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Abstract

Promoting lifelong learning among senior citizens is essential for fostering their confidence and independence. However, the absence of systematic planning and clear definitions of lifelong learning poses challenges in objectively assessing its efficacy. This study aims to establish evaluation criteria and develop a comprehensive health promotion curriculum and evaluation model. The study adopts a mixed methods research approach. In the first phase, semi-structured interviews were conducted to explore the factors influencing motivation and barriers to learning participation. The results identified five primary factors affecting elders’ participation: interpersonal dynamics, adaptation, motivation, interest, and confidence. Based on these findings, the second phase utilized three dimensions—cognitive engagement, physical activity, and social interaction—as the foundation for designing health promotion courses and materials. Appropriate course activities and materials were developed through sensory stimulation and nostalgic experiences to evoke interest. Additionally, a course evaluation scale was constructed based on the analysis of interview results and literature definitions. The Analytic Hierarchy Process (AHP) was employed to establish the hierarchical structure and influence weights for evaluating health promotion courses. Utilizing Analytic Hierarchy Processing (AHP), the evaluation model prioritizes experience and operation & cognition. Essential evaluation metrics include immersiveness, alignment with course objectives, difficulty level, proficiency in operating skills, and fostering creative imagination. To mitigate seniors’ apprehensions regarding failure and engagement, a phased approach to course design is recommended. This iterative process aims to incrementally cultivate confidence and a sense of security among participants, ensuring sustained involvement in the program.

Keywords

design activity design education design tools framing

Introduction

In response to the global aging population, the World Health Organization (WHO) proposed the concept of “active aging” as a global development policy in 2002 (WHO, 2002). The research indicates that continuous learning after retirement can significantly reduce cognitive and physical decline in senior citizens (Walker, 2015). Lifelong learning is considered a vital part of the active aging process, but it is important to consider the autonomy of senior citizens and not to intervene using compulsory methods (Schuller, 2019). From the perspective of social participation, the focus is on the level of involvement of senior citizens in society, with the goal of achieving “successful aging,” which includes (1) being free from serious diseases, (2) maintaining cognitive function and activity, and (3) interacting with others, all of which are in line with their own interests (Rowe & Kahn, 1997).

Senior learning is an effective method to assist the elderly in successful aging. Learning new things cultivates their interests, builds their confidence, and maintains their independence, thus promoting their personal happiness and vitality (Martin, 2003). In terms of curriculum design and planning, current courses can generally be divided into knowledge-oriented courses, such as art, writing, board games, reading, handicrafts, gardening, and cooking (Lach et al., 2004; Truman et al., 2020), and physical-fitness-oriented courses such as fitness and dance (Jiménez-Zazo et al., 2020). However, the classification definitions are broad, and there is a lack of systematic planning, which makes it difficult to objectively evaluate learning preferences, patterns, and outcomes. The existing assessment indicators, such as the Active Ageing Index (AAI; Zaidi et al., 2013), are used to evaluate the measurement methods of senior citizens’ independent living, paid employment, and social participation. The AAI focuses on the achievement level of senior citizens’ social participation from an expert’s perspective (Fernández-Ballesteros et al., 2013). However, senior citizens themselves are more concerned about their own abilities to “do” and “become” (São José et al., 2017). In light of this, this study aims to identify potential factors that may affect the willingness of senior citizens to participate in health promotion programs in order to design and plan courses accordingly and define appropriate evaluation indicators. The ultimate goal is to establish a Health Promotion Course Evaluation model.

Literature Review

With regard to the significance and impact of health promotion and lifelong learning in enabling senior citizens in an aging society to age healthily, cognitive ability and social interaction are regarded as two key indicators of successful aging. Therefore, this section will focus on (1) cognitive ability and (2) the status of health promotion development, with a view to comprehensively understanding the importance and implications of cognitive ability, social interactions, and the methods for fostering and training it. This will serve as a reference for the subsequent curriculum and instructional design applications, using comparisons with the existing development processes to construct the constitutive dimensions of health promotion curriculum design assessment.

Cognitive Function Promotion

General cognitive ability, also known as general intelligence (g), encompasses spatial awareness, language, memory, reasoning, planning, abstract thinking, and problem-solving abilities (Plomin, 1999; Simone & Scuilli, 2006). As individuals age, the deterioration of physiological function and cognitive ability affects their quality of life, making it difficult to achieve successful aging goals (Hildon et al., 2010). Factors contributing to cognitive decline include diseases such as dementia, which can lead to forgetfulness, disorientation in time and direction, a decline in computational ability, and difficulty finding words during language communication (Arevalo-Rodriguez et al., 2015). Next, aging-associated cognitive decline, which involves decreased attention span, slower information processing, and declines in language expression, reasoning, memory, and executive function (Deary et al., 2009; Murman, 2015). And the third, mental health issues, as there is a strong correlation between persistent depression and cognitive decline (Paterniti et al., 2002).

The Mini-Mental State Exam (MMSE) is a method used to evaluate the cognitive ability of senior citizens that includes assessments of orientation, attention, memory, language, verbal comprehension, behavior, and construction ability, among others (Cockrell & Folstein, 2002). To effectively delay cognitive decline in senior citizens, commonly used stimulating methods including continuous learning stimulation, which can effectively produce positive effects on memory, attention, thinking, and reasoning abilities and reduce the risk of dementia and Alzheimer’s disease. Second, exercise training, which helps maintain brain health and cognitive abilities and contributes to maintaining a positive mood (Ten Brinke et al., 2015). And the last but not the least, long-term information processing activities, which can maintain brain health and delay aging (Snowdon, 2002; Wilson, 2001), such as reading (Gallucci et al., 2009), board games (Ching-Teng, 2019), gardening activities(S.-A. Park et al., 2019), and handicrafts(Gustafsson, 2019).

For dementia patients, cognitive stimulation and training are common intervention measures. Multiple studies have revealed that cognitive stimulation is more beneficial than drug therapy for mild-to-moderate dementia patients. Therefore, in the context of an aging society, promoting cognitive health to delay dementia is widely advocated (Woods et al., 2012).

Current Status of Health Promotion Development

Health Promotion Courses

During the aging process, senior citizens often face the following problems: Sensory decline in vision, hearing (Simpson et al., 2012), and vocal cords (Martins et al., 2015), leading to a decrease in information reception and the ability to express opinions. Muscle atrophy (Dallaway et al., 2020) and deterioration in balance (Holloszy, 2000) and body coordination (Mahmood et al., 2012), which can result in falls, slow movements, and other issues. In addition, cognitive decline (Wang et al., 2004), causing memory impairment and weakened logical reasoning and problem-solving abilities, affecting daily life and self-care abilities. The degenerative effects caused by aging can mainly be divided into two aspects: physiological function and cognitive psychology. Current health promotion courses also focus mainly on these two aspects through physiological body training and cognitive psychology training (Lach et al., 2004).

Health promotion courses are regarded as a form of informal learning. Informal learning is predominantly unstructured, experiential, and non-institutional, encompassing activities such as self-directed learning, networking, coaching, mentoring, and performance planning (Marsick & Watkins, 2015), while also involving any activity aimed at acquiring understanding, knowledge, or skills without externally imposed curricular criteria (Livingstone, 1999). In order to maintain normal physiological functions, current community health promotion activities focus on encouraging senior citizens to effectively maintain their physical, mental, and spiritual health (Jiménez-Zazo et al., 2020) and on offering a wide range of physical fitness courses to meet the various needs of senior citizens (Klima et al., 2021). With regard to the promotion of psychological and cognitive maintenance and health, in addition to providing useful information to improve health and lifestyle, such as knowledge about health, food and nutrition, and digital skills (Truman et al., 2020), various activities have been demonstrated by research to help maintain and improve cognitive function, such as art (Silver & Lavin, 1977), writing (Olive et al., 2009), board games (Dartigues et al., 2013), reading (Gallucci et al., 2009), crafts (Caragay, 2015), gardening (Jenkins, 2007; S.-A. Park et al., 2019), and cooking (Abbott et al., 2010; Misan et al., 2018). These activities have been found to be effective means of training and maintaining cognitive ability (Iizuka et al., 2019). In terms of curriculum design and planning, the Young Men’s Christian Association (YMCA) divides its health promotion program into four major areas: Brain Fitness (brain activation), Mouth Fitness (strengthening oral function), Exercise (preventing falls and improving cardiovascular function), and Interaction (establishing interpersonal relationships). This approach is in line with the effects of aging on senior citizens and the emphasis on active interaction for successful aging. The Transtheoretical Model (TTM) is applied in health promotion programs for the elderly, advocating a focus on behavioral changes in curriculum design and planning, moving away from awareness and knowledge cultivation toward maintenance as the main process of curriculum development (Lach et al., 2004). The ultimate goal is to enable senior citizens to cope effectively with daily activities, maintain their independence, and communicate effectively with others (Murman, 2015), thereby enhancing their ability to do and become.

Factors Influencing Course Participation

Since the 20th century, elderly learning has been highly valued, with “self-directed learning” and “transformative learning” being regarded as important learning skills and experiences for maintaining a healthy life (Knowles et al., 2014). The margin theory of needs posits that the needs of older individuals vary across multiple levels, ranging from basic survival to self-actualization (McClusky, 1963). Factors influencing adult learning comprise both internal and external components (Gabriel & Bowling, 2004). Internal factors include physical health, an ability to connect with others, a capacity for critical thinking and reasoning, financial resources, and an ability to perform specific tasks (McClusky, 1963). External factors, on the other hand, comprise the difficulty level of the learning methods (J. H. Park & Choi, 2009), which, if too low, may fail to spark interest or, if too high, may result in frustration; learning costs (Rostami et al., 2015), encompassing monetary, temporal, and spatial expenses; flexibility in distance and time (J. H. Park & Choi, 2009), such that great distances and incompatible schedules may reduce willingness to participate; challenges posed by digital learning for older individuals, particularly the disparity between online interaction and computer operations and their previous learning and life experiences, thereby creating obstacles to learning; and adaptation to role changes (Chang & Lin, 2011), with research indicating higher levels of learning motivation among relatively young or unmarried retirees, with women being the predominant gender (Yeo et al., 2022). Moreover, negative interactions between instructors and students can lead to learning dropouts, with adverse emotions in interactions ultimately reducing learners’ willingness to participate (Hotho-Jackson, 1995). The theory of learning motivation, known as the ARCS model, includes four main elements: attention, relevance, confidence, and satisfaction (Li & Keller, 2018). Boshier and Collins (1985) divided adult learning motivation into six categories: intellectual interest, career advancement, escape/stimulation, social service, external expectations, and social relationships. The theory of learning motivation originated in a national survey of American adults conducted by Rivera (1996). Rivera found that the relationship between learning obstacles and demographic variables includes factors such as low income and education, as well as personal traits associated with low self-confidence and achievement (Rivera, 1996). Other factors that can influence learning motivation include the diversity of the courses (Tam, 2014), teacher behavior (Dean & Dagostino, 2007; Green & Kelso, 2006), peer relationships (Christenson & Havsy, 2004; Tu & Chu, 2020), and family circumstances (J. H. Park & Choi, 2009; Rostami et al., 2015).

As people age, their physical and cognitive functions decline, and promoting health is a goal to help senior citizens maintain their daily living abilities. Considering both physical fitness and cognitive enhancement, related activities are designed and planned, including brain activities, physical exercises, and social interactions to provide diverse and continuous stimulation. The aim is to build self-identification in relation to their abilities and to avoid the feeling of loss caused by the role transition after retirement, which may lead to learning obstacles and social disconnection. Lifelong learning is a critical element of successful aging. However, the systematic design and development of health promotion courses should keep up with the times. There is still a lack of objective assessment of factors that influence senior citizens’ willingness to participate in course-related activities, but in curriculum design and evaluation, reasonable difficulty levels, caring from course instructors, social interaction with peers, and confidence and enjoyment gained from courses are used to enhance senior citizens’ learning achievements and willingness to participate in health promotion activities.

Research Methods and Experimental Design

The study adopts a mixed methods research approach and is divided into three phases. The first phase is to understand the factors influencing motivation and obstacles to learning participation: through semi-structured interviews and qualitative analysis, the study aims to understand the “motivations” and “obstacles” to participation among senior citizens. The next phase is the development of health promotion courses and instructional design: Corresponding to the cultivation of cognitive abilities and training objectives in course and instructional design, the study extracts the factors that influence learning and the relevant literature from the results of the initial interviews to establish the evaluation elements of the third stage of the health promotion curriculum. And the third is construction of a curriculum evaluation scale: By inviting senior citizens who participated in the course and experts in the field to conduct a course evaluation questionnaire after the course-related activities, the study will conduct Analytic Hierarchy Processing (AHP) and principal component correction.

First Stage: Understanding the Influential Factors of Learning Participation Motivation and Obstacles

The study used the work of Tam and Chui (2016) as the interview framework to understand the current situation of senior citizens participating in health promotion courses. The interviews covered five major aspects of learning: learning habits, learning motivation, learning preferences, learning benefits, and learning obstacles. The goal was to gain insights into the factors that influence senior citizens’ participation in health promotion courses. Learning habits include four aspects: channels, frequency, targets, and experience (National Academies of Sciences, Engineering, and Medicine, 2018). Learning motivation was classified into two components: course content and motivation, with the latter being further divided into volunteer motivation and learning motivation (Schiefele, 1991), considering both volunteers and learners in health promotion courses. The aspect of learning preferences aims to understand participants’ preferences for different types of course (Hong & Milgram, 2000). Two aspects of learning effectiveness were covered: curriculum effectiveness and volunteer gains (Schuller et al., 2004), as well as potential behavior changes in daily life (Lach et al., 2004). Learning obstacles comprised personal health benefits, external social relationships (Schuller et al., 2004), and other possible causes of obstacles. Maintaining health condition and making new friends are the primary challenges for continued participation in learning activities. The contents of the interview questionnaire are shown in Table 1.

Table 1.

Qualitative Interview Questionnaire: Learning Motivations and Obstacles.

Aspect	Basis	Interview Outline
Learning habits	Source of information	How did you learn about this health promotion activity?
	Frequency of attendance	How many times do you come per week? When do you choose to attend?
	Companionship during classes	Do you usually come to class alone or do you come with friends or grandchildren?
	Prior experience of participation	Have you participated in similar health promotion activities or courses before?
Learning motivations	Course content	What are the main topics or contents that you participate in during this health promotion course?
	Volunteer motivation	How did you become a volunteer for this health promotion course?
	Learning motivation	Do you have any suggestions or areas that you think could be improved in terms of the course, activities, or facilities that would be of most interest to elderly participants?
Learning preferences	Course preferences	Do you have any classes that were particularly interesting or memorable?
		Did anything happen or did you meet anyone during the activities that left a deep impression on you?
		What aspects of this health promotion course could be improved?
Learning benefits	Course benefits	Did you learn anything new after participating in the activities/courses? (Multiple answers possible) □ Exercise □ Making handicrafts □ Talents □ Health knowledge □ Other_____
	Volunteer benefits	Did you encounter any setbacks during the courses or activities that made you consider giving up being a volunteer?
		What is the most fulfilling experience or biggest takeaway you have gained during your time serving here?
		What was your profession before retirement, and how did it influence your role as a volunteer? (For example, a retired physical education teacher serving as a physical fitness volunteer)
	Life changes	After participating in the course/activity, what impact or changes did it have on your life?
Learning obstacles	Health benefits	Did the course activities provide any physical benefits for you?
	Interpersonal relationships	Did you make new friends after participating in the course/activities?
	Others	Can you provide an example of a friend who prefers to stay at home and does not like to go out for an extended period?

Participants and Experimental Procedure

The participants in the study comprised 16 senior citizens who had prior experience participating in a health promotion course. The study adopts a quasi-experimental design, dividing the participants into two roles. One is activity volunteers, of which there were 10, who had completed volunteer training and were subsequently involved in instructing course activities for other senior citizens, and the other is course participants, of which there were 6, who were retired senior citizens and were no longer the primary economic providers of their households (N. A. Bowling et al., 2012). One respondent, who was still employed, was excluded due to not meeting the eligibility criteria. Total was 15 participants. The age distribution of the study participants was as follows: two participants were between 50 and 55 years, five participants were between 60 and 65 years, and eight participants were over 65 years. The study used a semi-structured interview approach and encouraged interviewees to respond freely. The interview framework started with the learning habits of the elderly, and by understanding the motivations and possible learning obstacles of the elderly to participating in health promotion courses, obtained their learning content preferences and generated learning benefits. The purpose of the interview was to obtain the current status of participation in health promotion courses and understand the psychological factors that attract the elderly to participate in such courses. In the study, the interview data were fully recorded and transcribed verbatim. The transcripts were then deconstructed, categorized based on observed phenomena, and assigned conceptual labels through open coding to explore senior citizens “motivations” and “obstacles” to participating in health promotion courses.

Motivations and Obstacles to Participation

Using the findings from the semi-structured interviews and related literature, factors influencing the participation of senior citizens were identified and discussed. Three factors, namely, increased interpersonal interactions, family bonding, and deterioration of social circles, were grouped under “interpersonal dynamics,” which refers to the mutual interactions between people (Rogers, 1962). Three other factors, environmental atmosphere, maladaptation to the environment, and adaptation to role changes, were grouped under “adaptation,” which refers to the level of familiarity and comfort that senior citizens have with their surroundings and the people in their environment (A. Bowling & Stafford, 2007). Factors such as making up for regrets from younger years, passing time, and finding a focus in life were grouped under “motivations” for senior citizens to participate in courses because they reflected the learners’ inner desires and the key elements that triggered a sense of achievement (Boekaerts, 2002). Factors such as friendly course instructors and enjoyable course interactions were identified as “interest” elements that attract senior citizens to participate in courses and enhance their ability to face challenges and increase their participation (Gopalan et al., 2017). The final aspect of “confidence” can be correlated with two factors: enhancing self-worth and attaining a sense of achievement. This signifies the ability to exert self-control and thereby influence the execution of significant life events (Mackay, 2010).

Based on the literature review, the 13 elements that influence participation, obtained through interviews, were classified into motivations and obstacles to participation. These elements were further divisible into internal and external factors that contribute to the formation of motivations and obstacles. Motivations for participation include internal factors such as passing time, environmental atmosphere, increased social interaction, attaining a sense of achievement, enhancing self-worth, finding a focus in life, and making up for regrets from younger years. External factors that influence motivation to participate include friendly course instructors and enjoyable course interactions. As for obstacles to participation, internal factors include difficulties in adapting to the role transition after retirement and to unfamiliar environments. External factors include a dwindling social circle, lack of time due to childcare responsibilities, and lack of family support due to family ties.

On the basis of the factors obtained from the interviews, the psychological factors influencing learning participation were summarized and categorized into two aspects: participation motivation and participation obstacles. These correspond to the five major psychological elements that influence learning participation: interpersonal relationships, adaptation, motivation, interest, and confidence. They are analyzed and summarized in Figure 1, where adaptation (10 times) was mentioned most frequently (30.3%) by senior citizens, followed by interpersonal relationships (9 times) and confidence (7 times). In contrast, interest (4 times) and motivation (3 times) were mentioned less frequently (12.1% and 9.1% individually), indicating that senior citizens place greater emphasis on adapting to their roles and environment.

Figure 1.

Factors and psychological aspects of participation motivation and obstacles.

Second Phase: Health Promotion Curriculum and Teaching Material Design

The categories of the YMCA health promotion program were used as the basis for designing and planning the three courses in the cognitive health promotion curriculum, covering brain health promotion, physical health promotion (oral and movement), and social health promotion. In the design and planning of the curriculum, incorporation of activities that promote these three abilities is the main focus of the experimental design. In line with the literature on course content, three experimental courses were designed, comprising “hands-on” course that focuses on improving participants’ attention through sensory and physical movement control and aims to build confidence and a sense of achievement. “Planting” course that involves planting, harvesting, and consuming plants, which provides participants with manageable physical labor, stabilizes emotions, and delays physical degradation. And “board game” course that aims to improve attention deficit, emphasizing hand-eye coordination and enhancing cognitive function. The health promotion curriculum is part of informal learning (Callanan et al., 2011), which refers to education outside of school that is initiated on the basis of learners’ interests or choices. In curriculum design, it is essential to generate interest among learners. Thus, this study incorporates the Gaming Involvement and Informal Learning model (Iacovides et al., 2014) in the course and instructional design experiment to enhance peer interaction, increase learners’ enjoyment, and strengthen the possibility of senior citizens achieving success through learning.

The courses and instructional design are mainly divided into two parts: sensory stimulation and nostalgic experience. In terms of sensory stimulation, continuous learning and repeated memorization are especially crucial for senior citizens, given their sensory degradation, visual impairment (Simpson et al., 2012), decreased coordination and reaction time (Mahmood et al., 2012), and cognitive decline (Wang et al., 2004). Brain stimulation through learning and memory exercises is, therefore, essential for senior citizens. Furthermore, senior citizens face maladaptation and withdrawal reactions during the aging process due to social role transitions (Boshier & Collins, 1985). Nostalgic design focuses on reducing the adaptation threshold for senior citizens through familiar atmospheres and the triggering of their interests, thereby accelerating their integration into the curriculum and enhancing their learning experience.

Five Senses Stimulation

The five senses, sight, hearing, smell, touch, and taste, are the principal tools used by humans to explore the world (Serres, 2008). With regard to visual stimulation, people’s response to color is most obvious. Wijk et al. (2002) studied color recognition and preference and showed that senior citizens have a significant correlation between color perception ability and visual and cognitive functions. In addition, when compared to colorless stimuli, color provides a significantly better discriminative effect for senior citizens’ cognition and is extensively used in product and home design (Delcampo-Carda et al., 2019). Sensory garden activity provides olfactory and tactile stimulation by encouraging proximity to nature, which generates an uplifting effect and reduces depression. This approach has been extensively applied in courses that promote learning and ability maintenance for conditions such as dementia (Cobley, 2002), Alzheimer’s disease (Kaplan, 2018), autism. (Yusop et al., 2020), and special education (Hussein, 2012). In curriculum and instructional design, content is designed to incorporate sensory stimulation through visual, auditory, olfactory, and tactile elements such as color recognition, color description, creative painting, material touch, and scent appreciation.

Nostalgia

Nostalgic experiences connect the user with past experiences, which can reduce fear of unfamiliar things and establish connections between people (Sedikides & Wildschut, 2018). Nostalgia has been shown to improve psychological well-being in terms of social relationships, subjective vitality, sense of competence, autonomy, meaningful life, optimism, and subjective happiness (Kelley et al., 2022). The addition of nostalgic elements can also increase the sense of reality in learning (Xue, 2017). Therefore, in curriculum design, retro styling design that reflects senior citizens’ past life experiences and ways to relive past experiences can be incorporated into curriculum and instructional content.

On the basis of the design strategies of sensory stimulation and nostalgia mentioned above, three types of course content were planned for the health promotion curriculum in this study, including handicrafts, sensory garden activities, and board games. The handicraft course included two activities: “Retro Sand Painting” which emphasized tactile and color stimulation through filling in colors with colored sand within a pre-designed area, and “Nostalgic Pinball Machine,” which involved assembling wooden parts to enhance hand-eye coordination and personalizing it with colorful painting. The board game course included searching and matching game prompts and model objects in terms of their shapes, colors, and accessories to strengthen the color recognition and memory training of the elderly in a “Memory Challenge.” In addition, a game, “Gift Exchange,” involved matching gifts based on descriptions on cards. If players were holding the corresponding items, they could exchange cards; if not, it had to be discarded it. This activity aimed to enhance participants’ abilities in color recognition, listening focus, speech and language expression, and executive cognition. The gardening course included learning about the use of herbal plant baths, identifying plants by scent, and personalizing packaging bags with colorful drawings. Participants would create personalized “Colorful Herbal Bath Bags” by filling them with their preferred herbs and planting potted plants by hand. The colorful packaging for the planters would be on the outer box, as shown in Table 2, to illustrate the contents.

Table 2.

Experimental Sample Design for Health Promotion Courses.

Courses		Handicrafts		Board games		Gardening
Pictures
Course names Design elements		Retro sand painting	Nostalgic pinball machine	Memory challenge	Gift exchange	Colored herbal bath packets	Colored planting kits
Brain stimulation	Attention	V	V	V
	Memory	V	V	V		V	V
	Visual-spatial skills	V	V	V
	Short-term memory			V	V
	Mathematical computation				V
	Reasoning				V
Physical stimulation	Fine motor skills	V	V
	Gross motor skills					V	V
	Hand-eye coordination	V	V	V	V	V	V
	Hearing			V	V
Social skills	Language expression	V	V	V	V
Social skills	Social interaction	V	V	V	V	V	V
Nostalgic elements	Retro appearance	V	V	V	V
Nostalgic elements	Re-experience			V	V	V	V
Sensory stimulation	Visual stimulation	V	V	V	V	V	V
	Auditory stimulation			V	V
	Tactile stimulation	V	V			V	V
	Olfactory stimulation					V	V

Third Phase: Construction of Curriculum Evaluation Scale

Psychological factors that affect the motivation to participate in learning and that act as obstacles include interpersonal dynamics, adaptability, motivation, personal interest, and confidence. With regard to interpersonal dynamics, this refers to the interpersonal interaction experience with others during participation in activities and whether one is integrated into the group (Fabricatore et al., 2002). The adaptability dimension encompasses more than just feeling comfortable in the activity environment and with the people and things around, which is referred to as environmental adaptability. It also includes the ability to integrate into the course content during participation in the curriculum, leading to positive course participation experiences, such as excitement, pleasure, and a sense of challenge (Phan et al., 2016). With regard to motivational, course learning motivation is a vital factor in making up for past regrets or seeking to establish interactions with others. Furthermore, the sense of feedback in the course (Rieber, 1996), which encompasses the acquisition of new knowledge, self-realization, and stimulation of curiosity, is a critical determinant of course participation. Regarding personal interest, the individual’s sense of recognition in relation to the course instructor, as well as personal interest stemming from prior informal learning experiences, can contribute to the richness and appeal of course content. Furthermore, incorporation of elements of group competition, where there are winners and losers, can enhance the emotional engagement experience of participants (Desurvire et al., 2004) and increase their engagement in the learning process. About self-confidence, the appropriateness of the course content to the individual’s needs and abilities is a primary consideration. The course difficulty should be appropriate, allowing participants to complete the course while also providing a sense of challenge without being dull or tedious (i.e., the “course challenge” factor). Given these factors, this study redefined the course evaluation criteria from the original five dimensions of interpersonal dynamics, adaptation, motivation, interest, and self-confidence into eight criteria, namely, interpersonal interaction experience, environmental adaptability, course participation experience, course learning motivation, sense of feedback in the course, personal interest, emotional engagement experience, and course challenge. These criteria were used to construct an overall evaluation framework and serve as the framework criteria for the subsequent AHP, as shown in Table 3.

Table 3.

Design and Evaluation of a Health Promotion Curriculum: Dimensions and Indicators of Assessment.

Psychological factors	Evaluation criteria	Evaluation indicators	Indicator source
Interpersonal dynamics	Interpersonal interaction experience	Cooperativeness	Fabricatore et al. (2002)
		Competitiveness
		Sense of belonging
Adaptation	Experience of participation in courses	Immersiveness	Phan et al. (2016)
		Focusedness
		Tenseness
		Joyfulness
	Environmental adaptability	Sense of security	Interview results of this study
	Environmental adaptability	Age appropriateness	Interview results of this study
Motivation	Sense of feedback in the course	Exploratoriness	Rieber (1996)
		Informativeness
		Sense of achievement
	Course learning motivation	Nostalgia	Interview results of this study
	Course learning motivation	Connectedness	Interview results of this study
Interest	Emotional engagement experience	Narrativity	Desurvire et al. (2004)
		Amusement
		Balancedness
		Accessibility
	Personal interests	Sense of identification	Interview results of this study
	Personal interests	Habitual participation	Interview results of this study
Confidence	Course challenge	Appropriateness	Iacovides et al. (2014)
		Skillfulness
		Autonomy

The interpersonal interaction experience included three evaluation indicators: collaborativeness, which involved seeking cooperation to increase the chances of success when the individual’s abilities are insufficient to meet the challenges. Competitiveness, which pertained to group competition activities, and sense of belongingness, which referred to the group’s perception of the individual and the individual’s own feelings (Fabricatore et al., 2002). The course participation experience included four evaluation indicators: immersiveness, which referred to the individual’s ability to focus and integrate himself or herself into the course or game content; focusedness, which pertained to having clear goals; tenseness, which pertained to feeling excited or nervous about the course or game content; and joyfulness, which referred to the experience of feeling happy (Phan et al., 2016). Drawing on the interview results, environmental adaptability included a sense of security in the environment and age appropriateness in adapting to role transitions. The sense of feedback in the course included exploratoriness, referring to whether the course aroused curiosity, informativeness, referring to whether useful knowledge and experience was gained, and sense of achievement, referring to whether self-realization was achieved. According to the interview results, learning motivation included a desire to compensate for nostalgia and to establish connectedness with others. The emotional engagement experience included narrativity, which addressed scenario differences; amusement generated by interesting interactive processes; balancedness, which emphasized the distribution of individual abilities; and accessibility, referring to the understanding of course operations and ease of learning. The criteria for obtaining interviews included factors related to personal interest, such as a sense of identification with the course instructor and habitual participation in relevant informal courses. Course challenge included suitability, referring to the appropriate balance between the mental and physical effort required to achieve learning objectives in relation to the individual’s own skills; skillfulness, referring to the degree of understanding and mastery of the required skills during the course of study; and autonomy, referring to the ability of members to make choices based on their own interests and ideas.

In the operational process of the Analytic Hierarchy Process (AHP), 5 psychological factors identified through interviews were used for problem definition and interpretation (8 evaluation criteria). Subsequently, 23 evaluation indicators were identified, and corresponding questionnaire items were designed. Data were collected through questionnaires to determine the relative importance of decision attributes across different hierarchical levels. A pairwise comparison matrix was then constructed to calculate the eigenvalues and eigenvectors of the matrix. Furthermore, an expert questionnaire was conducted, and feedback revisions were made based on consistency tests and hierarchical structure consistency tests. The optimal solution was proposed based on the weight of each indicator.

Ethical Considerations

The design and materials of health promotion courses adhered to ethical principles to ensure respect for participants’ rights and well-being. This included obtaining informed consent, maintaining confidentiality, and ensuring courses were accessible and inclusive. The course content was evidence-based and designed to promote well-being while avoiding harm. Researchers empowered participants by providing skills and knowledge for informed health decisions and encouraging active engagement to uphold accountability and effectively adapt to participants’ needs.

Results and Discussion

In the first phase of this study, we organized and extracted psychological factors affecting the elderly’s learning through semi-structured interviews to understand their motivations and obstacles to participating in health promotion courses. The five main factors identified were adaptation (30.3%), which ranked the highest, followed by interpersonal relationships (27.3%), confidence (21.2%), interests (12.1%), and motivation (9.1%). These were used as important reference factors in the second phase of designing the health promotion curriculum, which included cultivating brain function, physical fitness, and social skills. Brain Function encompasses seven dimensions: attention, memory, Visual-spatial skills, short-term memory, mathematical computation, and reasoning. Physical fitness includes fine motor skills, gross motor skills, hand-eye coordination, and hearing training. Social skills involve two key elements: language expression and social interaction. By leveraging sensory stimulation and nostalgic elements to connect with participants’ past experiences, six experimental samples—such as handicrafts, board games, and planting activities—were designed to meet the above criteria (as shown in Table 2).

In the third phase, a curriculum evaluation scale was constructed using principal component analysis and AHP to obtain the expert questionnaire structure elements. A total of 86 questionnaires were distributed in the experiment, with the participants being retired senior citizens who had participated in the design and planning of the handcraft, board game, and gardening courses in the second stage. A total of 60 valid questionnaires were collected, and the results were subjected to a reliability analysis to determine their validity and reliability. Before conducting a factor analysis, a KMO & Bartlett sphericity test was performed, resulting in a KMO value of 0.841 and a p-value of .000 for the Bartlett sphericity test, which is significant at a level of .05. The reliability of the scale was evaluated using Cronbach’s alpha coefficient, which was found to be .944, indicating that the item analysis and factor analysis of the scale have high stability and credibility. Both tests suggested that the sample collected for this study was suitable for conducting a factor analysis. A further reduction of the 23 assessment items was achieved through the factor analysis, resulting in 14 evaluation indicators.

These items were categorized into five groups using principal component analysis, summarized as (1) Operation & cognition: whether the difficulty level of the course met expectations and whether the environment was easy to integrate into and allow recognition; (2) Variability of the curriculum: whether the course content was challenging and team members had balanced abilities; (3) Sense of participation: whether social situations could be integrated and members could generate cooperative and competitive interactions; (4) Sense of feedback: whether knowledge and self-satisfaction could be improved; and (5) Experience: whether participants were able to feel happy while learning during the course. The post-revision course dimension and evaluation indicators are shown in Table 4, which can be used to establish an AHP framework for designing health promotion curricula, as illustrated in Figure 2. Finally, the revised design scale was evaluated by experts to obtain the corresponding weights.

Table 4.

Cumulative Explanatory Rate and Reliability Analysis of the Evaluation Criteria for the Health Promotion Curricula.

Item	Question items	Evaluation indicators	Criteria
Item	Question items	Evaluation indicators	Operation & cognition	Course variability	Sense of participation	Sense of feedback	Experience
1	I think it is important for the course difficulty to be suitable for me.	Suitability	0.735
2	I think it is important to be able to master the required skills in the course.	Skillfulness	0.757
3	I think it is important to be able to freely exercise my imagination during the course.	Autonomy	0.724
4	I think it is important to be able to integrate into the course.	Immersiveness	0.791
5	I think it is important for the course objectives to be clear so that I can focus on the course.	Focusedness	0.644
6	I think it is important to have a sense of recognition of the institution and the teacher.	Sense of identification	0.567
7	I think it is important for the course content to be exciting and stimulating.	Tenseness		0.723
8	I think it is important for the course mechanism to be balanced.	Balancedness		0.695
9	I think it is important to have similar learning experiences in the past.	Habitual participation			0.843
10	I think it is important to cooperate with others and complete tasks together in the course.	Cooperativeness			0.680
11	I think it is important to have a competitive environment in the course.	Competitiveness			0.719
12	I think it is important to learn new knowledge in the course.	Informativeness				0.797
13	I think it is important to feel a sense of achievement during the course.	Sense of achievement				0.673
14	I think it is important to feel happy during the course.	Joyfulness					0.844
Cumulative explained variance			48.37%	57.73%	63.98%	69.01%	73.41%
Cronbach’s alpha = .896

Figure 2.

Analytic hierarchy process framework for health promotion curriculum design.

In this study, three experts from a community integrated service center and a health service center were invited to participate in the questionnaire assessment. On the basis of the target population of the experts’ service units, the questionnaire data were divided into two groups: First, healthy senior citizens with strong autonomy and not requiring assistance from others. The experts interviewed were A, a female service center director with over 10 years’ experience at government health service center A, and B, a male service center director with over 10 years’ experience at government health service center B. Second, sub-healthy senior citizens requiring assistance from others for daily activities. The interviewed expert was female expert C, who has worked as a case manager for 5 years in community integration service center C. The questionnaire results from the three experts passed the consistency test (five evaluation criteria, consistency ratio = 0.086 < 0.1). The relative weights were then averaged and sorted, and the experimental results were discussed in the subsequent course questionnaire according to the classification of care goals.

On the basis of the overall expert analysis of the weighted average of design criteria, the weights of operation & cognition and experience were both 0.258, indicating that the importance of these two criteria was equally significant. Next came sense of participation (0.197) and sense of feedback (0.195), followed by consideration of course variability (0.091). For healthy senior citizens, experience is the most principal factor. A harmonious and pleasant learning atmosphere can make senior citizens happy and generate a sense of pleasure, which is conducive to progress in the course. The weights of sense of participation and sense of feedback were similar, indicating that creating a positive learning environment can encourage senior citizens to learn willingly and persistently, and that gaining new knowledge and a sense of accomplishment can encourage senior citizens to participate in learning. São José et al. (2017) observed that senior citizens tend to focus on things they can accomplish themselves. Moreover, senior citizens are believed to have rich life experiences and thus may place a lower emphasis on course variability. For this reason, course variability is ranked last in terms of weight. The coordination of course continuity is more important than the freshness of course changes, as suggested by the study of Lach et al. (2004) using TTM: courses should gradually increase in intensity from being knowledge-based to being operation- and maintenance-based. For sub-healthy senior citizens, operation & cognition was deemed the most important influencing factor. Due to the weaker physical function of sub-healthy senior citizens, experts should pay more attention to cognition and operation in course planning to achieve the goal of health promotion. Course variability was a secondary influencing factor. The diverse changes in courses may lead to a lack of security among senior citizens, which is consistent with the interview results regarding adaptation, which indicates that senior citizens have a similar degree of familiarity with their environment. Therefore, pre-sub-healthy senior citizens often need the help of family members to arrange courses, and thus sense of participation is ranked last in terms of weight. The criterion weights are shown in Table 5.

Table 5.

Relative Weights of Criteria.

CriteriaRelative weight	Overall experts		Experts - Health attribute		Experts - Sub-health attribute
CriteriaRelative weight	Weight mean	Mean rank	Weight mean	Mean rank	Weight mean	Mean rank
Operation & cognition	0.258	1	0.099	4	0.577	1
Course variability	0.091	5	0.050	5	0.174	2
Sense of participation	0.197	3	0.276	2	0.040	5
Sense of feedback	0.195	4	0.223	3	0.139	3
Experience	0.258	1	0.353	1	0.070	4
C.I.	0.096		0.089		0.111
C.R.	0.086		0.079		0.099

Note. The consistency ratio (CR) is used to determine the value of probability, and the judgment matrix in created in random manner, and the consistency index (CI) that depends on the order of the matrix given by Saaty (1987).

Table 6 shows the evaluation indicators, their relative weights, and the ranking of the elderly health promotion curriculum evaluation scale after weighted scoring. From Table 6, we can see that the indicator with the highest weight after weighted scoring is joyfulness, with a weight value of 0.258. The next highest weight is sense of achievement, with a weight value of 0.183, followed by coordination (0.120), and cooperation and mutual assistance (0.114). The indicator with the lowest weight value is creative imagination, which is only 0.021.

Table 6.

Weighted Scores and Ranking of the Evaluation Indicators for the Elderly Health Promotion Curriculum Design.

Evaluation criteria	Rank	Evaluation indicators	Relative weights of assessment indicators after weighted scoring	Rank
A. Operation & cognition (0.258)	1	A1: Difficulty level (0.150)	0.039	11
		A2: Operational skills (0.105)	0.027	13
		A3: Creative imagination (0.080)	0.021	14
		A4: Immersiveness (0.337)	0.087	5
		A5: Course objectives (0.175)	0.045	9
		A6: Sense of identification (0.303)	0.078	6
B. Course variability (0.091)	5	B1: Novelty (0.389)	0.035	12
B. Course variability (0.091)	5	B2: Coordination (0.611)	0.120	3
C. Sense of participation (0.197)	3	C1: Learning experience (0.244)	0.048	8
		C2: Cooperation and mutual assistance (0.587)	0.114	4
		C3: Competitive behavior (0.169)	0.044	10
D. Sense of feedback (0.195)	4	D1: Knowledge (0.292)	0.057	7
D. Sense of feedback (0.195)	4	D2: Sense of achievement (0.708)	0.183	2
E. Experience (0.258)	1	E1: Joyfulness (0.258)	0.258	1

The experts ranked the six indicators under the operation & cognition criterion in order of relative advantage, namely, immersiveness, sense of identification, course objectives, difficulty level, operational skills, and creative imagination. On the basis of the weight and ranking, it can be seen that immersiveness and sense of identification were key factors in the design of the operation & cognition aspect of the course. Therefore, both indicators are important in curriculum design.

According to Table 7, a comparison of the indicator weights for operation & cognition between health and sub-health elders reveals the following results. For healthy senior citizens, immersiveness (weight value of 0.376) is the most important influencing indicator, which aligns with the psychological factor of motivation mentioned in the interviews, emphasizing the interactive part of the course. Senior citizens tend to have thoughts of giving up when faced with learning difficulties that are too high, but content that is too simple will lose its challenge. Therefore, difficulty level (weight value of 0.196) is ranked second. Moreover, since most senior citizens need encouragement to achieve self-identification and a sense of belonging, sense of identification (0.116) is ranked third, which is consistent with the confidence factor in the previous interview results. Since healthy elderly people usually have sufficient knowledge to understand the content of a class, the importance of course objectives is ranked last for them. Due to a decline in physical function among sub-health senior citizens, by contrast, they rely more on the encouragement of course teachers and volunteers to achieve course goals. Therefore, sense of identification (weight value of 0.678) is the most important indicator, which is consistent with the psychological factor of adaptation in the previous interview results. In addition, focusing on the course can help senior citizens immerse themselves in the course. Therefore, course objective (weight value of 0.411) is a secondary influencing indicator. When senior citizens are integrated into a course, it helps attract their attention and concentration and increases their willingness to engage. Therefore, immersiveness (weight value of 0.261) is the third influencing indicator in the ranking. Senior citizens often have thoughts of not daring to try due to a fear of failure, and creative imagination is an uncertain factor for sub-health senior citizens. Therefore, it ranks last. In the future, if relevant courses are offered, it is advisable to plan the course in a step-by-step process to establish the participants’ confidence and sense of security.

Table 7.

Weight Values of Each Indicator Under “Operation & Cognition.”

Operation and cognition indicator weight	Overall experts		Experts - Health attribute		Experts - Sub-health attribute
Operation and cognition indicator weight	Weight mean	Mean rank	Weight mean	Mean rank	Weight mean	Mean rank
Difficulty level	0.150	4	0.196	2	0.06	5
Operational skills	0.105	5	0.076	5	0.163	4
Creative imagination	0.080	6	0.103	4	0.035	6
Immersiveness	0.337	1	0.376	1	0.261	3
Course objectives	0.175	3	0.057	6	0.411	2
Sense of identification	0.303	2	0.116	3	0.678	1
C.I.	0.114		0.117		0.108
C.R.	0.092		0.0945		0.087

Note. The consistency ratio (CR) is used to determine the value of probability, and the judgment matrix in created in random manner, and the consistency index (CI) that depends on the order of the matrix given by Saaty (1987).

This study integrates and compares commonly used models and scales in research areas such as active aging, learning motivation, game user experience satisfaction, and integrated cognitive assessment. Based on the evaluation criteria and applicable contexts, their suitability is systematically analyzed and planned. The AAI is suitable for comprehensive national assessments of aging populations and social participation, while the MMSE is widely used in medical practice for evaluating the severity of dementia. The ARCS Model and GUESS are applicable for general evaluations of learning motivation and game participation satisfaction. However, none of these frameworks explicitly align with the assessment needs of health promotion courses for elders. Therefore, the questionnaire is designed to address the five critical design elements required for health promotion courses: operation & cognition, course variability, sense of participation, sense of feedback, and experiential value. Through a comprehensive and integrated planning process, the current scale was developed for the evaluation of health promotion curricula for the elderly, as shown in Table 8.

Table 8.

Comparison of Applicability of Evaluation Scales.

Model/Scale name	Evaluation criteria	Applicable contexts
The Active Ageing Index (AAI)WHO (2002)	Level of ability of senior citizens to live independently, participate in paid employment, and engage in social activities	Social participation index of aging populations in different countries
ARCS modelKeller (1987)	Attention, relevance, confidence, and satisfaction	Design elements that trigger learning motivation
Game user experience satisfaction scale (GUESS)Phan et al. (2016)	Usability (playability), narrative, game, enjoyment, creative freedom, music esthetics, personal satisfaction, social connection, and visual esthetics	Tool for measuring satisfaction with gaming participation experience
Mini-Mental State Examination (MMSE)Folstein et al. (1975)	Cognitive function assessment tools evaluating time and place orientation, attention and arithmetic ability, immediate memory and short-term memory, language ability (including reading, writing, naming, comprehension, and operation), and visual-spatial ability	Widely used in medical cognitive (dementia level) assessments
Elderly health promotion curriculum design evaluation scale(in this study)	Five evaluation criteria covering operation and cognition, course variability, sense of participation, sense of feedback, and experiential aspects	Evaluation elements for designing health promotion courses

Conclusion and Recommendations

This study conducted interviews with senior citizens to understand their learning needs, motivations, and obstacles, and explored related research on health promotion courses. Through this process, the study defined the content and design of health promotion courses and developed an evaluation scale for assessing the design of health promotion courses. This scale can assist future curriculum designers in making modifications based on the criteria and weightings established in the evaluation scale.

Research Conclusions

The main psychological factors that affect the participation of senior citizens in health promotion courses are adaptation and interpersonal dynamics. Therefore, in curriculum design, the familiarity of the overall environment and setting and interaction between people will have a significant impact on participation. It is recommended that future research and learning for the elderly prioritize the consideration of these factors to effectively enhance learning goals.

On the basis of the results of the expert questionnaires, the evaluation criteria for assessing the impact of health promotion courses on elderly participants were ranked in order of importance. The criteria were operation & cognition and experiential learning, followed by sense of participation and feedback. The variability of the curriculum had relatively less impact on the evaluation. The operation & cognition aspect of the curriculum design emphasizes the need to make it easy for senior citizens to get started and adapt to things and their environment. Experience refers to bringing pleasant feelings to senior citizens, which encourages them to continue participating and enhances their motivation to learn. In the sense of participation, mutual interaction and participation with peers bring companionship and care, which is the primary factor in promoting senior citizens’ integration into course-related activities. Sense of feedback refers to the satisfaction of accomplishment after participating in activities. Curriculum variability is a major concern for curriculum designers and yet was shown to be the least significant aspect in the research findings. Overall, joyfulness indicating that creating a happy and friendly learning environment for senior citizens is a vital element in curriculum construction. The next most significant indicators were the senior citizens’ sense of achievement, the coordination of the curriculum, and mutual cooperation among peers. The two indicators with the lowest weighted influence in the index were creative imagination and operational skills. This shows that senior citizens participating in health promotion courses require clear and step-by-step teaching methods to avoid divergent teaching styles. They thereby receive clear course instructions and achieve teaching goals, which can increase their self-confidence and satisfaction with the course.

Research Recommendations

This study is centered around the design of health promotion curricula with a focus on the concept of prevention being better than cure. However, the majority of participants involved in the study were senior citizens in good health, and as such, there is still a segment of the population that has yet to be explored. If we were able to expand the scope of the courses to include those who are reluctant to leave their homes, more senior citizens would be able to benefit from the research findings, and in turn, those findings could contribute more to the field of long-term care. It is hoped that the scales and methods proposed in this study can be applied to the design of elderly education. Through curriculum design and revision, more research data can be obtained to improve the design and meet the needs of users. In addition, if the application of these measures can be extended to various types of course and if comparative analysis of outcomes can be conducted, more suitable evaluation scales can be obtained for different course types, and their interpretive power could be validated.

Footnotes

Acknowledgements

Thanks to all who have contributed to this project and other related projects. Each member of my dissertation committee has provided me with a wide range of personal and professional advice and has taught me much about scientific research and life in general.

ORCID iDs

Kai-Chieh Lin

Hsiang-Ju Chen

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Science and Technology Council [grant number 111-2221-E-036 -003-].

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: With respect to this work, full consideration is given to the protection of intellectual property, and we will confirm that there will be no hindrance to intellectual property, including the timing of publication.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Crafting Design Solutions for Lifelong Learning and Health Promotion in Elderly Communities

Abstract

Keywords

Introduction

Literature Review

Cognitive Function Promotion

Current Status of Health Promotion Development

Health Promotion Courses

Factors Influencing Course Participation

Research Methods and Experimental Design

First Stage: Understanding the Influential Factors of Learning Participation Motivation and Obstacles

Participants and Experimental Procedure

Motivations and Obstacles to Participation

Second Phase: Health Promotion Curriculum and Teaching Material Design

Five Senses Stimulation

Nostalgia

Third Phase: Construction of Curriculum Evaluation Scale

Ethical Considerations

Results and Discussion

Conclusion and Recommendations

Research Conclusions

Research Recommendations

Footnotes

Acknowledgements

ORCID iDs

Funding

Declaration of Conflicting Interests

Data Availability Statement

References