Table 2 Summary of feedback and amendments resulting from think aloud interviews

Introductory content

Worry about continuing before being reassured that it would be safe to try new activities with various health conditions/ other concerns

“I would have it earlier, yeah, because the question in itself is too sort of set, you know, it, it’s about increasing activity gradually rather than overdoing it. And I think something about that needs to go before. (P0136)

Although each subsection contained a section addressing concerns, it was deemed important to bring shared concerns forward to the introductory material so people felt happy to proceed with the intervention content

Some pages (and this applied throughout) perceived to be a bit cluttered/ busy with too much text which some found off-putting

“I immediately look at this page and find it untidy and as a, not a struggle, but as a barrier there to reading it clearly and understanding it. I’m struggling to find what to click to go to next.” (P0245)

Focusing on identified problematic pages, we edited text to a minimum. Wherever possible text was bullet-pointed and only key messages retained. If important to keep all text on a page, this was split over multiple pages where appropriate.

Getting Active

Uncertainty about goal setting: some seemed unsure about exactly what they had set themselves goals to do even when goal setting process complete

“… it’s good to have goals, but I think the goals need to be specific. If you're asking people to achieve a goal that's very vague, I don't think they're enthusiastic and I think they give up and they probably give up the whole thing.” (P0111)

After revisiting the activity suggestions made in this section, it was considered that this uncertainty was likely to be arising from the fact that the activity suggestions and plans that people could select were a little too broad—these were amended to more specific options for people to choose from

Many mistaking coloured, bolded text (to emphasise key messages in text) for hyperlinks and expected links to additional content

“…anything else that's in blue, you think you can click on it”(P0102)

We removed the colouring of these parts of text, but retained the bolding for emphasis. The minimisation of text to key messages only also addressed this issue.

Strength and Balance

Concern that information provided about the principles of how strength and balance exercises worked (including information about specific movements such as shifting weight to one side) was potentially risky if attempted by those who were less mobile.

“…if you have somebody with poor balance, it’s just trying to ensure, how do you ensure that someone who shouldn’t really be standing on one leg doesn’t stand on one leg, despite what you’ve said about being safe.” (P0106)

The text in this section was reframed to describe the underlying principles of the exercises without reference to specific examples that may be dangerous if attempted by someone with poorer mobility/balance. Instead it now talks about how the suggested activities allow practice of movements to expand individuals ‘comfort zone’ in terms of movements they can make.

Disagreement with advice that if users are unsure about whether suggested activities are suitable for them, then to consult with their GP – users not comfortable with the idea of taking up GP time with these types of queries.

“It’s… I always find this information about checking with your doctor before you start interesting, because I very… well, I say that. I very seldom make plans to go and visit the doctor. And I certainly wouldn’t regarding this, I think.” (P0105)

Revised to reassure users that the activities recommended were nothing outside of routine movements made in day-to-day life and that they were likely the best judge of whether they could safely/comfortably do these Also encouraged to discuss with those who knew them well, and only seek advice from GP for serious concerns.

Breaks from Sitting

Some activity plans about how to implement recommendations deemed unrealistic or ‘silly’—e.g. purposely leaving objects upstairs that you know you will need downstairs to increase steps around the house

“Leave your bedtime book on the kitchen table. I don't get that one. How does that work? You're just gonna pick it up when you're downstairs and carry it to the bedroom and then bring it back down…” (P0101)

Such examples were removed or replaced. New suggestions focused on ways people could: add some movement in to times they might be completely sedentary (e.g. leg raises whilst watching TV); add more movement into standing or mostly sedentary times (e.g. marching on the spot whilst brushing teeth)

Some activities to identify common times/places for sitting, were not considered either: a) a suitable target for change (i.e. at doctors surgery), or b) an activity that they would actually do sitting down (e.g. brushing teeth)

“Yeah, I think if you stood up when you were waiting to see a doctor or nurse… I think you'd… people don't stand up, do they?”

(J0112)

These suggestions were removed

Brain Training

The wording of some True/False quiz questions was considered confusing, e.g. one stated that the purpose of brain training games was to keep improving your score. If/when people answered ‘True’, they were surprised when their answer wasn’t considered correct

“Yeah, well that’s, that automatically to me should be true but it’s, you explaining it, but it’s not clear. The point of brain training is for you to get better, any training is to get better, but it said it’s false.” (P0104)

To ensure participants remained engaged with these quiz questions and did not take away the wrong message, wording/ feedback was revisited and amended where necessary. In this example, the feedback was clarified to state that whilst a good aim to try and improve scores, the important factor is continuing to practice these games whether or not your score improves

Given different structure of the Brain Training section compared to other sections, a page preceding the Brain Training menu explained how to use menu page, but this created confusion

“It's a bit confusing, this one. I don't know quite why. This bit I think might be more beneficial on the next page?” (J0112)

This page was removed and the navigation around the Brain Training menu pages was revised to ensure that it was clear how users could access each element of the Brain Training module—most importantly the link to the Brain Training games.