Abstract
The global shift toward digital health communication presents both opportunities and challenges for older adults, whose populations is expanding rapidly. This study explored how older adults and health content producers engage with health information across paper and digital formats, and assessed the potential of hybrid approaches such as augmented paper. Two qualitative studies were conducted in Surrey, UK: focus groups with older adults (n = 9) and interviews with public health professionals (n = 6). Data were analysed through content and thematic analysis to identify user requirements. Findings show that older adults continue to value printed materials for familiarity and reliability, but turn to digital formats for timeliness and convenience. Trust in online content, ease of use, and device compatibility emerged as central concerns shaping engagement. Content producers echoed these challenges , highlighting cost constraints and the need for accessible, multi-format materials. Both stakeholder groups favoured app-free connections between print and digital content, with QR codes preferred for their simplicity, familiarity, and avoidance of app installation. Participants also emphasised the importance of multimodal presentation (e.g., text, video, audio) and options to self-print key materials. While based on a small, UK-specific sample, the study highlights design implications for inclusive health communication. Hybrid solutions that combine print with carefully curated digital resources can reduce barriers linked to trust and usability, and extend access for older adults with varied levels of digital confidence. These insights provide action-able guidance for public health organisations and policymakers seeking to balance cost-effectiveness with accessibility. Broader testing in more diverse populations is recommended to refine these strategies and ensure equitable health communication worldwide. These findings underline the importance of designing hybrid health PLOS Digital Health | https://doi.org/10.1371/journal.pdig.0001090 November 17, 2025 2 / 25 communication strategies that are not only user-friendly but also equitable, supporting the goals of the WHO Decade of Healthy Ageing by promoting inclusive access to reliable health information for older adults worldwide. Author summary As more health information moves online, older adults, who are one of the fastest-growing age groups globally, face new challenges in accessing the content they need. While printed materials are familiar and easy to use, digital formats offer benefits like up-to-date information and wider access. In this study, we explored how older adults consume and engage with health information, and how professionals working in the public health sector create and deliver it. We worked with two groups: older adults, who are the main users of this information, and health content producers responsible for its design and dissemination. Both groups interacted with a new format called augmented paper, which combines physical printed materials with digital content accessed through smartphones. Our findings show that older adults appreciate the reliability of printed materials but often rely on digital sources for convenience and timely updates. However, they face barriers such as lack of trust in online content, difficulties navigating apps, and discomfort with technology. Both older adults and professionals preferred simple, app-free solutions such as QR codes to connect paper to digital resources. They also highlighted the importance of using clear and accessible formats, like videos, images, and audio, which can cater to different learning styles. This study highlights the need for hybrid communication strategies that respect older adults' preferences while taking advantage of digital tools. Augmented paper, when designed well, offers a promising way to improve health information delivery by combining the strengths of both formats. These insights can help make health communication more inclusive and effective for older populations with varying levels of digital confidence.