Larissa Ferraz

The global number of people aged 65 and over is expected to more than double in the next three decades, and the World Health Organization has declared that "ageing well must be a global priority." (United Nations, 2020) In this context, health education can be a powerful tool to help people age well as it informs them of health risks and promotes healthy lifestyles. Access to and the understanding of health information can lead to better health and social care outcomes. Digital channels have increased the volume of health information available but can also alarm, confuse or overwhelm people. This study was conducted to examine how paper and screen-based media are used in current forms of health promotion, and to collect feedback on the usability and value of a new technology for combining paper and screen reading through augmented print. This involved the use of a new platform for ‘ Next Generation Paper’ (NGP) developed at the University of Surrey for linking digital content on a smartphone with printed hotlinks on a document (Frohlich et al 2019). This kind of Augmented Reality paper was demonstrated through an NGP ‘a-book Player’ app and an augmented booklet on healthy ageing containing hotlinks to video clips, animations, voiceovers and web links (Figure 1). A video demo of this booklet can be found here: https://vimeo.com/926936499?share=copy.

ObjectivesTo map the current use of paper-based and/or screen-based media for health education aimed at older people.DesignA scoping review was reported following the Preferred Reporting Items of Systematic Reviews and Meta-analyses for Scoping Reviews checklist.Data sourcesThe search was carried out in seven databases (Scopus, Web of Science, Embase, Medline, CINAHL, ACM Guide to Computing Literature, PsycINFO), with studies available from 2012 to the date of the search in 2022, in English, Portuguese, Italian or Spanish. In addition, Google Scholar was searched to check the grey literature. The terms used in the search strategy were older adults, health education, paper and screen-based media, preferences, intervention and other related terms.Eligibility criteriaStudies included were those that carried out health education interventions for older individuals using paper and/or screen-based media and that described barriers and/or facilitators to using these media.Data extraction and synthesisThe selection of studies was carried out by two reviewers. A data extraction form was developed with the aim of extracting and recording the main information from the studies. Data were analysed descriptively using Bardin’s content analysis.ResultsThe review included 21 studies that carried out health education interventions with different purposes, the main ones being promotion of physical activity, hypertension prevention and psychological health. All 21 interventions involved screen-based media on computers, tablets, smartphones and laptops, while only 4 involved paper-based media such as booklets, brochures, diaries, flyers and drawings. This appears to reflect a transition from paper to screen-based media for health education for the older population, in research if not in practice. However, analysis of facilitators and barriers to using both media revealed 10 design factors that could improve or reduce their use, and complementarity in their application to each media type. For example, screen-based media could have multimedia content, additional functionality and interactivity through good interaction design, but have low accessibility and require additional learning due to complex interface design. Conversely, paper-based media had static content and low functionality but high accessibility and availability and a low learning cost.ConclusionsWe recommend having improved screen-based media design, continued use of paper-based media and the possible combination of both media through the new augmented paper technology.Registration numberOpen Science Framework (DOI: 10.17605/OSF.IO/GKEAH).

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.

With technological advancement and the COVID-19 pandemic, paper-based media are giving way to screen-based media to promote healthy ageing. However, there is no review available covering paper and screen media use by older people, so the objective of this review is to map the current use of paper-based and/or screen-based media for health education aimed at older people. The literature will be searched in Scopus, Web of Science, Medline, Embase, Cinahl, The ACM Guide to Computing Literature and Psyinfo databases. Studies in English, Portuguese, Italian or Spanish published from 2012 to the date of the search will be examined. In addition, an additional strategy will be carried out, which will be a Google Scholar search, in which the first 300 studies according to Google's relevance algorithm will be verified. The terms used in the search strategy will be focused on older adults, health education, paper-based and screen-based media, preferences, intervention and other related terms. This review will include studies where the average age of the participants was 60 years or older and were users of health education strategies through paper-based or screen-based media. Two reviewers will carry out the selection of studies in five steps: identification of studies and removal of duplicates, pilot test, selection by reading titles and abstracts, full-text inclusion and search for additional sources. A third reviewer will resolve disagreements. To record information from the included studies, a data extraction form will be used. The quantitative data will be presented in a descriptive way and the qualitative data through Bardin's content analysis. Ethical approval is not applicable to the scoping review. The results will be disseminated through presentations at significant scientific events and published in journals in the area. Open science framework (DOI: DOI 10.17605/OSF.IO/GKEAH).