Understanding the Prospective Acceptability of a Fall Prevention Exercise App Among Canadians Aged 50 Years and Older Living in the Community: Mixed Methods Study

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Abstract
Background: Falls are a major public health concern due to their impact on individuals and the health system. StandingTall (Ylva Health Pty Ltd) is a digital balance exercise app that has demonstrated strong adherence and fall-reduction effects in Australia. Before considering implementation in Canada, its acceptability must be assessed. Objective: This study aimed to explore the prospective acceptability of the StandingTall app among Canadian community-dwelling adults aged 50 years and older with varying levels of physical activity and technological skills. Methods: A concurrent mixed methods design was guided by the Theoretical Framework of Acceptability (TFA). After viewing a demonstration video, participants completed an online survey in which they rated the 7 TFA constructs using a 5-point Likert scale. Participants also reported demographic and health characteristics. A subsample completed interviews that were also based on TFA constructs. Convergence between data sources was assessed through overall patterns. Results: In total, 314 individuals completed the survey (mean age 61.8, SD 8.0 y; n=279, 88.9% female participants) and 22 completed interviews. The mean acceptability score was 5.8 (SD 1.3; out of 7). Participants viewed the StandingTall app positively, valuing its convenience, flexibility, clear design, and alignment with their health and aging goals. Both data sources indicated strong acceptability, shaped by high affective attitude and self-efficacy and tempered by burden and opportunity cost factors related to technology issues and existing lifestyle commitments. Participants also reported mixed beliefs about its effectiveness, with some skepticism about the mechanisms by which the app’s exercises improve balance and ultimately reduce the risk of falls. Conclusions: Although the sample was heterogeneous, StandingTall was viewed as generally acceptable, with some heterogeneity across participants and with challenges that could be addressed using implementation strategies cocreated with potential users.

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