Background: Physical activity (PA) in older adults can prevent, treat, or offset symptoms and deterioration from various health conditions and help maintain independence. However, most older adults are insufficiently active. Digital interventions have the potential for high reach at low cost. Objective: This paper reports on the implementation of ‘Active Lives’, a digital intervention developed specifically for older adults. Methods: This study had a qualitative design. The implementation team approached a range of National Health Service (NHS), public health, community, and third-sector organisations in the UK to offer Active Lives to as large and diverse a group of older adults as possible. Alongside real-world implementation activities, research was conducted to explore what supports and inhibits the implementation of a digital intervention for PA in older adults. Data collection involved interviews with implementation partners (n=15) and the implementation team (n=3) plus extensive field notes from stakeholder communications. Inductive thematic analysis was used to analyse the data. Results: Five broad themes were developed, capturing implementation barriers and facilitators. These were: I) Complex and opaque networks and influencers, II) Forming an understanding of Active Lives and its fit, III) A landscape of competition and conflicting interests, IV) Navigating unclear approval processes, and V) Shifting strategies: small and effortful to high reach and passive. Identifying key decision-makers proved arduous, consuming significant time and resources, and proposals from enthusiastic implementation partners often proved impractical or overly burdensome. Healthcare professionals demonstrated a comprehensive understanding of the potential benefits of digital interventions in alleviating operational burdens and improving patient care. However, stakeholders from disparate sectors held reservations about digital intervention and had different views on the best approaches to supporting physical activity among older adults. This discord was exacerbated by conflicts with existing local initiatives, such as group exercise programs, which occasionally hindered the implementation of Active Lives. Furthermore, bureaucratic hurdles within NHS trust approval processes acted as formidable obstacles, dampening progress, and resolve, highlighting the need for guidance in identifying sustainable and scalable practices. Conclusions: The findings highlight important implementation challenges to digital physical activity interventions for older adults such as bureaucratic barriers and alignment with ongoing initiatives. This research emphasises the necessity for strategic direction and multi-level guidance to efficiently implement digital interventions for physical activity among community-dwelling older adults.

Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (e.g., physical activity, healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multi-session digital binge eating intervention. Methods: We applied human-centered design methods to learn users’ preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as “nudges” for selecting positive behavior change strategies they could practice). We recruited target users of our multi-session intervention to complete design sessions. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (versus without) for their motivation and validation of the intervention’s efficacy. A few distrusted testimonials for appearing too “commercial” or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with “how-to” advice, whereas others preferred “big picture” success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allows users to choose between actions (e.g., behavioral strategies), participants preferred testimonials be available across all actions, but said that selectively delivering a testimonial with one action could “nudge” them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users’ most pertinent identities and tailor testimonials accordingly. Likewise, users’ divided preferences for testimonial messaging (i.e., “big picture” versus “how-to”) suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as “nudges” within interventions—a ripe area for further inquiry—though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors.

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