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

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.

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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.

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).

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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.

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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).

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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.

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.