LIFANA – User-centered design of a personalized meal recommender app for the elderly
Authors: Stahl Christoph , Ferrini Krizia , Bohn Torsten 
Published: January 2024

As the global population continues to age, the healthcare and technology sectors have witnessed an increased interest in understanding and addressing the unique needs of the elderly population. The health challenges faced by the elderly are multifaceted and often interconnected. Age-related cognitive decline can impair memory and decision-making abilities, while physical frailty, with reduced muscle strength and bone density, raises the risk of falls and fractures, affecting their quality of life. Comprehensive healthcare strategies that focus on prevention, early intervention are crucial to addressing these challenges.The general purpose of the LIFANA nutrition solution was to support healthy nutrition through all phases of aging in elderly people, from active seniors to elderly users and patients in need of daily care. The LIFANA mHealth application provided personalized meal plans that helped users to prevent undernutrition or overweight and followed WHO recommendations regarding caloric intake based on height, weight, gender and age as well as measured physical activity. The weekly meal plans maintained a balance between e.g fish and meat and plant-based dishes, ingredient variety, and macronutrients, and considered individual food restrictions. The LIFANA solution distinguishes itself from conventional food logging applications by providing users with seamless access to personalized meal plans that account for factors such as food restrictions, ingredient variety, macronutrient balance, and dietary preferences. For active users (60+) the solution integrated physical activity level measurement to balance caloric intake using the GoLive wearable clip provided by the Dutch project partner Gociety Solutions. Aimed towards users with limited mobility, the LIFANA prototype also integrated a digital shopping list with grocery home-delivery services during the field trials in the city of Porto. This service was provided by our Portuguese retail business partner MC Sonae to streamline the whole process of planning meals and acquiring food products.The target group for LIFANA differs from the general population in many aspects, i.e., cognitive and physical abilities, experience with smartphones, and eating behaviours. There are also considerable differences in food culture within Europe. For these reasons, we implemented a User-Centered Design (UCD) process with two iterative cycles of three phases: i) understanding the needs of the target group, ii) conceptualizing: specifying use cases and details of the technology, and iii) testing the system for usability and the assumed benefits. To facilitate understanding of the user’s needs, 37 stakeholders (seniors aged 65+, health professionals, and informal caregivers) participated in focus groups and co-creation workshops in The Netherlands (NL), Portugal (PT), and Switzerland (CH). The insights gathered from these sessions informed the creation of 7 personas and related scenarios, offering our developers a better understanding of the target users and their needs, considering factors such as age, gender, education, disabilities, and food preferences. Further, we added examples of typical meals for the age group in NL and PT. In the conceptualization phase, the functional requirements for the LIFANA solution were defined, considering the specific interests of all consortium partners, and a first prototype was implemented based on the personas defined in the first phase. The testing phase started with usability evaluation studies to validate that seniors can solve typical tasks. After successful request of ethical approval from the responsible national authorities, the LIFANA solution was then tested in a first round of short field trials in PT and NL. The feedback from the trials was used in a second iteration of the process to refine the requirements and develop a second prototype, which was then tested again in larger, long-term field trials in PT (53 participants, 14 months duration) and NL (107 participants, 3 months). The trials assessed various aspects including user friendliness and -acceptance, as well as changes of health-related aspects, determining its effectiveness regarding the improvement of markers related to health outcomes, and well-being, as well as potential effects related to budgeting. The results show a neutral effect regarding the participants’ anthropometric measures and blood pressure, while their motivation over time somewhat decreased in Portugal, though more pronounced in the Netherlands. This paper introduces the relevance of dietary applications for the healthcare system and the main objectives of the project LIFANA and its consortium. It provides insights into the results of the focus groups and shows two examples of the personas that were developed from them. Further, the results of the field trials are briefly presented. The paper closes with a discussion of the experienced benefits and challenges of the UCD process.