, a pattern particularly pronounced in conservative contexts such as Saudi Arabia. mHealth presents a promising opportunity for supporting PA behaviour change at scale, yet effective engagement requires interventions aligned with women's needs and preferences. This study aimed to co-generate and prioritise actionable recommendations for a contextually tailored mHealth PA intervention for midlife Saudi women experiencing menopause.

This study employed an exploratory qualitative design guided by the Generative Co-design Framework for Healthcare Innovation. Online group-based workshops were conducted between May and October 2024. In the first round, four co-ideation workshops were held with homogeneous groups of potential end-users (midlife Saudi women) and professionally diverse stakeholders relevant for intervention development, using storyboards to elicit women's perspectives of PA-related needs and challenges. The second round involved a cross-sectoral co-prioritisation workshop using a consensus-building matrix. Workshops were audio-recorded, transcribed, and analysed using inductive qualitative content analysis. Stakeholder-generated recommendations were subsequently mapped onto the COM-B model and Behaviour Change Wheel (BCW).

Twenty-three stakeholders participated across five co-design workshops, including midlife Saudi women (n = 3), various healthcare providers (HCPs) (n = 14), policymakers (n = 2), fitness trainers (n = 3), and an app developer, each participating in at least one workshop. Agreed priorities included tailored educational modules on menopause and PA, a home-based adaptable exercise library, empathetic messaging framing PA as self-care, progress tracking and feedback, personalisation options, and social and community support features. Cultural tailoring was identified as essential across all components. Stakeholders also recommended an ecosystem approach to implementation, encompassing technical training and intergenerational family digital support to enhance digital skills and inclusion, integration with existing health systems and HCP endorsement, and cross-sectoral partnerships to support uptake and sustainability.

This study represents one of the first applications of a structured participatory co-design approach to digital health intervention development within the Saudi Arabian context. The co-design process proved feasible and acceptable and generated culturally grounded insights for a population that remains underrepresented in health research. The findings provide a foundation and practical direction for intervention content, design features, and implementation strategies aligned with women's lived experiences and sociocultural context. The necessary next steps are prototype development and feasibility testing.