Table 1.

Features and function of the KeepWell application

Feature	Description and function
Standalone and accessible	KeepWell is not integrated so it can be accessed and used by older adults regardless of where they live and used at any time on computer or table devices.
Multidisease focus	KeepWell can generate, evidence-based lifestyle advice for any combination of the top 11 high-burden chronic conditions (ie, highly prevalent and associated with significant morbidity and mortality) commonly affecting older adults.
Wellness vision	A feature of KeepWell to help participants to think about a personal reason for why they want to keep well, which may help to motivate them in their everyday life and activities. It involves asking participants to fill in the following statement: ‘I want to keep well so that I can:…’ and to select images from a series of wellness categories that are related to wellness (physical health, emotional wellness, creative and intellectual pursuits, hobbies and volunteering, friends and family, and spiritual wellness).
Avatar health coach	An animated avatar health coach with optional voiceover that guides users through the KeepWell application, particularly through the initial sections that require completing tasks (ie, wellness vision, HRQ and a health prioritisation and goal setting exercise).
Health Risk Questionnaire (HRQ)	The HRQ covers three risk dimensions: health (demographics, chronic diseases and risks), lifestyle (physical activity, diet, smoking, alcohol, caffeine, bladder health), and social and emotional well-being (social isolation, loneliness). It also includes validated questionnaires to assess self-efficacy,47 48 quality of life,50 physical activity,51 nutritional health,52 social connectedness53 and eHealth literacy.54
HRQ results output 1	Summary of the HRQ results: after completing the HRQ, the KeepWell user will receive a table outlining their responses to all questions across the three health dimensions (health background; lifestyle; social and emotional well-being) of the HRQ.
HRQ results output 2	What HRQ results mean and why they are important: the second output that KeepWell users receive is a table with more detailed information about the user’s HRQ results. For each health condition or risk factor, there is an explanation of what it means, and why it is important for the tool user to know about it.
Action planning: selection of health priorities	After viewing their HRQ results, the next part of the journey for KeepWell users is to create an action plan that is customised just for them. Based on their responses to the HRQ, the health coach avatar walks KeepWell users through an exercise to select their health priorities. Depending on the results of the HRQ, the person may see the picture of one, two, three or all six of the lifestyle areas that KeepWell addresses (alcohol intake, caffeine intake, diet, physical activity, smoking and bladder health). KeepWell users are prompted to select a maximum of two lifestyle areas to work on at any given time, and to think about those that they consider important and feel ready to tackle right now. It can be overwhelming for anyone to attempt to work on all lifestyle areas at once. The complexity of multiple lifestyle advice can hinder self-management in older adults with multimorbidity. The avatar health coach advises that it’s a good idea to start small by selecting only one or two areas, which will make it easier for them to manage and therefore a better chance for success in the long term. Furthermore, tool users can always come back later to select other lifestyle areas to work on once they have a handle on the first two that they selected.
Action planning: setting goals for each health priority	Once KeepWell users select their lifestyle priority areas, the avatar health coach walks them through a goal setting exercise for each. For example, if the first lifestyle area selected is diet, the user will receive customised diet recommendations organised according to different food types such as vegetables, fruit, whole grains. For each food type, there is a description of the serving size for that food, and the recommended number of servings per day for that food. Next, the tool user can set their food goals for up to three food types using dropdown menus, and for each food type, they can select the number of servings for that food. This exercise works in a similar way for the other five lifestyle areas.
Action plan	Once KeepWell users complete their goal setting exercise, they will receive an evidence-based Action plan with lifestyle advice customised to their identified health risks (generated from the HRQ) as well as the health priorities and goals they had set. The Action plan includes everything they have worked on within KeepWell up to that point: their wellness vision, customised plan for the two lifestyle areas (which shows their recommendations as well as the goals they set for each), tips as well as resources for achieving their goals (eg, if they selected the lifestyle area for diet, they will receive a shopping list). Finally, users are given suggestions about how to put their plan into action. These include: (i) printing their action plan for themselves, family member or their healthcare professional; and (ii) to track their activities using the KeepWell tracking tool.
Interactive lifestyle tracking tool	KeepWell has an interactive lifestyle tracker, which allows participants to track up to six lifestyle areas (diet, physical activity, alcohol, caffeine, smoking and bladder health) that have been identified as their health priority area and for which they can set a goal for. Tracking is a great way to stay motivated, and it has been proven to help people achieve goals. Once a participant sets a goal for a lifestyle area, they can track their activities daily or weekly. Tracking is set up similarly for each types of lifestyle area. For example, for caffeine, alcohol and smoking, tracking involves selecting the amount that was consumed using dropdown menus. For bladder health, it’s to track the number of Kegel exercises they had performed. For physical activity, users can select from among a wide range of pictures to select the type of activity (including whether this was a light, moderate or vigorous activity) and then the number of minutes they spent doing each activity using dropdown menus. For diet, people can track what they ate that day by clicking on the number of servings for each of the foods they set a goal for using a dropdown menu. To make it more fun, each food type that is tracked flies onto a plate so that users can see everything they ate that particular day. There is also a tracker for weight, but this is an optional feature in KeepWell. The idea is that tracking weight may help users see how their body is changing as a result of their new lifestyle habits.
Tracking progress viewing tool	The tracking progress viewing tool can be used by KeepWell users to view their tracking history for each of their priority lifestyle areas and to see their progress over time. When users open up the progress viewing tool, they will see their tracking history for a particular week. Users can toggle between each of their two lifestyle areas to see their tracking history. For example, if diet was one of the lifestyle areas they tracked, the user will see a green circle for tracked days and an open-circle for days that they did not track. The idea is that users get rewarded for tracking rather than goal attainment which helps maintain motivation and minimise disappointment. The progress viewing tool is set up similarly for the other five lifestyle areas.
Gamification rewards	Once participants have tracked their lifestyle activities for at least two consecutive days, they receive congratulatory messages and trophies. The more participants track, the higher the rewards and trophies they receive.
My journal	KeepWell allows participants to create their own, private journal to record anything they like (eg, thoughts, reflections about their wellness journey, to help organise and record their activities and events or anything they like). There is also an option for users to select a category for their journal entry, to view the history of all their previous entries, and to search by topic, category or by the text within their entries. The journal feature can be accessed from the home page or from any page within KeepWell.
Menu	The menu star is a great resource for KeepWell users to access different features and functions of KeepWell. It is accessible on any KeepWell page, and allows users to view and modify their wellness vision, to turn the audio on or off, to change to their preferred measurement units (metric or imperial), to update their email, to access instructional videos, to provide feedback about their KeepWell experience, ask for help, and to log out.
Resources	Extensive resources library, which has links to additional high-quality health and lifestyle information across topics that may be of interest to older adults (ie, social, mental and emotional health, sexual health, physical health, and disease-specific information). There is also a section that includes inspiring videos of other older adults who are keeping well.
Instructional videos	The menu includes five instructional videos designed to provide information and instructions for completing tasks and using the various features of KeepWell. The videos are available through the Menu star and include an: introductory video (an overview of all the features and functions of KeepWell), how to use the menu, how to use the journal, how to create an action plan, and how to track lifestyle activities and to view progress.
Home page	The KeepWell home page provides access to the many tools and resources to help KeepWell users put their plan into action. It has six tabs corresponding with all the activities they can perform at any time: (i) to track their lifestyle activities in the areas they have selected as priority; (ii) to view their tracking progress; (iii) to create journal entries or view their journal history; (iv) to view or update their lifestyle priorities and/or goals through their existing action plan; (v) to view their HRQ results and (vi) access the resources page, which provides other helpful health information that may be of interest to older adults including inspiring videos of other older adults keeping well.