Co-design of a digital 24-hour time-use intervention with older adults and allied health professionals

Using co-design principles based on the Health CASCADE framework, we aimed to describe the collaborative process undertaken to develop a 24-hour time-use intervention, called Small Steps, which promoted gradual and incremental health-behavior change. A secondary aim was to reflect on the challenges and benefits of co-design in this project, offering insights into the “why” and “how” to co-design 24-hour time-use interventions with priority populations. Twelve participants were invited and participated in 6 co-design workshops (June 2023–January 2024). To prioritize older adults’ views in the end-product, 8 adults aged >65 years (the target population) and 4 allied health professionals with >2 years’ experience working with the target population were recruited. Workshops and activities were structured using the British Design Council's Double Diamond Design Process to stimulate design thinking. Where possible, participant-led documentation was used to reduce the bias associated with academic scribing and empower participants to provide input and facilitate ownership for the project. Workshop activities and discussions were captured through printouts, audio and iPad screen recordings and analyzed through reflexive thematic and content analysis. Co-designers contributed to all elements of the intervention including the website design, the content, and the level of researcher input during the intervention. Iterative improvements were made based on the unique perspectives and needs of the community experts. During the action planning process, older adults wanted both support and autonomy, while maintaining the freedom to adapt these options to their individual needs. Older adults also preferred a step-by-step approach, allowing for gradual behavior changes across the intervention to avoid feelings of becoming overwhelmed. The co-design process enabled the tailoring of the Small Steps intervention to the specific needs of its intended audience. Key factors contributing to the co-design included flexibility in the design process, fostering a supportive environment, and empowering participants through activities that guided and stimulated their thinking. These elements not only helped shape the development of Small Steps but reinforced the value of co-design in developing personalised interventions for older adults

‘Small Steps’ towards improving 24-hour time-use behaviours to decrease the risk of dementia: protocol for a personalised, web-based randomised controlled trial in community-dwelling older adults

Introduction Addressing physical inactivity is a promising dementia risk reduction strategy due to its direct benefits for brain health, and indirect benefits for other modifiable dementia risk factors. A potential limitation of previous interventions is that they often overlook how increasing physical activity affects other behaviours throughout the 24-hour day, such as sleep and sedentary behaviour, which are also important for brain health. Further, interventions are rarely tailored to the individual, considering their needs, preferences and constraints that may serve as barriers or facilitators to behaviour change. The current phase I randomised controlled trial, Small Steps, aims to investigate feasibility, acceptability and preliminary effectiveness of a personalised 24-hour time-use intervention to improve lifestyle and cognitive health in older adults.Methods and analysis Participants aged ≥65 years from Adelaide, South Australia will be recruited and randomised to either the Extended or Condensed programme. During the first 12 weeks, participants in the Extended programme will use a tailored website to set personalised weekly goals to move towards their ‘optimal’ 24-hour day for brain health, facilitated by weekly website ‘check-ins’ and weekly phone calls with a research staff member. Participants randomised to the Condensed programme will have access to the website educational resources only but will not undergo personalised goal setting or telephone calls. Following the introductory phase (first 12 weeks), phone calls will be gradually withdrawn for the Extended programme. Primary (feasibility and acceptability) and secondary outcomes (changes in time use, cognitive function and behaviour change metrics) will be assessed 12, 24 and 36 weeks after the beginning of the intervention.Ethics and dissemination Ethics approval has been obtained from the University of South Australia’s Human Research Ethics Committee (205989). Study findings will be disseminated through peer-reviewed journal articles, conference presentations, media releases and community engagement.Trial registration number NCT06291909)