Co-designing the Join4Joy approach to boost enjoyment and social inclusion for the increase of physical activity among older people in nursing homes and community settings: a qualitative study in Spain, Denmark, Germany, Italy and France

Abstract

The global ageing population faces significant health challenges linked to insufficient physical activity (PA). Although PA offers emotional, cognitive, and physical benefits, long-term participation among older adults remains low. Enhancing enjoyment may boost their motivation and sustain engagement, while improving inclusivity is essential to reach underserved groups. This study describes the process of co-designing strategies to enhance enjoyment and social inclusion in PA interventions for community-dwellers and nursing home residents, guided by the Octalysis gamification framework. Using a qualitative phenomenological approach, we conducted 13 focus groups and 3 online individual interviews, with 98 participants in total, including 51 older adults, 29 formal caregivers, 5 family members, 10 policymakers, and 3 students, from Spain, Denmark, France, Germany, and Italy. Analysis revealed barriers such as fatigue, fear of injury, and social isolation, as well as facilitators including enjoyment, adaptability, and community support. Participants emphasized tailoring interventions to individual abilities and cultural contexts, integrating social connection, and fostering supportive environments. Stakeholders proposed innovative strategies to improve accessibility and enjoyment of PA. The findings underscore the value of co-design in meeting the needs of older adults and fostering a sense of ownership and commitment to PA programmes. Group-based initiatives will be able to benefit from the Join4Joy approach, which promotes enjoyment, improves movement behaviour, and mitigates social isolation. Following the co-design process, practical strategies are presented to increase PA and reduce sedentary behaviour, offering a pathway to more impactful, inclusive, and sustainable interventions for older adults.