Overcoming development and deployment challenges in geriatric digital health: lessons from the AFFIRMO mobile app and dashboard

The AFFIRMO project implements the iABC model (Integrated care, Anticoagulation, Better lifestyle, and Comorbidity management) through a digital platform for older adults with multimorbidity. It comprises a mobile app for patients and a clinician-facing dashboard for remote monitoring across 6 European countries.

To disseminate the key insights gained throughout the co-design, development and rollout of the AFFIRMO platform, with an emphasis on technical fixes, interface refinements, and coordination strategies enabled by cross-border teamwork.

Development followed an agile framework with privacy and security embedded from the outset, drawing input from a multidisciplinary team including clinicians, engineers, and ethics advisors. The GDPR-compliant platform hosted on an secure cloud service supports multilingual access, adheres to international accessibility standards, integrates with electronic clinical report forms, and incorporates iterative feedback specifically designed for older users. To manage feature requests and translations from 6 countries a liaison was appointed to consolidate input. The app was distributed to leads for user acceptance testing, and they collected feedback from various users to guarantee alignment while maintaining localisation. During the trial regular feedback was sourced from patients and clinicians via study teams. Testing included automated end-to-end tests, end user validation and penetration testing.

The platform was launched in May 2024, with over 600 downloads by participants in the AFFIRMO trial. Content was modified for accessibility, relevance, and clarity; the app now supports 7(languages) User-facing improvements addressed app responsiveness to font and zoom settings, fixed auto-logout and weekly notification issues, enhanced editable entries for adherence logging, and added a blood sugar graph. Dashboard upgrades included searchable and filterable patient tables. In-app update notifications, enhanced admin user management, and an improved End-User License Agreement (EULA) interaction flow were among the other enhancements.

The AFFIRMO study demonstrates the viability of providing older populations in multiple European countries with a reliable, inclusive, and patient-friendly digital solution. Structured coordination, centralised requirement gathering, and continuous testingimproved the platform, resulting in a secure, localised, and scalable, offering transferable lessons for future multinational digital health initiatives for the care of older people.

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