Aging involves physical and life changes [1-4], where eHealth services have the potential to provide support and benefits [4-7]. The prevalence of many diseases increases with age [8,9], and multimorbidity is common among people aged ≥65 years [10,11]. Conversely, healthy behaviors can extend people’s lives [12-14].

eHealth can help people nurture their health and well-being, potentially extending their lives. eHealth can also make treatment more accessible, promote treatment continuity, enhance communication, help shared decision-making, and enable patient self-management [10]. Older adults seem to be generally positive toward eHealth in a health management context [15]. They can benefit from eHealth services, as they often have complex health issues and engage in many self-management tasks supporting their health and well-being [1,5,16].

However, older adults sometimes face challenges with eHealth services [5,16,17], including a lack of skills and interest [3,16,18]. Hirvonen et al [19] reported that some older adults find the content or functionalities of eHealth services irrelevant (eg, [20,21]). Sometimes, older adults might even feel that digital services are not “meant for them” (eg, [20,22]). Thus, older adults might have a risk of exclusion from digital services [16,18,23,24] and society [16,23].

Older adults have not always been involved in technological development, especially in mainstream technology [25-27]. At the same time, the older population is growing [28], and health care costs are rising [29]. Stephanidis et al [30] encourage understanding emerging new technology possibilities and context-based user needs when designing digital solutions for the health and well-being (hereafter, eHealth services or eHealth) of older adults and a better understanding of the role of technology in older adults’ lives [30]. Ideally, the technology should be harmonized with these adults’ lives [15].

European older adults regularly engage in work, household chores, exercise, cultural activities, and tourism [31]. On the basis of the literature, many older adults in Europe live in rural areas, where they have easy access to nature and can engage in refreshing activities [31]. On the other hand, older adults with urban lifestyles access a variety of services [31]. For example, in Finland and Sweden, rural areas are in the north and distant from health care services, and eHealth services offer a promising option for taking care of one’s health [32]. Physical activities might support older adults’ health situation during aging. In 2017, in total 43.2% of Europeans aged 50 to 64 years and 44.5% of those aged 65 to 74 years old spent >3 hours per week engaging in physical activity [31]. On the other hand, older adults’ daily routines differ. Older adults are a heterogeneous group of people, and aging is a process, not a static state [33]. Therefore, it is important to obtain qualitative insights into older adults’ activities. These could help inform the idea and role of eHealth services and harmonize it with older adults’ routines [15,30]. We know that older adults use eHealth services, for example, depending on their digital devices, capabilities, interests, or education [31,34]. Statistically, 100% of Europeans have, at least in theory, access to eHealth services or health information [35].

The best approach to eHealth service development means selecting the optimal approach case by case [36]. In eHealth, technology, tasks, individuals, and contexts are holistically combined, which should all be considered in developments [36-39]. eHealth services should genuinely support people pursuing healthier lifestyles and be accessible to all [10], although older adults may perceive the technology differently from other generations [1,40]. Humanity is needed alongside IT. Therefore, design decisions should also help ensure that as a part of eHealth services development, the human touch of personal care will not be removed [30,41].

Mapping user needs is important because without understanding needs, designing high-quality solutions is challenging [42]. User needs can be defined as the problems that prevent users from reaching their goals or possibilities to support them in reaching these goals [43]. User needs can be personal or more social in nature, and they can be related, for example, to available information or technology functions [44]. Poor understanding of users, user needs, and use contexts increases the risk of failure in eHealth service development [39]. On the other hand, user needs are not a stable phenomenon; they might change with age or the use of technology [45]. However, not much is known about what kind of user needs for eHealth services arise in older adults’ lives, which is unfortunate because understanding user needs is a great innovation source [46]. In addition, Hirvonen et al [19] recommend further investigation into older adults’ eHealth service use as a part of their daily lives.

We aimed to understand older adults’ everyday lives in terms of well-being and health and their needs for eHealth services. We investigated 2 life stages: working at an older age and life after retirement, possibly with a chronic disease. We were interested in the health and well-being practices of 2 age groups to understand older adults’ needs for eHealth services. Investigating these aspects allows developers and designers to better understand how eHealth services can meet older adults’ needs and support their healthy living.

Users’ needs change with life situations, including aging [47]. Therefore, if we want to harmonize eHealth services with older adults’ everyday use, as is recommended by Cabrita et al [15], and to support technology development for well-being and an active, healthy lifestyle, it is important to identify user needs at different stages of life and daily routines in different life situations. The research questions were as follows:

This empirical qualitative study consisted of cultural probes [53,63], which included 4 background information questionnaires (background questionnaires), sentence completion tasks [42,58,59], and a diary-based exercise [64-66], and remote interviews [52]. Data collection included 6 phases, which all played an important role (Figure 1). Data collection started with filling out a consent form. After that, background information was collected, and a short remote interview was conducted. Then, the participant had time to respond to the cultural probe package (ie, sentence completion tasks and diary-based exercise). Participation ended with a long remote interview and the return of the probes package to the researcher. Finally, the data were analyzed.

The research was conducted in Finland between the fall of 2020 and the spring of 2021 (ie, during the COVID-19 pandemic) as part of the DigiIN project (2019 to 2025).

Defining an older adult purely by age is somewhat complex [67]. Generally, they are people in late adulthood. In line with the study by Ware et al [5], this study focused on older age groups associated with a higher risk of chronic disease, with participants from 2 age groups (those aged between 55 and 74 years and employed and those aged >75 years and retired). Group 1 participants (ie, those who were still working) were relevant because aging includes preparing for retirement [68].

The participants were selected through purposive sampling (digital survey) and snowball sampling [69]. Group 1 participants (12/20, 60%) were recruited via a digital survey [70]. Group 2 participants (8/20, 40%) were recruited in 2 ways: via the digital survey and snowball sampling. To ensure a diverse and engaged sample for this long-term study, participants’ interest in digital services was assessed in advance. The groups were formed according to the life situation: group 1 participants were still working, and group 2 participants were retired. The age category of group 1 was between 55 and 74 years (later, 55-74 years). The age category of group 2 was between 75 and >90 years (later, >75 years). Participants in group 1 had different professions, such as yoga teacher, director, project manager, or entrepreneur. The participants were from different parts of Finland but did not fully cover the whole country.

After participants expressed potential interest in participating in the study, the researcher explained the study in a telephone call. This call lasted for 15 to 30 minutes, depending on the participant’s questions. If the participant was still interested, the researcher mailed or emailed the information letter that described this study in detail and a consent form to the participants for their signature.

The empirical study was conducted as part of the DigiIN project (2019 to 2025). The study protocol was reviewed and approved by the Ethical Review Board of Aalto University (95_03.04_2019_DigiIN). All participants provided their voluntary, informed, and written consent. Patients’ ability and willingness to participate in the study were confirmed through a phone conversation before they signed the consent form. During the call, the study process was explained, and it was emphasized that participation was voluntary, with the option to withdraw at any time. This was also mentioned in the written consent form.

The study comprised six phases (Figure 1):

The themes of the cultural probes were investigated in more detail in remote, semistructured interviews [52], which took 1.5 hours maximum to complete with group 1 participants and 1 hour maximum with group 2 participants. If an interview took longer, the participants were offered the opportunity to continue the interview the next day. The researcher made phone calls using either the Teams call function or a mobile phone, making it easier for participants to take part. Two researchers conducted the interviews, but only 1 conducted each interview for trust-building purposes. The interviews were audio recorded and documented with field notes.

The interviews comprised different perspectives regarding the participants’ everyday lives and activities concerning health and well-being. The interview structure (Multimedia Appendix 3) was created based on the themes of the cultural probes. The participants were asked to describe the contents of their cultural probes. The idea was to empower the participants and let them decide how much or in how much detail they were willing to express their thoughts on their well-being and everyday lives. In the interview design, the interview checklist by Tong et al [75] was followed.

The results are discussed in three parts: (1) participant information; (2) description of older adults’ everyday lives; and (3) user needs, which were expressed based on the findings from the sentence completion and remote, semistructured interview data.

The data comprised 19 cultural probe packages and 329 pages of transcripts of 20 interviews (in Verdana font, 11-point font size, single spaced). One participant did not return the cultural probe package.

The study included 20 participants (Table 2). The participants were divided into two groups: group 1, those who were still employed, and group 2, those who were retired. Both groups included active computer users with many different devices, but compared to group 1, group 2 included more participants who did not routinely use the internet and IT. However, the variation in device types was greater in group 2 compared to group 1. The results suggest that perhaps retired people use health and well-being services less frequently in general than those who are working.

All group 1 participants (12/12, 100%) and half (4/8, 50%) of the group 2 participants checked their health information and renewed their prescriptions via eHealth services. Internet users used it for banking and information searches, and 80% (16/20) of them also used it for health services.

Multimedia Appendix 5 presents the background questionnaire results. The eHEALS results (20/20, 100%) show the participants’ familiarity with using digitally offered health information, with differences between the participant groups. The results of the HLS-EU-Q16 (19/20, 95%) on health literacy indicate that the participants seemed to have at least basic health literacy skills. One participant did not send the questionnaire back to the researchers. The HCS results (20/20, 100%) on patients’ confidence in taking care of their own health show that the participants had at least a basic understanding of their health situation and how to operate in case of health challenges [63].

The analysis of the data from the diary-based task and the interviews resulted in 15 themes in the participants’ everyday activities. The themes were spending time at home, dining and cooking, routines, hobbies or exercising, sleep, mundane activities, work-related activities, medical treatment, cottage or nature, friends, pets, pampering and rest, communication with a relative, planning and controlling everyday life, and weather.

The most common activity was spending time at home, often watching television (102/622, 16.4%); spending time at home and dining and cooking (96/622, 15.4%) were the most popular regular activities of the participants. The importance of food for well-being was often mentioned in the data. Exercising was also popular (72/622, 11.6%), with walking and jogging being commonly practiced, including Nordic walking and climbing stairs. Walking could also be a social activity with a partner or a dedicated group. Sleep was mentioned in the data 51 out of 622 times (8.2%), as were mundane activities, such as going to the post office or having lunch or a coffee (51/622, 8.2%). The repetitive nature of routines, including spending time at home, the importance of food, and the variety of exercises, is reflected in the following quotes (the quotes are translated from Finnish):

Watching television was emphasized in both groups, and activities related to cleaning and housekeeping were popular. Overall, participants in both groups seemed to like routines. The everyday life activity themes are detailed in Multimedia Appendix 6.

Our results show that understanding the user’s life stage and the key interests at that stage is important, as found in other literature [47]. Owing to older adults’ changing health and life situations [1-3,10,11,47], an individual eHealth service should function as part of a wider service offering so that the service supports and adapts to changing life situations and health statuses. For example, in this study, it was recognized that both those who are still working and those who are retired use IT and eHealth services. IT use at work might support learning new skills and sometimes even updating them [70]. In addition, eHealth service flexibility is valued [4]. The need for eHealth services to adapt to the older adult’s current life and health situation is in line with the study by Reiners et al [81].

Earlier research recognized a large variation in activities that support older adults’ well-being, in line with our findings: exercising; cooking; and hobbies, such as language courses [82]. Even with poor health, older adults achieve well-being and positive effects from daily activities [82,83]. In addition to physical activities, daily activities, such as reading books or watching television, can also offer relaxation [81]. Owing to the differing routines and daily activities, the need for eHealth adaptation based on the current life situation, use contexts, and everyday life was recognized in this study, and we recommend that eHealth services work as a part of older adults’ daily living smoothly. Previous research supports our results behind this user need: older adults are a heterogeneous group whose activity possibilities vary regarding their living conditions or current health situation [31]. However, the importance of studying the use of eHealth service as part of everyday life has been recognized [19].

The devices with which the eHealth services are used should be considered when designing these services. Given the possible effect of the small sample size, it can be seen from the data that group 2 participants seemed to use eHealth services somewhat less than group 1 participants. One reason for that could be that older adults who are still employed might use eHealth services for work reasons, as well [70]. On the other hand, it can probably be expected that, nowadays, older adults who are retired have used at least some IT at work.

Understanding the safety of eHealth services use was important to older adults, as in earlier research [4,5,10,18]. In line with previous literature [18,70], they needed available support and training for eHealth service use. In particular, the older participants in this study also needed not to be forced to use the eHealth service. However, this varied considerably between participants, which supports earlier research results [18].

In line with an earlier study [15], one of the most important design functions is to ensure that the eHealth service conveys empathy to older adults. This can be offered via an empathic tone of voice in the services and by offering them through service channels that are especially suitable to each older adult’s current situation. The whole life span, including transitions to different life phases, such as retirement, should be considered in design decisions [2,47,70]. This can be done, for example, by offering relevant content related to health and well-being to different older adult groups and by making sure that the content is relevant to each end user’s unique life and health situation.

On the basis of our findings, both those still working and those who have already retired have suitable devices and sufficient technical skills, as also reported by Mielonen et al [28]. However, eHealth services were used only by half (4/8, 50%) of the older participant group. Our findings support the observations of Kruse et al [3] regarding common barriers to eHealth use among older adults: a lack of self-confidence, a fear of making irreversible mistakes, and content that does not meet their needs. Fear can be dispelled with a clearer service concept, implementation support, user support, and instructions, as well as reassurance, such as by highlighting safety both in the service content and in the presentation of the service. In addition to minimizing fear, strengthening the self-confidence of the end user of the service plays an important role. Another phenomenon that emerged from the data was that well-being, health, and illness seem to be subjective, personal experiences.

The need for eHealth services changes due to the user’s current health and well-being situation; eHealth services become unnecessary when health and well-being improve. Therefore, it should be possible for older adults to easily try out whether the eHealth service will benefit them. This can be done, for example, by offering trial versions of services, which other research [15,18,84] recommends. Being able to safely try out an eHealth service could help reduce fears, build self-confidence, and better identify the current need for the service. Another helpful option would be to group service functions into easier basic functions and possibly other more complex functions that are recommended to be familiarized with time, as is recognized in the literature [15,47]. However, based on the study findings, the end user’s age or life situation does not appear to be a decisive factor in determining the need for user interface content. That said, older adults who are retired may face slightly more challenges in using eHealth services compared to those who are still working.

As also found in other literature [18,70], individual eHealth service should function as part of a wider, multichannel service package so that it adapts to changing life situations and changes in health status. It should work as a channel for end users to receive empathy in challenging health situations. This could be done with effective but sensitive communication possibilities and with empathic content. Because eHealth services should support older adults’ health and well-being, it is important to look at and connect their well-being in the IT context [84]. This can be done according to content and with easy and logically functioning user interfaces. In addition, this study’s participants wished for an option to not use eHealth services or specific eHealth functions. This need is in line with other research findings [85].

This qualitative exploratory study aimed to gain a more in-depth understanding of older adults’ needs. The sample was small; the participants were from 1 country, and they were likely to be more interested than average in eHealth services. Older adults are a diverse group from the perspective of, for example, cognitive, motor, or technology use abilities [61]. Therefore, completely covering the population with a representative sample was not possible. This has potentially biased the results. In addition, the COVID-19 pandemic era could have influenced the results, but this was not especially followed as a part of this study.

Regarding the adaptation of eHealth services to different life and health situations, we do not know whether the service should always be the same or differ depending, for example, on whether the health situation has changed, in which case the role and meaning of the service changes from supporting well-being to treating illness. We recommend this as a future research area, especially in long-term studies. More research is needed on the best service channel combinations for older adults to obtain sufficient holistic health and well-being support. In the future, it would be worthwhile to test the design recommendations with representatives of the designer community and older adults, for example, in co-design workshops. In this study, the older adults’ needs in different life situations were not compared to those of other age groups. However, this would be valuable to study in the future.

From a methodological perspective, the cultural probe package, including diary-based and sentence completion tasks, combined with remotely conducted semistructured interviews seemed to be effective in collecting information about participants’ everyday lives and in mapping user needs for eHealth services. This is interesting because, as far as we know, not many cultural probes studies on this topic are available. The working participants completed more handwriting-based sentences. Therefore, cultural probes including many handwriting exercises might fit better for them. On the other hand, the data were collected using several methods, which confirmed the findings of the study and helped identify user needs. The methods seemed to work well in remote conditions during the COVID-19 pandemic era.

In this qualitative study, we collected information about the everyday lives of older adults in different life situations and identified their related needs for eHealth services. The results helped us understand how older adults see and experience health care with the help of eHealth services as part of everyday life. The older adults in this study often preferred a consistent routine in their daily practices including healthy eating and exercise. eHealth services could offer time saving and flexibility within these routines. A lack of devices or skills was often mentioned as a use barrier. On the basis of the results, four main needs of the older adults for eHealth services were identified: (1) the need for a carefree mind, in which older adults could receive status information on their current health and well-being situation via eHealth services; (2) the need for eHealth service adaptation based on the current life situation, use contexts, and everyday life; (3) the need for a holistic perspective, in which older adults wished to receive support for health issues from many perspectives and through several different service channels; and (4) the need to avoid using eHealth services but to use specific eHealth service functions, in which face-to-face support for their health was especially appreciated. On the basis of the results, eHealth services should be designed such that they fit well in older adults’ everyday lives and adapt to users’ everyday practices and health statuses according to content. eHealth services should be accessible and reliable.