# A person-centred approach to further develop a digital tool (KOKU-Nut) by developing a nutrition game for older adults living in the community

## TL;DR

This study developed a nutrition game called KOKU-Nut for older adults, using a person-centered approach to improve dietary habits and digital tool usability.

## Contribution

A new digital nutrition game for older adults was developed and tested using focus group insights and a person-centered design approach.

## Key findings

- Four themes influencing food intake included personal preference, perceptions of food, and age-related changes.
- The nutrition game prototype (KOKU-Nut) had excellent usability with a median SUS score of 87.5.
- A matching pair’s card game format was chosen for the nutrition game based on participant feedback.

## Abstract

Digital tools embedded with behaviour change theories can encourage the successful implementation and maintenance of positive lifestyle changes. Keep on Keep up (KOKU) is a wellbeing app offering strength and balance exercises and educational games to raise awareness of fall prevention. We aimed to further develop KOKU using a person-centred approach to inform and improve the eating habits of older adults living in the community.

Initially, adults aged 65 and over were recruited from assisted living facilities across Greater Manchester. Five focus groups involving 33 older adults (aged 69–96 years) were conducted between October and December 2022. A topic guide was used flexibly to understand factors that influence the groups eating habits and explore their thoughts around a digital tool to support nutritional intake. Conversations were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Researchers then collaborated with designers to develop a nutrition game based on UK dietary guidelines and findings from the focus groups. The nutrition game was tested with older adults in January 2024 before making any necessary changes. The older adults provided feedback and completed the system usability scale (SUS).

Four themes emerged from the dataset. The main determinants of food intake were personal preference, perceptions of foods and changes as a result of age-related decline. The ability, engagement and willingness to use digital technology varied among participants but the majority had a positive attitude towards the digital platform. A matching pair’s card game was chosen, and the educational content was produced by the research team. A prototype of the nutrition game (KOKU-Nut) was tested with 10 older adults on an iPad provided by the research team. Feedback was generally positive, and the median SUS was 87.5 (IQR: 65, 95) out of 100 indicating the nutrition game had excellent usability.

We anticipate this person-centred approach will improve the design of KOKU-Nut to empower and educate users to improve their diet. Future research should focus on maximising social inclusion and diversity.

The online version contains supplementary material available at 10.1186/s12877-025-06434-2.