User experiences of older adults navigating an online database of community-based physical activity programs

Abstract

Objectives

This study aimed to (1) explore older adult user experiences navigating an online health database of local physical activity programs; (2) compare navigational feedback with age-friendly website design guidelines; (3) assess online database completeness.

Methods

Focus groups, including guided tasks and a semi-structured interview script, gathered navigational user experiences of fifteen older adults. A review of the literature sought age-friendly best practice website design guidelines and a website search for local physical activity programs was completed.

Results

The design of the online database website was challenging for older adult participants to navigate and was not ‘intuitive’. Based on focus group feedback, there were multiple discrepancies between the evaluated online database and the established guidelines for designing age-friendly websites. A total of 187 physical activity programs were missing from the database.

Conclusions

Findings provide novel insight into user experiences of older adults navigating online health and physical activity program sites. Redesigning the following age-friendly website recommendations would empower older adults in the use of online databases and promote awareness of local physical activity programs. Health care providers need reliable and age-friendly online resources to link their patients with local physical activity programs to promote healthy aging.

Introduction

Ways of connecting older adults living in the community with local, high-quality, supervised community-based physical activity programs is a gap in efforts to support and promote physical activity by older adults. A lack of awareness and sufficient information about community-based physical activity programs continues to be a major barrier to participation.^1,2,3 Since 2015, the World Health Organization has advocated teaching older adults to use the internet to obtain valid and applicable health information to support healthy ageing. ⁴ In the past 10 years, the use of the internet by older adults to access resources is increasing.^5,6 Gordon and Hornbrook ⁷ reported over 80% of their American older adult participants had access to an internet-connected device; 63% reported going online to find health information. The majority of these older adults used a desktop, laptop or netbook for internet-access, whereas only 25% owned and used a tablet. ⁷ Statistics Canada reported that internet access rates by Canadian older adults (aged 65 +) increased from 32.2% to 68.2% between 2007 and 2016. ⁸

As internet-based services become more prevalent in health care, older adults are increasingly expected to access these services online. Digital literacy is defined as the ‘ability to use information and communication technologies to find, evaluate, create and communicate information, requiring both cognitive and technical skills’. ⁹ Based on this definition, older adults face several digital literacy barriers. Physical and cognitive limitations for older adults using computer technology to search online health resources include impaired vision, hearing loss, decreased motor skills, memory loss and issues with recall.^5,10 Further, a lack of familiarity is prevalent with finding health information using search engines,^5,6 low health literacy ¹¹ and the mechanics of navigating (e.g. scrolling) website features (e.g. search boxes) and recognizing ‘access points’ to information (e.g. ‘clickable’ links) on websites. ⁵ Moreover, older adults may not have critical evaluation skills to appraise which are reliable, accurate sources of information, ¹² particularly with the volume and organization of online content by search engines.^13,14 For example, the order of results listed during a Google search may be perceived by naïve users as ‘best’ in descending order rather than generated by ranking algorithms using specific key search terms.^13–15

Concerted efforts to address website design for senior users began in 2002 by the National Institute on Aging and National Library of Medicine (NIA/NLM). ¹⁶ Since then ‘age-friendly’ web-based or online communication guidelines for website development to optimize the online platform for use by older people were published by the Government of Canada in 2011 (updated in 2021) and the international World Wide Web Consortium Web Accessibility Initiative (W3C WAI).^17,18 The W3C WAI Developing Websites for Older People Guidelines was developed in 2010 and the website continues to update its guidelines, with the most recent review completed in 2018. ¹⁸ These guidelines describe optimal screen layout, including placement of ‘buttons’, tools (e.g. scrolling), font size and typeface, organization or ‘chunking’ of the website content, appropriate vocabulary and recommendations for ease of navigation to provide the best older adult user experience. There is considerable overlap in the recommendations of these three age-friendly website development guidelines, although the wording and detail of criteria differ between guidelines. The Government of Canada and NIA/NLM guidelines include criteria that are more subjective, such as ‘organization of the website should be simple and straightforward’, and highlights the importance of including older adult input in website creation. The W3C WAI guideline is more comprehensive due to its inclusion of three unique website development categories and more specific criteria. All three website development guidelines have been included for readers to view the benefits and drawbacks of each when evaluating a physical activity program database website using older adult navigational experiences and feedback (Table 1). With the major shift in society to digital cataloguing, storage and sharing of information online, age-friendly websites could play a major role in improving accessibility to community physical activity program information. Previous studies have been completed on the needs, barriers and facilitators of older adults using eHealth,^19,20 as well as on the development of websites via age-friendly guidelines. ²¹ However, none of these previous studies included user experiences on the navigation of a physical activity database website. Specific information important to older adults could be displayed in accessible ways for them and improve awareness of available physical activity opportunities in the community for greater participation. For example, information important for older adults in making decisions to participate or not in physical activity programs include cost, location, mobility/accessibility, ²² types of physical activity, safety, ²³ age group, schedule and supervision. ¹

Table 1.

A summary is presented of reported missing and present age-friendly website features in an online database of local physical activity programs.

Category Website Guidelines	American: National Institute on Aging & National Library of Medicine Guidelines 16	Government of Canada: Age-Friendly Communication Guidelines 17	International: W3C Web Accessibility Initiative Guidelines on Developing Websites for Older People 18 Copyright © 2020 W3C
Designing Readable Text/Perceivable Information
Text (Size, Style and Layout)	Use 12- or 14-point font size for body text Use sans serif typeface that is not condensed Avoid use of serif, novelty, and display typefaces Use medium or boldface type Present body text in upper and lowercase letters Use all capitals or italics in headlines only Reserve underlining for links Double-space all body text Left justified text is optimal	Use 12- or 14-point font size for body text Use sans serif typeface that is not condensed Use medium or boldface type Present body text in upper and lowercase letters Use all capitals or italics in headlines only Reserve underlining for links Double-space all body text Leave wide margins and space between paragraphs Left justified text is optimal	Resize text: Text can be resized without assistive technology up to 200 percent without loss of content or functionality. Visual presentation: Presentation of blocks of text, a mechanism is available to achieve the following: text is not justified, width is no more than 80 characters or glyphs, foreground and background colours can be selected by the user, line spacing is at least space-and-a-half within paragraphs, paragraph spacing is at least 1.5 times larger than line spacing, and text can be resized. Example: Providing controls on the webpage that allows users to incrementally change the text size of all text on the page Example: Providing large fonts by default Example: Avoid the use of text in raster images* Example: Using readable fonts Example: Using upper and lower case according to the spelling conventions of the text language Example: Avoiding chunks of italic text* Example: Providing a button on the page to increase line spaces and paragraph spaces Example: Providing sufficient inter-column spacing
Colour and Contrast. Background	Avoid yellow, blue, and green in close proximity Ensure that text and graphics are understandable on black and white monitor* Use dark type/graphics on a light background or white lettering on a dark/black background Avoid patterned backgrounds*	Avoid yellow, blue, and green in close proximity Ensure that text and graphics are understandable on black and white monitor* Use dark type/graphics on a light background or white lettering on a dark/black background Avoid patterned backgrounds*	Use of colour: Colour is not used as the only visual means of conveying information, indicating an action, prompting a response, distinguishing a visual element Contrast minimum: The visual presentation of text and images of text has a contrast ratio of at least 4.5:1 Contrast enhanced: Requires a higher contrast ratio of at least 7:1 for the visual presentation of text and images Example: Use a light pastel background rather than a white background behind black text to create sufficient, but not extreme contrast
Including Other Media*
Multimedia*	Use text-relevant images only* Use short segments for animation, video and audio to reduce download time on older computers*	Use text-relevant images only* Avoid using wavy lines or dots* Use short segments for animation, video and audio to reduce download time on older computers*	Time-based Media: Provide alternatives for time-based media* Example: Provide open (always visible) captions* Example: Provide a version of a movie with audio descriptions*
Text-to-Speech (Speech Synthesis), Text Alternatives*	Provide text alternatives like open-captioning or a static version of the text for all animation, audio and video*	Provide text alternatives like open-captioning or a static version of the text for all animation, audio and video*	Non-text content: Provide text alternatives for any non-text content so that it can be changed into other forms people need, such as large print, braille, speech, symbols or simpler language* Info and relationships: Information, structure, and relationships to be made available, for example, to text-to-speech software*
Improving Ease of Navigation and User Interface
Navigation and Location	Use explicit step-by-step navigation procedures when possible Use single mouse clicks to access information Use pull-down menus sparingly Incorporate buttons like ‘previous page’ or ‘next page’ to review or move forward Provide a site map to show the website organization Use the same set of navigation buttons in the same place on each page Use buttons that do not require precise mouse movements Avoid automatically scrolling text* For manual scrolling, incorporate icons	Use explicit step-by-step navigation procedures when possible Use single mouse clicks to access information Use pull-down menus sparingly – opt for static Use the same set of navigation buttons in the same place on each page	Multiple ways: More than one way is available to locate a Web page within a set of Web pages Location: Information about the user's location within a set of Web pages is available Page titled: Web pages have titles that describe the topic or purpose Consistent navigation: Navigation is presented in the same relative order across a website Consistent identification: Components with similar functionality are identified consistently Example: Providing a site map Example: Providing a search function to help users find content Example: Providing descriptive titles for webpages Example: Indicating current location within navigation bars Example: Providing link to the home page or main page
Links	Carefully label links Use icons with text as hyperlinks	Carefully label links Use icons with text as hyperlinks	Link purpose (context): Requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context. Link purpose (without context): A mechanism is available to allow the purpose of each link to be identified from the link text alone. Focus visible: Requires a visible keyboard focus indicator that shows what component on the webpage has focus. Example: Limiting the number of links per page Example: Making links visually distinct Example: Highlighting a link or control when the mouse hovers over it, or when it receives keyboard focus
Distractions, Pop-ups, and Page Refresh*			Pause, stop, hide: Mechanism for the user to pause, stop, or hide moving or blinking content* Interruptions: Can be postponed or suppressed* Audio control: A mechanism is available to pause or stop the audio* On focus: When any component receives focus, it does not initiate a change of text* On input: Changing a setting does not automatically change the context unless the user has been advised beforehand* Change on request: Changes of context are initiated only by a user request or a mechanism is available to turn off such changes*
Time*			Timing adjustment: Users can turn off, adjust, or extend any time limits* No timing: Timing is not an essential part of the event or activity presented by the content* Pause, stop, hide: Scrolling content should be able to be paused and that auto-updating content can also be paused or controlled*
Instructions and Input Assistance. Error Prevention and Form Recovery			Labels or instructions: Are provided when content requires user input Consistent identification: Components that have the same functionality within a set of web pages are identified consistently Error prevention (legal/financial/data): Pages with legal commitments or financial transactions have reversible submissions and can be checked and corrected* Error prevention (general): Users can check and correct any information they submit* Error identification: If an input error is automatically detected, the item that is in error is identified and the error is described to the user* Error suggestion: If an input error is automatically detected and suggestions for correction are known, then the suggestions are provided to the user* Example: Providing linear form design and grouping similar items Example: Providing spell checking and text input suggestions Example: Providing expected data format and example
Help	Offer phone number or email address for questions/comments	Offer phone number or email address for questions/comments	Help – context-sensitive help is available
Presenting Understandable Information
Layout and Organization	Organization of the website should be simple and straightforward Use standard page design with same icons and symbols throughout Label each page in the same location Use text with icons if possible Organize content in a standard format Break lengthy documents into short sections	Organization of the website should be simple and straightforward Use standard page design with the same icons and symbols throughout Label each page in the same location Use text with icons if possible Present ideas with illustrations or diagrams if it makes them easier to understand Break lengthy documents into shorter sections/pages Organize text in a standard or familiar format Put key points up front Repeat main points multiple times for reinforcement	Headings and labels: Headings and labels describe the topic or purpose Section headings: Section headings are used to organize the content Visual presentation: Includes techniques to help with text organization Example: Providing descriptive headings and labels Example: Organizing a page using headings Example: Use vertical (bulleted or numbered) lists instead of inline lists*
Language	Present information in a clear and familiar way Use positive statements * Use active voice* Write in simple language Provide an online glossary of technical terms	Present information in a clear, simple and familiar way Use a conversational, personal tone* Use active voice* Write in simple language – short words and sentences Provide an online glossary of technical terms Limit number of key steps	Unusual words: A mechanism is available for identifying specific definitions of words or phrases used in an unusual or restricted way Abbreviations: A mechanism for identifying the expanded form or meaning of abbreviations is available Reading level: Providing a version that does not require reading ability more advanced than the lower secondary education level Example: Using the clearest and simplest language appropriate for the content Example: Providing the expansion or explanation of an abbreviation Example: Making the text easier to read

Experiences and feedback about website navigation and mechanics were gathered from 15 older adult study participants. Reported missing items are bolded within the lists of age-friendly website features advocated by each of three age-friendly best practice website guidelines: the American National Institute on Aging & National Library of Medicine Guidelines, the Government of Canada Age-Friendly Communication Guidelines, and the international W3C Web Accessibility Initiative Developing Websites for Older People Guidelines. Plain text website features were present on the review of the online database of local physical activity programs.

Bold = Theme/characteristic flagged as needing improvement by older adult focus group participants. Italics   = Theme/characteristic that was considered well done by older adult focus group participants. Text with * = Theme/characteristic was either not applicable to the website or not discussed by older adult participants in the focus groups. Plain Text = Theme/characteristic was discussed, but no older adult focus group participant feedback was given about it.

Physical activity, particularly a mix of aerobic and resistance training, has been shown to improve older adults cognitive and physical function, prevent frailty, and maintain or increase independence in activities of daily living (ADLs).^24,25 Sustained physical activity participation is more likely in older adults who exercise in supervised groups and with other older adult peers^26,27 A study by Killingback et al. ²⁸ found that social interactions and support from older adult peers provided program enjoyment and aided in long-term (≥ 1 year) adherence. A systematic review on older adult adherence to community-based exercise interventions found adherence rates of ∼ 70% when older adults participate in community-based group physical activity programs of at least six months duration. ²⁹ To promote exercise uptake and adherence, health care providers are important links to connect older adults with local physical activity programs. ¹ In particular, physicians and physiotherapists play a major role in influencing patient physical activity behaviours.^30,31 Having a comprehensive, age-friendly online resource of local community programs would be a valuable resource for primary health care providers to raise awareness of high quality, supervised community-based physical activity programs for referral, and support uptake to maintain and/or improve function in their older adult patients. Therefore, the purpose of this research project was to complete an assessment of an online database for ‘age-friendly’ ‘user interface’ characteristics and the content of local community-based physical activity programs for older adults. The specific objectives were to: (i) explore the user experiences of community-living older adults navigating an online database; (ii) assess characteristics of the database website design compared to age-friendly best practice guidelines and user feedback from navigating experiences of older adult study participants; and (iii) assess completeness in the database website cataloguing of local physical activity programs.

Methods

Study design

An exploratory sequential mixed-method design^32,33 was used to collect qualitative data during focus groups with older adult study participants followed by quantitative data gathered from an extensive search of online community-based exercise programs advertised for older adults. Prior to the quantitative data collection phase, the experiences and insights derived from the focus groups informed the second phase of data collection; that is, the search strategy for online older adult exercise programs and the information they considered important for included programs. Ethics approval of the study was provided by the institutional Research Ethics Board and all participants provided written informed consent prior to study enrolment.

Research paradigm

Our underlying philosophy in this study, addressing the gap in our understanding about how older adults navigate online webpage information to seek out an exercise program that they have an interest in joining, comes from wanting to know the associated practical or real-life experiences. We employ pragmatism, as a research paradigm, as a way of thinking about and addressing practical concerns using the meanings and truths from the described experiences of the study participants within their lived context.^34–36 We aim to adhere to the description of Creswell for mixed methods research in which multiple data sources are used to work towards a holistic understanding of the problem of focus, bringing qualitative and quantitative data together. ³²

Study participants

A convenience sample of 15 older adults living in the local community either alone or with others (i.e. spouse, children and friend), physically able to participate in a community physical activity program, aged between 65 and 82 years with the ability to understand and speak English and without cognitive impairment were recruited to participate in a single focus group session.^37,38 Recruitment took place in-person at a local community centre offering older adult physical activity programs. Information letters were handed out to all older adults in the local community centre over the course of several days. Potential participants were requested to read through the information provided in the letters and, if interested, to contact the authors (AL, DC) by email. Participants were included if they used a computer/laptop/iPad/tablet to communicate with family/friends via email, Facebook, Facetime or Skype, to do games/puzzles, to store photos or to read the news/books. Each participant had to have their own electronic device (i.e. laptop, iPad or tablet) that they knew how to use for internet searches and that they could bring to use during the study. Participants were excluded if they had difficulty speaking, did not speak or understand English, did not have an electronic device they could bring to the study, did not use a computer to connect with others or for leisure, lived with any self-reported cognitive or visual impairments or if they were advised not to exercise by their physician.

Database case example

A provincially funded online health and services database, which includes cataloguing local community-based physical activity programs for older adults, was selected because it is: a searchable online source for local community-based physical activity programs specific to older adults; advertised as a comprehensive ‘age-friendly’ resource for older adults; and publicly available free of charge to anyone with internet access. This is the one local regional database among fourteen provincially funded regionally focused online health and services databases for older adults, which are similarly structured in design, format and access features, supported by funding and dedicated staff to maintain them. This study was proposed to the database host organization and approval was received to use the database website in this research. For confidentiality, the name of this online database will remain anonymous.

Procedures

Data collection was completed in sequential phases (Figure 1). A meeting took place with the database host organization where they approved the use of their database website in this project. The qualitative component of this study was completed first to inform the quantitative component. Once qualitative and quantitative components were completed, the combined findings were presented to the database host organization as age-friendly website recommendations.

Figure 1.

The figure of study procedures.

Objective 1: Four focus groups comprised of three to six older adults per session were conducted in a room at a local community center, and lasted approximately 1.0–1.5 h. Focus groups were used to share opinions and thoughts, generate ideas, spark friendly discussion about challenges and recommendations, and are considered by some participants to be less intimidating. ³⁹ In order to ensure a supportive comfortable environment, participants knew ahead of time that they would be participating in focus groups with other older adult peers in a familiar community setting over a provided lunch.

First, as a group, step-by-step instructions were provided by the authors (AL, DC) at a pace to keep all older adult participants in the group navigating through the online database simultaneously, with verbal problem-solving details provided on request to the group or individuals. Guided instructions included, ‘Find a specific physical activity program for older adults that is close to where you live’ and ‘Find a specific physical activity program for older adults with your chronic health condition’ (Appendix A: Focus group instructions). Field notes, based on the guidelines of Phillippi and Lauderdale were taken (AL) during the guided search of the online database navigation to capture the setting, participant details, interview comments, verbal exchanges among study participants, and author participation. ⁴⁰

Second, participants were asked to respond to scripted interview questions about their user experiences navigating the online database (Appendix B: Focus group guide). Questions included, for example, ‘Tell us about how you searched for the physical activity program’, ‘How would you like to see the information presented on the home page?’ and ‘What changes would you recommended for easier navigation?’ Participation from all focus group members was encouraged in a round-robin question format, and all participants had an opportunity to contribute. The interview section of the focus groups was audio-recorded for transcription.

Objective 2: Participant experiences and feedback on characteristics of the database were compared to age-friendly website guidelines including the World Wide Web Consortium Web Accessibility Initiative (W3C WAI) Developing Websites for Older People Guidelines; the National Institute on Aging and National Library of Medicine Guidelines (NIA/NLM); and the Government of Canada Age-Friendly Communication Guidelines (Table 1). These website guidelines represent international, American and Canadian standards, respectively. To facilitate the comparison of study participant feedback, a summary of the three age-friendly best practice guidelines was constructed in a table format using the wording from the original sources. The table served as a checklist for the authors (AL, DC) to review and compare the themes, sub-themes, and feedback from the navigation experiences of the older adult participants to best practice guidelines for age-friendly websites. For example, if participants reported having difficulty understanding the meaning of a label used for a link, then this link was considered as not being labelled carefully. This comparison to age-friendly website development guidelines provided additional support in determining the age-friendliness of the physical activity database website and a rubric to follow for age-friendly update recommendations after study completion.

Objective 3: Physical activity programs were located through an online search of the city website, the city recreation program guide, local community centre websites (e.g. YMCA) and Google. The search strategy for online older adult physical activity programs was informed by the insights and feedback derived through qualitative analysis of the focus group interviews. The older adult participants gave suggestions: for the words they would use to search for physical activity programs which informed our search terms to be used; to search for and include programs from a locally published magazine of city programs; about programs that they know about which they couldn’t find and thereby perhaps were missing from the database; and about what program information to include in order to update the database website and allow older adults to make informed decisions in choosing an exercise program(s) (e.g. key word search terms, type of exercise, level of exercise, cost, location, dates offered, time of day). The search strategy was completed using ‘community physical activity programs’ or ‘community exercise programs’ and ‘older adults’ or ‘seniors’ as search terms. A spreadsheet was created of all programs offered providing aerobic, balance, resistance and/or flexibility/stretching physical activity within this mid-sized city. Programs were excluded when the age of participants was 55 years old or younger, it was a seated physical activity program or a social activity (i.e. board/card games and crafts), or if the program was not currently scheduled/discontinued. Seated exercise programs were not addressed in this study because the volunteers to participate in our study were not interested in these programs. None of the study participants mentioned seated programs nor suggested seated program information or search terms for seated programs. Therefore, in keeping with our participant interests and recommended search terms, seated physical activity programs were excluded from our community-based physical activity program search. Details about each program were gathered from program webpage(s), description in a locally published magazine of city programs and telephone interviews with the program contact person. Program details included program type, cost, frequency and schedule of the program, aerobic/strength/balance/flexibility components of the program, accommodations for special needs and location. The database website catalogue of community-based exercise programs was then assessed for completeness by comparing the findings of exercise programs from the comprehensive search with the catalogued community-based physical activity programs in the database. A meeting was held with the website host organization to review a summary of the findings and recommendations about the website.

Data analysis

Objective 1: Focus group audio recording transcriptions were separately read and re-read by the authors (AL, DC) to code phrases spoken by study participants and together generate themes using the reflexive thematic analysis described by Braun and Clarke. ⁴¹ Following Braun and Clarke's six-phase process to guide our thematic analysis, we separately engaged in data familiarization, independently coded the data, cooperatively generated initial themes from these codes, together reviewed and developed the forming themes, jointly refined and defined these themes, and then wrote them. ³⁵ Discrepancies from the coding process were discussed (AL and DC) to arrive at an agreement. A third party was not required to settle any discrepancies. Field notes from the focus groups were used to review and provide further insight into the developing themes and context for participant data. Study themes of user-experiences and needs were inductively developed.

Objective 2: After focus group themes surrounding database website navigation were defined, they were then compared to previously established website age-friendly best practice guidelines. These guidelines were not provided to the older adult study participants in order for them to respond honestly and without influence in their reflections. The checklist of age-friendly website development guidelines provided a second source as a rubric for determining the age-friendliness of the physical activity database website.

Objective 3: A comparison of the programs found from the comprehensive search and the existing online database of catalogued physical activity programs for older adults was completed to determine how many programs were listed in the online database, how many and which programs were missing, and were provided to the website hosts to facilitate conversation about the process implemented to collate available physical activity programs for older adults on the website.

Results

Demographic information

Fifteen older adults from a local community centre participated in this study. Participants ages ranged from 65 to 82 years old. All participants reported searching the internet at least multiple times a week on their internet-connected devices (laptop, desktop or tablet) and all used their own email daily. Fourteen participants brought an iPad/tablet and one participant brought a laptop to the data collection session, although several iPad users reported also using a desktop at home. All participants expressed familiarity with searching the internet on the devices they brought to the focus groups.

User experiences of older adults from focus group sessions

Theme 1: Participant insights of database website characteristics. The characteristics of the online physical activity database website were challenging to the participants including navigation, visual design, terminology and program information.

Sub-theme 1: Navigation. The database website provided many different ways to access information including tabs, a search bar, a postal code finder and a regional map, for example, and participants felt unsure about where to look, which search method to use, how to search and which of the several different links to use. When discussing website navigation for physical activity programs, a participant in Focus Group 1 said ‘I was thinking that, if I wasn’t sitting with you all and you’re telling me where to go, it would take me a lot longer to find (the information)’. Another participant in Focus Group 1 described the search for program information saying, ‘… I think it's scattered. It's in so many different places’. However, accessing the information through the variety of investigator-led search strategies produced varying information, rather than funnelling the participants, as ‘website navigators’, to the same content from the variety of access points. ‘My other impression is that there are a lot of topics to go through and find what you need. I wonder if there is a simpler way to do this’ [Participant in Focus Group 2]. The organizational layout of the database website pages posed challenges to the older adult participants when the links were not visible because they were at the bottom of the page; participants didn't know to scroll down to see the ‘whole page’ and they found it difficult to go ‘back’ to a previous page or revisit information they found earlier. ‘That's the other thing is that you have to remember to get back to where you were. There's a lot there, and once you find something, you have to remember how to get back unless you save it’ [Participant in Focus Group 1].

Sub-theme 2: Visual Design. The visual design of the database website made it difficult for participants to easily read and use. A challenging visual aspect of the database website design included small font that made it difficult for the older adult participants to read and search appropriately. For example, a participant in Focus Group 1 said ‘I didn’t find the layout very user friendly, and the size of the writing, I don’t know if it is the iPad [tablet], but it's small writing. The postal code doesn’t jump out at you. So for the first couple of searches, I didn’t even know I could search by postal code’. Another challenging visual aspect for older adult participants was the overabundance of information on each page of the database website making it difficult to easily read. ‘I think the webpage is too dense, there is lot of words’ [Participant in Focus Group 2]. ‘I find there is a lot of information and uh, I was frustrated’ [Different Participant in Focus Group 2]. When trying to get through all the information on a page to know where to search, a participant in Focus Group 3 said, ‘… to get everything on one page I had to change my screen down to 67% zoom, so you could see everything on the page’. A final visually challenging aspect reported by older adult participants was not being able to see the search boxes clearly due to the design of the database website, which led to difficulties accessing information efficiently. When discussing the search bar a participant in Focus Group 2 said ‘… the only comment I have would be if I was setting it up, I’d want this box to be larger, especially because it gets over-powered’.

Sub-theme 3: Terminology. The terminology used on the database website gave older adult participants difficulty when searching for physical activity programs. They found that the terminology used was not always appropriate for the reading level of the audience. ‘Once again, the terminology has to be motivated towards people like older people who are not that computer savvy. We are, but it's difficult. Very difficult. I’m sure you’ll have the same trouble 50 years from now’ [Participant in Focus Group 1]. This concern regarding terminology was repeated by older adult participants in the second focus group. ‘You might be surprised how many people have difficulties reading. So I’d like to see something more simple and cleaner to start with’ [Participant in Focus Group 2]. Again, a participant in Focus Group 2 discussed the terminology saying, ‘I feel it's kind of intimidating. I have to tell you I’ve volunteered with people with low literacy for many years, and that is often my impression looking at websites’.

Older adult participants also found that the labels of some of the tabs were too similar or not intuitive in their descriptions, making it difficult to know what they included. For example, when it was suggested by the focus group leader that you could search for physical activity programs under an Events tab, a participant in Focus Group 1 responded ‘I would never go under event for a fitness program’. Another participant in Focus Group 1 discussed her difficulties searching using the health tabs, ‘there seems to be a difference between Health Resources and Health Services … I think it's confusing because both mean more or less the same thing …’. This difficulty using the health tabs was echoed by a participant in Focus Group 3, ‘I know it's a different tab. But what's the difference between health services and health resources?’ A participant in Focus Group 2 spoke to the general nature of the search results saying, ‘the initial titles were pretty broad, so sometimes when I was looking for a fitness class I wasn’t getting that specifically’.

Sub-theme 4: Program Information. Participants found that the content of the actual database website was missing valuable program information. Many of the older adult participants involved in the focus group discussions were active members of community-based physical activity programs and spoke of important programs that were missing from the database website entirely. When searching for physical activity programs, a participant in Focus Group 1 said ‘… there isn’t the walking in the malls, the VMOs, the box fit– all the free things for the seniors to do. I think that would be good to add’. This concern of missing content was reiterated by a participant in Focus Group 3 that reported ‘… an exercise program that I’m involved in for Parkinson's which is boxing program. And it's been around since 2006 and there's like 300 branches worldwide. It wasn’t there. So to me that's a big gap’. Older adult participants also had concerns regarding whether the information provided by the database website was accurate and reported missing information about program time(s), date(s), level of ability and descriptions about the type of physical activity. When discussing whether there was enough information provided to decide whether the physical activity programs were appropriate, a participant in Focus Group 1 responded with ‘No, you have to phone the agency to get the details of what exercises are available tomorrow. I’d like to come every Tuesday and I don’t see on your website what time is your program’. Accurate and comprehensive program information is necessary to determine whether a program is appropriate for a participant with more than one health condition, for example, ‘I was looking for dementia and fitness, but it seems I can’t find anything that overlaps the two. I only found some fitness, or services, but it wasn’t clear what kind of services they were for’ [Participant in Focus Group 2]. This participant had already found an appropriate program for their health condition, but had friends and family with two or more health conditions. Without detailed program information, including what health conditions are targeted by the program, it is difficult to find and recommend appropriate programs. When trying to find an appropriate physical activity program within their ability level, a participant in Focus Group 4 said ‘there weren’t any specifics on what kind of exercises and that type of thing. I was going to an exercise class here, and a big portion of that was bikes. But because of my leg problems, I can’t do bikes’.

Theme 2: Connection/interface between participants and the database website. In general, older adult participants had some difficulty with their ‘know-how’ of website navigation and using the database website to search for appropriate physical activity programs was not intuitive for them. According to several of the older adult participants, the database website was not easy to use when searching for physical activity programs. ‘I think it's not very user friendly. If you could put information at the very beginning – this is my name, this is where I live, this is what I need – and then go directly there’ [Participant in Focus Group 1]. A second participant from the first focus group said that ‘… if you weren’t familiar with [town] and knew exactly what you wanted, you know, by hearing or word of mouth, it would be a very confusing website’. A fourth participant from Focus Group 1 raised the issue of not having access to a computer or regular practice searching online for information. ‘I still have friends who don’t have their own laptop and will go to the library and they’re not using it as regularly as I am and they’d have more difficulty going through it’ [Participant in Focus Group 1]. During a discussion of the database website navigation, a participant in Focus Group 2 said ‘… I wasn’t too bad after I’ve done it once or twice, after I’ve got a sense of how things are organized’. When the discussion of database website navigation occurred in the fourth Focus Group a participant answered ‘there's a lot of information on there, it took me a while to get used to and to read’ and that same participant ‘didn’t find it difficult, I’m just not that proficient on the iPad’. When discovering there was a phone number available to call for issues when navigating the site, a participant in Focus Group 3 said ‘… if I can’t find something within a reasonable amount of time before my frustration level, you know, makes me walk away, I would call and go “hello, can you connect me to whatever”’.

Older adult participants described it as challenging and not intuitive to know the best keywords to access the information that they wanted when navigating the database website. Some participants felt that they could not find specific programs using the key words that they typed in and they needed to use different key words in order to find them. In some instances, when key words were used together, participants’ searches did not return desired results. For example, a participant in Focus Group 3 said ‘… mine is a lower back issue but not exactly a back injury, it's a condition for old age or whatever. And so I wasn’t sure how to name it. So I typed in (I’m assuming a key word search) “back” and I got “back to the future” or “wave back to your friends.” So then I had to sort of go back through, so to speak, and go through and if I used the word “spinal,” it was very much too specific for my condition. So, you know, how you again filter or match is what something, I need to figure out’. A second-older adult participant in Focus Group 3 described her navigation experience as overwhelming and that ‘it was way too much information. A lot of information. And I have a habit when I get to that point that I enlist my daughters to do it for me. But I did navigate pretty well through everything, but, you know, sometimes I don’t know what it is I really need either’. Additionally, the order of keywords used in the search bar altered the physical activity program search results and was not always common knowledge to older adult participants. ‘When I put falls prevention and [town] I couldn’t tell they were in [town], but when I put [town] first then falls prevention, then the exact location I wanted to find came up. It is useful to know, but I do not know how that works and I’ve found that in searches before where it matters a lot which word you put first …’ [Participant in Focus Group 2].

Theme 3: Older adult recommendations to improve age-friendly user-experience. At the end of each focus group session participants gave their recommendations for improving the database website and the navigation experience. There were two main recommendations: improving the database website's exposure to its intended older adult audience and improving the search/navigation strategy of the database website.

Sub-theme 1: Improving Exposure. All of the older adult participants reported that the database website was previously unknown to them. Therefore, it was recommended that steps should be taken to improve how easily the database website can be found on Google and that the database website should be made known to older adults in the community. As a regularly updated database website for community-based physical activity programs, it could be an important resource for older adults in the community if they were familiarized with it. ‘I think when you do a Google, they need to do a better job at having it at the top’ [Participant in Focus Group 1]. A second participant in Focus Group 1 reported that ‘I would not have gone to the [online database] to look for this and I didn’t really know it existed. And when I googled some question about exercises, it didn’t show up anyplace as a link’. When discussing how to make the physical activity database website more accessible to older adults, a participant in Focus Group 1 suggested ‘From health care groups, doctor's offices, or even at the hospital. But I mean, at doctor's offices or an awareness program in the community, or have it on channel 9 … and I think it's an excellent news program at 6 o’clock at night and they have a session where they introduce programs and maybe something like this put up – they would be the first people I’d go to’.

Sub-theme 2: Improving Navigation. As discussed earlier, the search strategy design of the database website itself was not organized and older adult participants did not find the database website intuitive to navigate. As such, participants made several suggestions on how to improve their search experience. The first suggestion was to allow them to search not just by location or general physical activity, but by both their location and individual needs or specific capabilities in the search bar. ‘What would be most helpful is that if you can search something like “supervised exercise program” for cardiac patients or something like that – and see if anything pops up’ [Participant in Focus Group 1]. This would also allow participants to search for overlapping concepts when they have more than one health condition. A participant in Focus Group 2 was looking for a physical activity program for participants with dementia, but could not find one. ‘… I didn’t know which direction to take. It seems it couldn’t properly overlap between dementia or slight dementia and fitness’ [Participant in Focus Group 2]. The second suggestion for improving database website navigation was to make tutorials available for older adults to search the database website for appropriate physical activity programs or information. When asked for feedback on how to improve the ease of searching the database website, a participant in Focus Group 3 suggested ‘I guess the only thing would be is some kind of tutorial on how the website works and for you to develop that and then ask us to try to use it and see whether it answers our questions, would be helpful’. The third suggestion for improving database website navigation was to teach librarians about the database website and how to search it in order to help seniors/older adults successfully find the information they need on community-based physical activity programs. ‘I was just going to say that the library is good place to introduce this program because there are lots of people who go to the library to use computers. If you introduce the programs to the librarians, it would be very helpful’ [Participant in Focus Group 1].

Comparison of participant experiences to established age-friendly website guidelines

Based on the participant feedback and generated themes from the focus group sessions, the database website's age-friendliness was compared to the three established age-friendly website guidelines (Table 1). This comparison found improvement needed in the following database website characteristics: text; navigation; links; layout; organization; language.

Text. The font was not an appropriate size and did not allow for easy alteration. For example, a participant in focus group 1 said ‘… the size of the writing, I don’t know if it is the iPad [tablet], but it's small writing’. The default font was not large enough for an older adult population (see Figure 2).

Text. The body text of the website was too dense to easily read and could have used more spacing. For example, a participant in focus group 2 stated ‘I think the webpage is too dense, there is lot of words’. A second participant in the same focus group said ‘I find there is a lot of information and uh, I was frustrated’.

Navigation. Step-by-step easy-to-follow navigation was lacking and participants could not easily search for content. There was no funnelling to the same content when using different navigation methods. For example, when discussing the different search strategies a participant from focus group 1 said ‘… I think it's scattered. It's in so many different places’. Another participant in the same focus group said ‘I was thinking that, if I wasn’t sitting with you all and you’re telling me where to go, it would take me a lot longer to find (the information)’.

Navigation. Participants did not know their current navigational location and did not know how to return to previous pages or content. Participants also had difficulty navigating back to the homepage. For example, a participant in focus group 1 said ‘That's the other thing is that you have to remember to get back to where you were. There's a lot there, and once you find something, you have to remember how to get back unless you save it’.

Navigation. The search bar method to find content was difficult for participants to see and participants were unsure of how best to use this method (e.g. what keywords should they use). For example, when discussing the search bar a participant from focus group 2 said ‘I’d want this box to be larger, especially because it gets over-powered’. Another participant said ‘When I put falls prevention and [town] I couldn’t tell they were in [town], but when I put [town] first then falls prevention, then the exact location I wanted to find came up’.

Navigation. The database website provided a regional map that most participants overlooked and/or did not realize could be clicked on for navigation (see Figure 3). For example, when asked about using the map to navigate, a participant from focus group 3 said ‘I didn’t realize the map was something you could use’. Similarly, a participant in focus group 2 said ‘Oh I didn’t look at the map. No. The map is a good idea though’.

Links. Links were not well described (or appeared to mean the same thing) and participants had difficulty determining which would navigate them to the content they wanted (see Figures 2 and 3). For example, another participant in focus group 1 expressed confusion over the tab links, ‘there seems to be a difference between Health Resources and Health Services … I think it's confusing because both mean more or less the same thing …’.

Links. There were too many links available per page and participants had difficulty viewing them all and deciding which to choose for the content they wanted (see Figure 2). For example, a participant in focus group 3 opted to change the website magnification to see all the content at once. They said ‘… to get everything on one page I had to change my screen down to 67% zoom, so you could see everything on the page’. Similar to list numbers 7, 8 and 15, participants reported difficulty in understanding what the different links meant.

Layout and distractions. Participants had difficulty scrolling. For example, a participant in focus group 3 had trouble scrolling and instead opted to change the website magnification to see all the content at once. They said ‘… to get everything on one page I had to change my screen down to 67% zoom, so you could see everything on the page’.

Layout and distractions. Webpage content/information was not organized in a familiar way. For example, when discussing the organization and layout, a participant from focus group 1 said ‘I didn’t find the layout very user friendly’.

Organization. Organization of the database website was not simple or intuitive for older adult participants (which link gets them from the main health webpage to the physical activity section) (see Figure 2). For example, a participant in focus group 1 said ‘I think it's not very user friendly. If you could put information at the very beginning – this is my name, this is where I live, this is what I need – and then go directly there’.

Organization. Webpage content/information was not broken down into small enough sections for participants to easily understand/follow. Similar to point number 2 above, participants from focus group 2 said ‘I think the webpage is too dense, there is lot of words’ and ‘I find there is a lot of information and uh, I was frustrated’. Additionally, a participant from focus group 4 said ‘there's a lot of information on there, it took me a while to get used to and to read’ when discussing the content.

Organization and language. Headings and labels were not descriptive enough for participants to understand their content when reading them. For example, the heading ‘Events’ included physical activity programs, but participants would not have intuitively thought this (see Figure 3). A participant from focus group 1 said ‘I would never go under event for a fitness program’.

Organization and language. While pages had titles/headings, participants had difficulty understanding the difference between the titles/headings used because they lacked description (see Figure 3). For example, a participant from focus group 3 said ‘I know it's a different tab. But what's the difference between health services and health resources?’ When discussing program titles, a participant from focus group 2 said ‘the initial titles were pretty broad, so sometimes when I was looking for a fitness class I wasn’t getting that specifically’.

Language. Information was not presented in a clear and simple manner. For example, a participant from focus group 2 told us ‘You might be surprised how many people have difficulties reading. So I’d like to see something more simple and cleaner to start with’.

Language. The language used was not simple for participants to follow. Terminology used was not for the average older adult and participants had difficulty at times understanding the information given. Additionally, a glossary of terms was not provided and explanations were not given for advanced terminology or abbreviations. For example, a participant from focus group 1 said ‘… the terminology has to be motivated towards people like older people who are not that computer savvy’.

Figure 2.

The landing page of the health website that older adult participants used to navigate to the physical activity section of the website. Encircled numbers correspond with numbered recommendations itemized in the ‘Comparison of the Results to Established Age-Friendly Website Guidelines’ results section. For example, the encircled number 1 ‘Example of 12 Point Font’ on the figure corresponds with characteristic number 1 ‘The font was not an appropriate size and did not allow for easy alteration’. Search-related actions (3, 4, 6, 11) and recommended content that was missing (12, 13, 14, 15, 17) are unable to be illustrated in the figure.

Figure 3.

The health events page of the website that older adult participants used to navigate for physical activity programs. Encircled numbers correspond with list numbers given in the ‘Comparison of the Results to Established Age-Friendly Website Guidelines’ section. For example, the encircled number 7 s on the figure correspond with characteristic number 7 ‘While pages had titles/headings, participants had difficulty understanding the difference between the titles/headings used because they lacked description’. Search-related actions (3, 4, 6, 11) and recommended content that was missing (12, 13, 14, 15, 17) are unable to be illustrated in the figure.

Community-based physical activity program exploration and compilation

A database of 1351 existing community-based physical activity programs offered in a mid-sized city, between September 2018 and August 2019 were retrieved from the regionally focused online health and services website. In this dataset, there were 59 community-based physical activity programs that were unique by program title, program organization and location (i.e. community centre). These 1351 existing community-based physical activity programs did not include programs that were cancelled or discontinued.

The search for additional programs to add to the existing database produced 187 community physical activity programs that met the inclusion criteria. Of these 187 programs, 86 were unique in terms of the program title, program organization and location, as above (see Figure 4). In addition to providing assistance with online search terms for physical activity programs, older adult participants identified 11 of these 86 unique community-based physical activity programs to add to the database and provided us with their titles, organizations and locations. The other 101 programs were duplicates, with the majority being additional sessions or locations, of the physical programs posted on the regional health and services website. With all missing programs added, the database could hold a total of 1538 community physical activity programs for older adults in this study's location. On plotting the program by postal code, a large number of community-based physical activity programs were located in the northern and central neighbourhoods of the city (Figure 4). Southern neighbourhoods or along the municipal city borders did not have many programs (Figure 4).

Figure 4.

A map of the distribution of the locations of community-based physical activity programs in relation to the mid-sized city municipal boundaries (heaviest outline) was generated using Google My Maps.

Discussion

People are living longer, but patterns of sedentarism and the number of chronic health conditions within these older individuals are increasing. ⁴² To augment their health care, manage their chronic health conditions and maintain functional independence, older adults have been increasingly accessing health information online. ⁴³ However, while an increasing number of older adults (i.e. ≥ 65 years of age) are accessing the internet, proportionately they are the minority among internet users.^44,45 In general, but especially with the coronavirus-19 (COVID-19) pandemic, older adults are facing digital exclusion because they cannot fully participate in all aspects of everyday life due to society's dependence on the internet and technology.^46,47 With regards to online health services, Heponiemi et al. ⁴⁸ reported that older adults are at risk of digital exclusion as they found that increasing age was associated with poor digital competence (the ability to use the internet) and a decrease in the use of online health services. Also, while good digital competence moderated the decline in online health service use, the oldest old were at risk of digital exclusion regardless of their digital competence level. ⁴⁸ In addition to digital competence, older adults need to have a level of internet literacy to determine the authenticity of online posted health information.^5,11,43 This study explored the user experiences of older adults in navigating an online website cataloguing local community-based physical activity programs. Findings from their experiences, in addition to age-friendly best practice guidelines for websites, were used to assess characteristics of a regionally focused website cataloguing physical activity programs for older adults; a targeted online search of local websites for physical activity programs and hand searches of community brochures and magazines was completed to address comprehensiveness of the chosen regionally focused database website.

No previous studies were found where older adults evaluated an online website database of local community-based physical activity programs. Additionally, previous studies were not found comparing older adult feedback from the navigation of an online database of physical activity programs with best practice guidelines for older adult website design. There have been previous studies on the barriers, facilitators, and needs of older adults with regard to the use of eHealth technology.^19,20 Also, previous studies were found on the development of websites via age-friendly guidelines using one or two of the three established website design guidelines employed in this study, and, ²¹ while two of these included user experiences, neither included user experiences about navigating a health or physical activity website.^49,50 This study found that, while older adult study participants appreciated having an online database of local community-based physical activity programs to search, they expressed difficulty without the age-friendly features to connect them with physical activity programs they were looking for based on their physical health conditions (e.g. stroke, hip and/or knee osteoarthritis, and/or age-related impaired physical function).

Older adult study participants reported difficulties with the navigation (e.g. how and where to search), organization (e.g. overabundance of information), design layout (e.g. search feature, location of tabs or links, scrolling), readability (e.g. text size, spacing), and language (e.g. terminology, literacy level) of the online database itself. Additionally, participants described that the user-interface was not intuitive, familiar, or straightforward. Chronic pain participants in a study by O’Reilly et al. ¹⁹ on the use of eHealth interventions likewise reported barriers including a lack of a user-friendly interface, difficulty with programme navigation, difficulty changing the text size and lack of understanding to open links. Similarly, Patsoule and Koutsabasis ⁵⁰ found that there were nine usability issues with the website they chose to evaluate for age-friendliness. In agreement with this study, some of the issues found in the Patsoule and Koutsabasis ⁵⁰ study included: too many graphics/text, impaired visibility of important information, poor organization, not self-explanatory links or buttons, too many steps for user tasks and an absence of quality and credibility. The study by Fiksdal et al. ¹² reported that, while participants and patients preferred finding health information online, the navigation process for reliable content was difficult; websites should be developed taking into consideration differences in user literacy, health needs, and demographics. Further, Waterworth and Honey ⁶ found that older adults face barriers, such as a lack of familiarity with the internet and low health literacy levels, when accessing online health information. A study by Becker ²¹ evaluated the reading complexity of health information websites and found that the majority of these websites required higher than an eighth-grade reading level for comprehension. In general, it has been recommended that health-related information be written at a sixth-grade reading level to reach various audiences and most older adults face a decline in reading comprehension due to aging. ²¹

Based on the focus group themes generated in this study, there are multiple discrepancies between the evaluated online database website and the recommendations of three established guidelines for designing age-friendly websites. The flaws in the website related to the text, the lack of step-by-step navigation, the non-descriptive links, the lack of input assistance when using the search bar, the layout and organization of content, and the language literacy level. Similarly, the age-friendly website redesign study by Patsoule and Koutsabasis ⁵⁰ found they had to correct several texts, navigation, links, layout, input, organization and language issues. They did this by implementing components of several different age-friendly website design guidelines, including several components of the NIA/NLM guidelines and the W3C WAI Developing Websites for Older People Guidelines also used in this study. For example, they used the ‘operable user interface and navigation’ and ‘understandable information and user interface’ sections of the Web Content Accessibility Guidelines, when evaluating the website's consistency in navigation, layout and organization. ⁵⁰ A study by Becker ²¹ evaluated 125 websites for age-friendly website design and usability, finding that none of the websites achieved a high score for each category of the NIA/NLM guidelines. For example, 93% of the websites failed to meet the appropriate font size recommended for older adult users. ²¹ Many of the websites included lengthy homepages with extended scrolling, lacked site maps and lacked ‘help’. ²¹ Becker ²¹ argues that the NIA/NLM guidelines are a solid framework based on previous research using older adult participants for website design and should be utilized more frequently to eliminate barriers to older adult website use. A study by Hart et al. ⁴⁹ evaluated websites based on the NIA/NLM guidelines for age-friendly compliance and recommended that website evaluation and redesign include usability testing by older adults. Taken together, the findings of this study and the study by Patsoule and Koutsabasis ⁵⁰ suggested that website redesign guided by older adults themselves and age-friendly established guidelines together could produce a more satisfactory and usable website as determined by study participants.

Finally, this study found that the online database website held a total of 1351 community-based physical activity programs, but was missing an additional 187 programs located in the community. Information on these 187 additional programs was reported to a contact at the physical activity database website after data analysis was completed. According to the American Medical Association guidelines for health information websites, ⁵¹ sites that report any form of medical or health information should be time-stamped with their most current update, should be updated on a regular schedule and should have an on-going process developed to update or remove time-sensitive information. As 187 programs were missing from the online database, the process used to update and/or catalogue the community-based physical activity programs may need to be revised or redeveloped to present the most current content for older adults seeking out physical activity programs and activity-related information. The National Institute on Aging ⁵² (NIA) suggests users check the date of the last update at the bottom of each webpage visited to help determine if the content is reliable and based on current information. Best-practice would be to use the established age-friendly website guidelines and American Medical Association recommendations for updating and/or mapping new community-based physical activity programs to online databases. ⁵⁰

Study limitations

This study had four limitations. The first limitation was that the researchers did not ask older adults during the focus group sessions every detailed aspect of each of the three age-friendly website design guidelines. This was due to focus group time limitations and the nature of the research where participants were asked open-ended questions about the database website to elicit candid responses about what they considered relevant. The second limitation was that the older adult readability and navigational challenges with database searching during the focus group sessions could have been due to the type of technological product/platform they used. Secondary to Responsive Web Design, where a website's content layout adapts to different screen dimensions and resolutions,^53,54 the physical activity database website presents slightly differently on an iPad/ tablet than a desktop or laptop. The search functions, visual layout and organization are the same, but the text appears smaller and may be more difficult for older adults to read. While this database website has a mobile phone version, none of the study participants used a phone to participate in the focus groups and it would not have impacted their experience. The third limitation is that this study used a convenience sample of older adults that were regular internet users. Older adults from different socio-economic neighbourhoods or that do not regularly use the internet could potentially have provided differing results. The fourth limitation is that our online search of local physical activity programs did not include seated physical activity programs. Older adult participants with more physical limitations or not cleared for weight-bearing exercises may benefit from seated physical activity programs, such as chair yoga.

Recommendations

The novel contributions of this study include older adults themselves providing an evaluation of a provincially funded and purportedly current online database website of community-based physical activity programs; as well as, a comparison of their feedback on navigating the selected database with three established website design guidelines for older adults. While studies have addressed older adult health literacy levels and website use,^5,6,21 this is the first study to include older adults navigating and assessing the age-friendliness of a health and services website for the purpose of finding a physical activity program of interest and suitable to them in the context of any health condition(s).

Based on participant feedback, even a regionally focused health and services website that is provincially funded and regularly maintained needs to incorporate best practice guidelines for age-friendly website design in order to serve and improve the user-experience of older adults. One particular feedback from study participants was to include a search feature to permit users to find information by searching by ‘health condition’ to improve the relevancy of results for their individual needs. It was recommended that website designers should involve older adults during the creation and testing of their website to improve the level of age-friendliness, and correct any shortcomings prior to website publication. Further, study participants recommended that website designers should make a tutorial available on the main page to help older adults, who have low digital competency or little online experience, use online resources like this effectively.

Older adult study participants also recommended improving awareness of and user-experience with an online database for older adults in the community by partnering with local health care practitioners and librarians. Local health care practitioners, in particular, may be key to promoting physical activity uptake through linking their patients with an online database of community-based physical activity programs. It has been recommended by Kampmeijer et al. ⁵⁵ that older adults would use e-Health tools for health promotion more successfully if they received increased support. Gordon and Hornbrook ⁷ recommend that online health information and eHealth be used to supplement the care they receive traditionally from their primary care practitioners and recognize that older adult patients may face a digital divide that requires help with health information from their usual health care providers. Honey et al. ⁵⁶ found that, of those older adult participants that searched the internet for health information, 19% reported feeling either frustrated about the information found, confused by all the information or unsure about the trustworthiness of the information. Individuals felt it would be useful for health care providers to frequently present specific information about physical activity programs in the surrounding area using varied mediums (e.g. websites, pamphlets). ¹ Overall, older adults may be influenced by their health care providers to access health information online. ⁶ Physiotherapists working in community clinics routinely provide patients with recommendations for appropriate community physical activity programs post-discharge to promote self-efficacy and self-care among their patients. ⁵⁷ Physicians in family medicine follow the principles of maintaining a community-based approach to care, building a strong rapport with their patients and acting as a resource to their practice population. ⁵⁸ As such, physicians could use a local database of community physical activity programs as a way to support their older adult patient-physician rapport, link patients with community resources, and maintain a community-based approach to care. Therefore, this local online database geared towards serving older adults, for example, could be a valuable resource for practitioners to link their patients to community-based physical activity programs, if the database is revised and updated based on the findings of this study. This study's combined qualitative and quantitative findings were provided to contacts at the database website in order to give a comprehensive assessment of the age-friendliness and program information of the database.

Conclusions

The established age-friendly website guidelines are important to improve online health website accessibility and usability by older adults, particularly as the global population is comprised of an older and a greater number of elderly adults increasingly accessing the internet for health information. Redesigning websites following the best practices guidelines, including the database website evaluated in this study, would reduce challenges that prevent older adults from fully participating online and finding the reliable information they need to maintain their health and functional independence.

Future research should expand upon this study to include other online database health resources in different communities, such as rural or larger metropolitan centres, as well as include participants that do not use the internet on daily basis or who may be more physically limited. Secondly, future research should be done to compare the different website development guidelines. Thirdly, future research should determine if supported exposure to an online database of community-based physical activity programs, via librarians and health care practitioners, increases the number of older adults participating in local exercise/physical activity programs.