A Person Centred Approach to Developing a Digital Tool (KOKU-Nut) to Improve Dietary Intake in Community-Dwelling Older Adults

Abstract Background Digital tools embedded with behaviour change theories can encourage the successful implementation and maintenance of positive lifestyle changes. Keep on Keep up (KOKU) is a wellbeing app offering strength and balance exercises and educational games to raise awareness of fall prevention. We aimed to further develop KOKU using a person-centred approach to support nutritional intake and align with the service users’ needs and priorities to maximise engagement and usability. Methods Initially, adults aged 65 and over were recruited from assisted living facilities across Greater Manchester. Five focus groups involving 33 older adults (aged 69–96 years) were conducted between October and December 2022. A topic guide was used flexibly to understand factors that influence the groups eating habits and explore their thoughts around a digital tool to support nutritional intake. Conversations were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Researchers then collaborated with designers to develop a nutrition game based on UK dietary guidelines and findings from the focus groups. The nutrition game was tested with end users in January 2024 before making any necessary changes. Users provided feedback and completed the system usability scale (SUS). Results Four themes emerged from the dataset. The main determinants of food intake were personal preference, perceptions of foods and changes as a result of age-related decline. The ability, engagement and willingness to use digital technology varied among participants but the majority had a positive attitude towards the digital service. A matching pair’s card game was chosen and the educational content was produced by the research team. A prototype of the nutrition game (KOKU-Nut) was tested with 10 end users on an iPad provided by the research team. Feedback was generally positive and the median SUS was 87.5 (IQR: 65, 95) out of 100 indicating the nutrition game had excellent usability. Conclusions We anticipate this person-centred approach will support the uptake and sustained use of KOKU-Nut to empower and educate users to improve their diet.