Implementation process of community-based lifestyle interventions supported by technology for elderly population: qualitative evaluation of six European regions case studies

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Introduction: Community-based interventions represent a strategic approach to integrating the salutogenic model, involving multi-sectoral stakeholders to improve the health of specific communities. In the context of the EU's ageing population, eHealth technologies provide valuable solutions by improving older individuals' health and well-being through better access to knowledge, strengthening environmental relationships, and supporting the sustainability of health systems. This manuscript explores a community-based health promotion intervention focused on eHealth apps tested across six European regions within the GATEKEEPER project. Method: An observational studies were conducted in the European regions of Basque Country (Spain), Aragon (Spain), Saxony (Germany), Puglia (Italy), Lodz (Poland), and Central Greece and Attica (Greece). Qualitative techniques were used to evaluate the implementation process of the community-based interventions, focused on the analysis of the facilitators, barriers, and contextual factors influencing delivery and end-users engagement to the technologies tested. Results: Several factors influenced the success of the interventions, including the customisation and adaptation of applications to users' specific needs, the provision of incentives to promote engagement, and the support from health and community professionals. Customising apps to be user-friendly and culturally relevant ensures accessibility for diverse populations, while adaptation addresses varying levels of health literacy and digital skills. Continuous support from professionals fosters trust, reduces barriers to adoption, and promotes sustained engagement. Discussion: This study provides insights into factors influencing the implementation process and adherence to digital health interventions. Understanding adherence, intention to use, and dropout rates is essential for identifying the factors contributing to the limited impact of digitally-enabled real-world interventions. The findings stress the importance of co-designing interventions, ensuring user involvement from the beginning, which improves the alignment of technology with users' needs and increases engagement.

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