Participatory Development of Digital Innovations for Health Promotion Among Older Adults: Qualitative Insights on Individual, Contextual, and Technical Factors.

Location-based games offer innovative approaches for health promotion among older adults, but their effectiveness depends on understanding complex contextual factors beyond technological design. In our study, we aimed to adapt a location-based game in the form of a smartphone application which originally targeted younger people. We employed ethnographic observations in a field test under real-world conditions for identifying the needs and preferences of older adults in this regard. Field notes of one co-creative workshop were analyzed using thematic analysis. Four key contextual factor categories emerged that significantly influenced user engagement: (1) temporal/spatial factors including weather conditions, topography, and traffic safety that impacted screen visibility and cognitive function; (2) virtual-physical orientation challenges requiring high cognitive load to transfer abstract digital maps to real environments; (3) individual factors such as technical competence, mobility levels, and prior accessibility experiences that shaped usage patterns; and (4) social dynamics that provided motivation and peer support while potentially creating exclusionary practices. Successful digital health innovations for older adults require a socio-technical systems approach that addresses environmental conditions, reduces cognitive transfer demands between virtual and physical navigation, leverages social elements while preventing exclusion, and accounts for heterogeneity among older adults as contextually interactive factors rather than merely individual differences.