Co-creating Digital Services to Promote Active Lifestyle among Older
Adults: The Turntable Project
Benedek Szakonyi
1
, István Vassányi
1
, Angelika Mantur-Vierendeel
2
, Daniela Loi
3
,
Guilherme Correia
4
and Bojan Blažica
5
1
Medical Informatics Research and Development Centre, University of Pannonia, Veszprém, Hungary
2
EuroFIR AISBL, Brussels, Belgium
3
Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
4
Laboratory for Automation and Systems, Instituto Pedro Nunes, Coimbra, Portugal
5
Jožef Stefan Institute, Ljubljana, Slovenia
Keywords: Older Adults, Co-creation, Digital Services, Well-Being, Gardening, Health, Turntable.
Abstract: In this paper findings from co-creation sessions for the Turntable Solution addressing challenges around
vitality, activity, and social interactions amongst older adults (over 60 years of age) are reported. Having
digital skills is more common, even amongst older adults, and some digital services can be utilized to support
healthy ageing. During the co-creation sessions, held in Portugal, Italy, Belgium and Slovenia with five
participants each, features of a gardening mobile solution were discussed. In the form of hands-on trials using
mock-ups and prototypes, users’ lifestyle and general acceptance of mobile technology was surveyed, along
with their experience with using the existing and planned features. Results showed that, if accessibility for
the target age group (i.e. good user experience) is provided, even less technologically proficient users would
try the Turntable App for gardening hints, nutritional guidance, and social interactions.
1 INTRODUCTION
1.1 Background
People tend to become more sedentary and less active
as they age, expediting age-related physical and
cognitive decline. Maintaining social activity and
eating healthily prove increasingly challenging
(Amarya et al., 2015). Due to continued decline in
muscle mass, strength and power, falls become both
more frequent and dangerous. Even everyday tasks
seem to be more intimidating than before. The
resulting inclination of avoiding risky situations (e.g.
by not leaving the house) not just worsens the
physical condition, but also causes social isolation (as
people stop visiting each other). This decay
contributes to the occurrence of chronic diseases, the
main causes for healthcare expenditure, making this
problem significant not only on an individual level,
but on a global level too.
It has been proven that physical activity, good
nutrition and social interaction have powerful impacts
on both the actual and perceived quality of life in
older adults (McReynolds and Rossen, 2004; Shinkai
et al., 2016; WHO, 2015). Thus, motivating and
supporting them in preserving (or re-adopting)
healthy habits is vital (Urtamo et al., 2019). Helping
individuals prepare healthy meals to achieve a
balanced diet, and assisting them with an active
lifestyle through recreational social activities is
crucial.
One potential activity addressing physical,
cognitive and social aspects all at once is (leisure)
gardening (Howarth et al., 2020). There is increasing
evidence in recent scientific literature that home and
community gardening have numerous physical,
health and restoration benefits (Gagliardi and
Piccinini, 2019; Soga et al., 2017; Spano et al., 2020).
The positive effects include improved self-perception
related to aging (Scott et al., 2020), and even the risk
of premature death can be lowered (Lêng and Wang,
2016; Wannamethee et al., 2000). As most people like
and benefit from spending time in nature, gardening
can be used as a motivator in solutions aiming for
achieving lifestyle changes, and in turn, healthy
living.
Szakonyi, B., Vassányi, I., Mantur-Vierendeel, A., Loi, D., Correia, G. and Blažica, B.
Co-creating Digital Services to Promote Active Lifestyle among Older Adults: The Turntable Project.
DOI: 10.5220/0010474902130220
In Proceedings of the 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2021), pages 213-220
ISBN: 978-989-758-506-7
Copyright
c
 2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
213

Having basic digital skills is necessary to
participate in modern societies, even for older adults
(European Commission, 2016), and using digital
solutions could prove to be an effective intervention
with the right motivation. Thus, providing well-
designed applications can even support older adults in
developing and maintaining these much-needed
skills.
1.2 The Turntable Project
Based on these concepts, the development of a
platform able to promote active aging among older
adults began in the Turntable AAL project
(Turntable, 2019). The project also aims to help older
users to prolong their autonomous and independent
lives. As a first stage of the project, co-creations
sessions were held in four European Member States
(Portugal, Italy, Belgium and Slovenia), to investigate
gardening habits and needs of target users, and to
discuss and test possible features of a gardening-
oriented mobile solution. In this paper, findings of
these co-creation sessions are reported, along with a
brief introduction to the main components and
features.
2 RELATED WORK
Already in 2013 a literature review (Wang and
MacMillan, 2013) has found that there is ample
evidence that gardening (horticultural activities) has
positive effects on the lives of older adults, including
overall quality of life, health, physical and cognitive
ability, and socialization. Since then, other reviews
examining the findings of more recent works have
also confirmed these positive effects (Gagliardi and
Piccinini, 2019; Soga et al., 2017; Spano et al., 2020).
The similar results of their reviewed studies, with
participants from multiple different countries (China,
Hong Kong, Iran, Japan, Netherlands, Norway, South
Korea, Taiwan, UK, USA) suggest that the positive
effects of gardening can be perceived by older adults
regardless of their cultural background. Findings
from Australia (Cheng and Pegg, 2016) and
Singapore (Sia et al., 2020) also confirm this. This
makes gardening a potent tool for addressing the
difficulties facing older adults in achieving healthy
living, on a global scale.
The number of available assistive technologies for
older adults is increasing. There are generic smart
living solutions in the form of wearable devices
(Akbar et al., 2018), programs for cognitive
stimulation (Álvarez-Lombardía et al., 2018), and
applications used by home care organisations (Honor
Technology Inc., 2020) and more. While useful, these
solutions in general focus on only one or two aspects
needed to achieve healthy living, not all at once (or at
least as much as possible).
As an initial gardening based solution, Lekjaroen
et al. introduced a so-called IoT Planting solution that
allowed users to monitor soil moisture, temperature,
light via an Android application, and found that older
adults have the willingness and capacity to use such
solutions (Lekjaroen et al., 2017). However, the
offered functionality can be considered quite limited,
being more like a remote-controlled plant manager
instead of aiding users in active gardening. Moreover,
it completely lacks the sociality and skill sharing
aspect of gardening, which is one of its key domains
(Maddali and Lazar, 2020).
In (Wherton et al., 2015), through co-design
workshops, 4 main topics were able to be revealed
that assisted living applications must consider: raising
awareness and sharing knowledge, offering sufficient
customisation and adaptation, providing social
support, and ensuring effective coordination of care
services. Feedback provided by participants trying
already existing applications (e.g. fitness
applications) can provide both a beneficial
foundational basis for newly created solutions and
ways for improving already existing ones, allowing
applications to be made more suitable for older adults
(Harrington et al., 2018). Including older adults in the
design process can also find the key barriers towards
digital solutions, such as the accessibility of
technology, technology literacy, data privacy and
management, and the need itself for having co-design
in technology (Wang et al., 2019). Co-design sessions
with individuals living with physical or mental health
conditions can reveal additional specific needs to be
addressed, such as crisis support and advanced
emotional support, along with the general need of
being informed and motivated (Easton et al., 2019).
With this in mind, the main goal of the Turntable
project is to develop a solution covering all important
aspects of gardening, by constant inclusion of older
adults, in order to provide an effective tool for
assisting them in achieving healthy living.
3 DIGITALS SERVICES
INCLUDED
In the development phase of the Turntable Solution,
five already existing components with thousands of
registered users serve as the foundations. These
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components are OPEN, Tomappo, Lifely, IntegrAAL
Social Engine and MARIA. The aim is to integrate
these into one single solution tailored to provide the
necessary features.
The OPEN nutrition app serves as a dietary
assessment and personalized meal logging and
planning tool. It aims to help users to pay more
attention to their eating and physical activity habits,
as well as providing a basis for planning changes and
setting goals.
Tomappo, a web- and mobile application, helps
users manage their garden, so they can grow their
own vegetables. It guides them through a whole
gardening season with daily advice, from preparing
the soil and planning where and what to plant (i.e.
garden planning) to taking care of the plants
themselves. With its seed exchange feature, users are
encouraged to connect with other fellow gardeners, to
exchange not only seeds or seedlings, but experience
too, and it aims facilitate social interaction.
Lifely Agrumino is a gardening device comprising
a wireless sensor monitoring temperature, light water
reservoir and soil humidity. The device is to be
installed in the user’s garden, and uses a mobile
application to manage it. Apart from providing “raw
data”, it also allows users to set the type of the plant
it is attached to. This helps users in interpreting the
measured values (e.g. “the plant needs more sunlight,
and much less water”, etc.).
The IntegrAAL Social Engine (ISE), working in
the background, is aimed to build a user profile that
can monitor user behavioural patterns and detect
unusual changes, to trigger an alert or other action
when non-conformant trends or events are detected.
MARIA is a region-specific multi-audio device for
voice recognition. It allows voice interaction for
sensors and services used by users in their own house.
Additional information about the components
(with screenshots) can be found in Appendix A0.
The idea behind the integration process is that a
single application could be created to combine and
exploit the various features of the standalone
components. To allow users to do everyday tasks such
as designing their garden based on their food
preferences (by extracting the information from their
dietary logs). Or vice versa, to plan their next meal
based on what can be harvested from their garden. To
learn or share gardening tips with old or new friends,
exchange seeds, request help with chores, etc. All in
order to promote and support achieving an active and
healthy lifestyle.
4 CO-CREATION SESSIONS
User-oriented co-creation sessions took place in
Portugal, Italy, Belgium and Slovenia, each with five
participants each. The mean age for the 20
participants (11 female, 9 male) was 67.35 years with
standard deviation 5.285. Scenarios (topics to be
asked and covered) were divided into three sessions,
resulting in a total of 60 sittings. The inclusion criteria
were being aged 60 or over, being able to give
informed consent and having an interest in gardening
activities. I.e. the exclusion criteria were being unable
to give consent and/or having any kind of
impairments that would interfere with executing the
sessions. Ethical approvals needed to execute these
sessions were managed and acquired locally in each
participating country, as necessary.
The co-creation sessions complied with public
health measures related to control of Covid-19 and
took place between the end of June and the middle of
July 2020. The originally planned multiple group
sessions were replaced with one-on-one sittings or
remote sessions, where all necessary precautions
were adhered to (e.g. social distancing, face
coverings, hand washing or sanitizing).
All sessions followed the same structure, where
first the project goals and the main components were
introduced and users were allowed to ask any
questions. This was followed by a pre-session
questionnaire, where more general topics were
discussed (usually regarding the habits of the
participants). In the following task completion part
users were asked to test prototypes and mock-ups
available on mobile devices (smartphone, tablet) or in
some cases, on computers (online sessions). The
mock-ups were used to represent the user interfaces,
functionality and possible features that might be
present in the solution. While users were executing
the tasks, investigators present monitored their
progress. They assessed user results on a 5+1 point
scale (1 – user tried to complete but with no result at
all, 5 – perfect solution, 0 – the user did not even try
due to reluctance, technical or any other problems)
and free text. Finally, a post-session questionnaire
was completed where participants were asked to
describe and rate their experience (with regard to both
conceptual and accessibility aspects). In general,
during the pre-session phase open-ended and
dichotomous questions were asked (e.g. “What is the
main reason you garden?”, “Do you use any social
network application like Facebook, Twitter,
Instagram, etc.?”). In the post-session rating
procedure, mostly 5-point Likert scale questions were
used (1 being the most negative, 5 the most positive
Co-creating Digital Services to Promote Active Lifestyle among Older Adults: The Turntable Project
215

response). The questionnaires used can be found in
Appendices A1, A2 and A3, the tasks (user manuals
on what to do) in B1, B2 and B3, respectively.
During the first session, questions related to
gardening habits and information technology
proficiency were asked prior to task completion. The
tasks consisted of testing the standalone OPEN,
Tomappo and Lifely components, in the development
status they were in at that time (e.g. logging a meal in
the nutrition app, planning a garden, setting up a
sensor for a plant). After completing the tasks, users
were asked to rate their experience with each
standalone. They were also asked to express any ideas
about possible features of ISE and MARIA (e.g.
“Would you like to have a function that alerts your
friends if something was unusual in your activity?”,
“Do you find voice more useful than buttons to
manage Turntable?”).
The second session explored social interactions
and activity. Users were asked about their habits
related to contacting family and friends, such as
frequency (e.g. once a week) and means of making
contact (e.g. via mobile, landline or online
calls/messages). During the testing phase, a mock-up
representing the so-called Dashboard component was
used. This component will be used for social
interaction and managing other application users (e.g.
adding friends, messaging others), and editing
personal settings (e.g. what personal information is
visible to whom, which components the users allow
to access their data). Similarly to the first session,
users were then asked to rate their experience with the
features tested.
The third session focused on future Integrated
features of the platform and its possibilities. Users
were asked how they imagined using such a system,
what information should be shared amongst the
components, and how they should work together.
During the testing phase, possible workflows were
tested and rated by the users (e.g. importing sensor
data into the garden planner, having OPEN plan a
meal based on the status and content of the garden
managed in Tomappo, etc.).
Data gathered during the sessions were
anonymized locally before being forwarded to the
partner doing the data analysis, to maintain the
protection of sensitive personal data.
5 DATA ANALYSIS
5.1 Data Preparation and Conversion
The first step in processing the data provided was
quality assessment. As for any data collection
process, some inaccurate, incorrect and missing items
were found. Reasons behind these were human error
(interviewer mistakes), technical and/or coding
anomalies (e.g. the number of assists needed for a
user to complete the task is set to zero while the text
report clearly states that two interventions were
needed). Where possible, such mistakes were
corrected, and missing values were replaced when
related answers could be used as a reference.
As another basic step for data analysis, to obtain
meaningful results, the key numerical and textual
Table 1: The nominal variables defined for user-level statistics.
Variable name Multi
p
licit
y
No. of classes Note
Age For each use
r
2 Younger, olde
r
Gende
r
For each use
r
2 Male, Female
Countr
y
For each use
r
4 Countr
y
no. 1, 2,3 and 4
Completion
time
For each user 3
Avg. time needed to complete a session: low, middle,
hi
g
h.
Task scores For each user in each tas
k
5 Score
g
iven b
y
the mana
g
er: 1, 2, 3, 4, or 5.
Component
scores
For each user, avg. for
each a
pp
5
Component-wise average of task scores: 1, 2, 3, 4, or
5.
User score For each use
r
5 Use
r
-wise avera
g
e of task scores: 1, 2, 3, 4, or 5.
Task assists* For each user in each task 4
Number of occasions when assistance was requested
by
the user: 0, 1, 2 or 3.
Table 2: The global values of the satisfaction indices related to tested components.
Com
p
onent
Dashboard Integrated features Overall
O
p
en Toma
pp
o Lifel
y
ISE Maria
Average 3,2 4,13 4,08 2,6 3,47 4,15 3,83 3,58
Standard deviation 0,73 0,51 0,63 1,44 0,97 0,51 0,48 0,48
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variables were transformed (categorized) into
nominal variables wherever possible, based on a
priori classes or actual data ranges and distributions.
User- and task-level descriptors and satisfaction
indices were also introduced. Free text answers were
processed one-by-one and conclusions were drawn
based on majority opinions.
A total of eight variables were defined as user-
level descriptors (shown in Table 1). These were
gender, age, scoring parameters and average
completion time. For the age, two categories were
defined, the first including those above the average
age (68 years) and the second all other users. Scoring
parameters were divided into three groups: the task
scores given by investigators (rating user’s success in
completing a given task); the component scores
(component-wise average of task scores); and the user
scores (user-wise average of task scores). As an
additional variable, “task assists” was added, i.e. the
number of occasions when assistance was requested
by the user for given a task (values were derived
manually using text logs of the tasks).
The average task completion time for a user,
calculated from the time needed for a user to complete
all sessions, shows how much time the user needed to
complete one session. Based on these average values,
three classes were defined: LOW (0-17 minutes),
MIDDLE (18-26 minutes) and HIGH (more than 26
minutes).
For task-level descriptive statistics, a total of nine
variables were defined. These are the minimum,
maximum and average values for completion time,
number of assists needed, and scores given for each
task.
Satisfaction indices were computed based on
specific post-session answers to provide insights into
the overall impressions of users about the features
introduced. Indices range from 1 (did not like at all)
to 5 (really liked). A total of 8 assessment
categories/indices have been defined: 5 indices for the
five main components, one index for the Dashboard
mock-up, one for the Integrated features mock-up,
and one as an Overall rating index (i.e. the weighted
average of the other 7 indices). These indices were
calculated for each user, and their average values,
which are shown in Table 2. The questions they were
based on and the user-wise indices and can be found
in Appendices C1 and C2.
5.2 Results
Attribute rankings were generated based on predictor
(explanatory) nominal variables age, gender, country,
completion time and component score. Class labels
were the seven satisfaction indices used (without
Overall). The source table used for this analysis can
be found in Appendix C2.
The ranked attributes (shown in Table 3) specify
the information content of predictor variables with
respect to the selected class variable, in the order of
importance. An attribute with higher value means that
it has more influence over how the given item is
perceived than others.
For example, Country: 0.6250 as the highest value
in the OPEN satisfaction list means that the country
attribute of users (i.e. their nationality / where they
live) had most influence on user satisfaction with
regard to OPEN, and it had about twice the influence
as the Score attribute with the weight (information
content) 0.28.
Based on task-level statistics, session I proved to
be the most demanding in terms of completion time
and number of assists. It was also shown that, except
for OPEN, components used were considered
satisfactory regarding usability. The exact task-wise
values computed are shown in Appendix C3. All
categorized answers for the questions can be found in
Appendix C4.
Based on the free text answers given, the
following conclusions were formed:
1. Overall acceptance of Turntable was highly
positive. Most users would be glad to use the solution
once available (this is also shown by the high average
scores of the post-session answers).
2. With only a few exceptions, users were able to
master the mobile technology presented in the form
of working prototypes and mock-up applications.
3. Most users would avoid using individual
components, as they preferred a single integrated
solution.
4. A significant number of the users did not use
social media, and would prefer not to create such.
This means that the Dashboard app’s social
functionality must be implemented to provide related
features.
5. Many users missed a health profile and related
functions, even if Turntable is primarily aimed at
healthy users (as it offers no condition specific
recommendations or features).
6. Users had more interest in Tomappo and
Lifely. OPEN should be coupled more tightly to those.
7. Users stated that the Dashboard app should be
integrated in the other component apps (if possible).
8. ISE must be better positioned and explained,
as users found behaviour assessment and profiling
intrusive and unwarranted.
9. User proposals for additional functionalities
should be considered carefully during fine-tuning.
Co-creating Digital Services to Promote Active Lifestyle among Older Adults: The Turntable Project
217

10. Regarding usability, the user interface of
OPEN should be redesigned, and some minor
changes might prove beneficial for other components
too. Almost all users preferred using checkboxes to
toggle switches as they find the latter perplexing.
While text and button sizes were adequate, means for
personalizing them should be provided. Tooltips or
other support features should also be available to
support those with lower proficiencies.
6 DISCUSSION
In accordance with the initial concepts of the Turntable
project, it was found that users consider the gardening
oriented approach quite interesting, and use of
information technology solutions to be accessible. This
confirms that Turntable has the potential to be an
effective way for assisting aging people in (re)adopting
and maintaining healthy habits.
The number of 20 participating users (five from
each country) can be considered to be a low sample
count, and is not enough to offer statistically
significant conclusions nor statements. In practice,
however, it can serve as an adequate starting point,
and observations made only on the trend level still
provide useful information (Nielsen, 2000).
Satisfaction indices calculated verified that users
were positive about most of the components tested.
Tomappo, Lifely, the Dashboard and the Integrated
features mock-ups received the best remarks and
were liked the most. Users showed less interest in
OPEN, but this might be related to user interface
reasons (this is detailed later in this paragraph) rather
than its concept. Low satisfaction indices for ISE
comply with remarks made in free text answers, i.e.
most users found its features and functionality to be
too intrusive. It must be noted, however, that in
Portugal, where ISE was developed, users gave highly
positive remarks, which might be related to its
presentation or social factors. In general, however,
positioning and introduction of this component must
be better matched with users’ needs. Providing better
transparency about how it works and what are its
purposes is vital. Doing this correctly is important as
the profiling aims solely to aid users, without any
purpose for gaining financial profit (e.g. by targeted
marketing). Regarding MARIA, some discrepancies
appeared between the indices calculated and other
answers given. Most users stated that they preferred
voice control over touch screens. However, when
asked specifically about using the main features of the
components by voice, and how useful that is, they
gave low(er) ratings. Moreover, when asked to give
hints about what kind of questions they would ask the
voice assistant, no meaningful answers were offered.
This might indicate that these questions were not
formulated correctly, or that the functionality of the
component was not explained adequately.
The country attribute was found to be the most
important in how users perceived components and
which ones they preferred. While this could be
interpreted as a country- or culture-specific
difference, alternatively, results might be affected by
translation and/ or subtle differences in how sessions
were run. Also, some missing or inaccurate answers
could not be substituted, reducing the accuracy of
analysis in some cases. Nevertheless, if the country
attribute is disregarded, completion time has the most
notable effect on user satisfaction. This means that
those needing more time to complete tasks tend to like
them less – which confirms the generally accepted
perception that users do not like gruelling chores.
As anticipated, usability and user experience had
an immense impact on how users perceived
applications. The best example for this is that OPEN
received the most criticism and was the least desirable
service with a graphical user interface (GUI). The
reason behind is that only this component had a GUI
not following widespread and generally accepted
design principles such as the ones given in Flat
Design (2.0) or Material Design. Unsurprisingly,
even self-declared low proficiency users could
complete tasks easily when components with
interfaces adhering these design principles were used.
Thus, for the solution to be effective, providing good
user experience is crucial.
Table 3: Satisfaction index-wise ranked attributes values.
Ranked attribute
Component
Dashboard Integrated features Overall
OPEN Toma
pp
o Lifel
y
ISE MARIA
Age 0.1050 0.2052 0.2350 0.3170 0.1684 0.1972 0.0680 0.2420
Gende
r
0.2310 0.0529 0.2770 0.1500 0.1041 0.2278 0.2057 0.2090
Countr
y
0.6250 0.3697 0.5910 1.6250 1.0735 0.4596 0.3079 0.6110
Completion time 0.5190 0.2560 0.1720 0.7250 0.3498 0.0591 0.1565 0.4170
Score 0.3810 0.2456 0.2800 0.3530 0.1395 0.1972 0.2461 0.4070
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One interesting observation regarding GUIs was
that the majority of the testers (17 out of 20) had
problems understanding and using toggle switches,
preferring checkboxes instead. This is surprising as
most users reported being familiar with apps that use
toggle switches, and as more and more software use
these elements in general. One possible explanation
is that these elements appear mostly in the settings
part of applications (but there they are used
extensively) – features that most users seem to ignore.
Accepting this as it is, however, is not appropriate
from neither a legal nor an ethical perspective,
especially when personal data are involved. This
means that all application developer should take this
into consideration when user interfaces are created, to
develop them to be accessible in fact.
7 CONCLUSION AND FUTURE
WORK
Results from the co-creation sessions showed that
users found the concepts, purpose and available
(initial) versions of the Turntable Solution interesting
and potentially beneficial. The insights gained from
their ideas and expectations allow for further
improvements of existing features and serve as a
guide for the implementation of future functionalities.
An additional testing phase is being planned to
validate whether beneficial effects on quality of life
are measurable for users who engage with Turntable
for a longer time period. To obtain statistically
significant results, complete data of at least 50 users
from each country is anticipated (which means that
about twice as many, 100 participants should be
included, due to possible quitters). If this hypothesis
is confirmed, it would mean the solution is indeed
capable of supporting older adults in achieving
successful aging.
ACKNOWLEDGMENTS
The authors thank all the partners involved in the
project and the participants for their contribution to
the co-creation sessions and the Turntable Solution.
Project no. 2019-2.1.2-NEMZ-2019-00003 has
been implemented with the support provided from the
National Research, Development and Innovation
Fund of Hungary, financed under the AAL-2018-5-
163-CP funding scheme.
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APPENDIX
Additional material, due to page limits, is available at
http://rebrand.ly/submisAppndx_ACT4AWE2021.
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