This thesis investigates how older adults engage with health information across paper and digital formats, and how hybrid solutions such as augmented paper can support inclusive communication. In the context of the growing reliance on digital health dissemination, the research responds to concerns about accessibility, usability, and trust among ageing populations. The overarching aim was to optimise older adults’ engagement with digital health information through a people-centred design approach, guided by three research questions: (1) How are paper- and screen-based media currently used in health promotion for an ageing population? (2) What are the problems and opportunities for improving health information in these formats? (3) What is the role and user experience of augmented paper in this context? 

The thesis follows a PhD by publication format, comprising four interlinked studies. Study 1 was a scoping review that mapped how health promotion interventions use paper and digital media, identifying ten design-related factors that act as barriers or facilitators for older adults. Study 2 explored the practices of older adults and local health stakeholders in Surrey, showing the coexistence of paper, digital, and interpersonal channels, and highlighting tensions between institutional cost-efficiency and user accessibility. Study 3 involved participatory co-design workshops where older adults proposed multimodal, customisable solutions and reframed assumptions about paper-digital integration. Study 4 conducted usability testing of augmented paper prototypes, demonstrating older adults’ preference for digital-first engagement anchored by printable, shareable outputs that provide reliable pathways back to digital content. 

Findings across these studies clarify hybrid media as reciprocal paper-digital systems shaped by users’ everyday practices, rather than as transitional steps from paper to digital. Augmented paper is shown to function as an inclusive mechanism for supporting movement between formats, enabling access to core information while allowing selective engagement with digital content according to users’ needs and confidence. The thesis contributes conceptually by refining understandings of hybrid media and participatory design, and practically by informing inclusive communication and publishing strategies that are relevant not only to health information, but also to other contexts where accessibility, trust, and user choice are critical.