Co-design with older adults with fewer basic skills: developing a playful healthy aging program

Background In the context of an aging population, older adults with fewer basic skills face compounded challenges in achieving healthy aging. These individuals often experience barriers to health literacy and self-reliance, exacerbated by conventional educational programs that inadequately reflect their needs and experiences. Little is known about how to develop educational solutions that match this groups preferences and language that supports access to, comprehension, and application of health information in everyday life.Aims To fill this gap, we describe and reflect on the participatory development of a healthy aging educational program. Our goal is twofold in showing: 1) how the co-design process was shaped by participants needs and preferences, and 2) to identify what practice-based lessons can be drawn from this process for developing inclusive educational programs for this population.Methods The educational program was co-created with community-dwelling older adults (50+) with fewer basic skills in three countries: Denmark, the Netherlands, and Portugal. Following a participatory design approach, our process involved three phases; 1) exploration of the learning needs and formats of our target audience (N = 55), 2) co-design of the program with participants (N = 7) and interdisciplinary experts (N = 11), 3) field testing with iterative adjustments based on participant feedback (N = 73).Results Phase one yielded five core curriculum themes – the aging body, nutrition, wellbeing, being heard, digital (safety) - as well as two learning approaches: meaningful play and collaborative learning. The resulting program took the form of a physical, card-based game designed with accessible language, peer-learning, and practical information on healthy aging. Field testing showed that focusing on lived experiences through playful and collaborative activities helped participants engage with health and digital literacy skills without stigma, while learning together about healthy aging.Discussion We distilled three practice-based lessons for inclusive co-design: 1) centering learners lived experiences through co-creation, 2) playful and collaborative learning methods that reduce barriers to participation, and 3) iterative and flexible design that builds trust and agency. These lessons demonstrate how participatory design focused on participants’ needs and lived experiences, has the potential to promote more equitable health literacy programs and support healthy aging among underserved older adults.