Research-based persona narratives for targeted health interventions in the elderly population: a narrative review

1 Introduction

Personas originated within the domain of software development, primarily as a tool to enhance the usability of tech products. Alan Cooper, a pioneer in the field, is credited with the conceptualisation of personas as a design tool in the 1990s. It is claimed that Cooper introduced them as a method to bring the user to the forefront of the development process (Cooper 1999). These fictional characters, or personas, were meticulously formulated from a synthesis of individual data points collected from real users, aimed at epitomising the collective attributes, behaviours, motivations, and goals of entire user groups. The initial application of personas in software design was to bridge the gap between the creators of technology and the end-users. According to Cooper, developers often designed software based on their own experiences and assumptions, leading to products that did not necessarily reflect the needs or understandings of their intended audience. By advocating for the use of personas, Cooper initiated a paradigm shift by emphasising that a successful product must align with the goals, behaviours, expectations and limitations of its end-users (Cooper 1999; Pruitt and Adlin 2006).

Over time, the persona method began to be applied beyond the software space, as it began to influence a range of practices in other areas of human life. In marketing, for example, personas have been employed to tailor communication strategies to customer segments, enhancing the efficacy of campaigns and customer experience (Mulder and Yaar 2006). In the realm of website design, personas have facilitated the creation of interfaces that resonate more deeply with user expectations and browsing habits (Nielsen 2013). As personas found their niche in various fields, their application within healthcare began to take shape. The confluence of healthcare and user-centred design principles heralds a significant evolution in the conception and implementation of health interventions.

This shift in healthcare interventions is centred on the strategic employment of personas, which seem fictive, yet they are empirically rooted archetypes derived from real user data. These personas transcend their narrative boundaries to function as pivotal tools for healthcare providers, offering profound insights into the complex tapestry of user needs and behaviours (Nielsen 2013; Pruitt and Grudin 2003). In this context, personas are not merely used to fine-tune user interfaces but are instrumental in shaping the entire ecosystem of healthcare products and services. They help healthcare professionals and designers to envisage the complex web of needs and experiences that define patient groups, ranging from medication adherence to the use of wearable health technologies (Rönkkö et al. 2004).

The evolution of personas in the healthcare sector reflects a growing recognition of the patient’s role in their own care (Timmermans 2020). This shift is seen in the emergence of patient-centred care models that prioritise individual patient preferences, needs, and values. Personas in healthcare encapsulate the multifaceted nature of patients’ lives, informing the design of interventions that are not just clinically sound but also empathetic to the patient experience (Lindgren et al. 2007). The adaptation of personas to healthcare has been marked by a nuanced understanding of health behaviours and the socio-economic determinants of health. Healthcare personas are often enriched by data on health literacy levels, cultural backgrounds, and emotional states, which are all crucial for designing interventions that are accessible and effective across diverse populations (Liang et al. 2018).

By distilling vast and complex datasets into relatable narratives, personas enable healthcare professionals to transcend traditional demographics and penetrate the deeper layers of human experience. This is particularly significant in addressing chronic conditions, mental health, and ageing, all areas that benefit from personalised and sensitive approaches to care (Johnson et al. 2023). In essence, personas in healthcare represent a confluence of data analytics and narrative empathy. They provide a structured yet flexible framework for capturing the dynamism of human health needs and are key to designing health interventions that are not only technically sound but also holistically attuned to the individuals they are meant to serve.

As stated earlier on in this section, in the context of healthcare, personas are not fictive; rather, they are data-driven, research-based constructs that encapsulate the diverse needs, experiences, and environmental factors influencing patient populations (Cooper 1999; Miaskiewicz and Kozar 2011). The utilisation of personas in health intervention design is anchored in the principle that understanding the end-user is paramount to the creation of successful products and services. The efficacy of health interventions is inextricably linked to their usability and the degree to which they address the specific needs and contexts of their target users. When designers and stakeholders engage with the detailed, story-like presentations of personas, they are better equipped to anticipate how different users will interact with the health products, thereby facilitating the design of interventions that are more likely to be adopted and effective in real-world settings (Grudin and Pruitt 2002).

There is no doubt that health interventions hold profound implications for public health, as they can drastically improve or hinder the quality of life for individuals and populations (United Nations 2017, 2019, 2024). Positive health interventions – those that are well-received and effective – can lead to improved health outcomes, reduced healthcare costs, and greater patient satisfaction (Adams 2010; Hibbard and Greene 2013; McMillan et al. 2013). Such interventions may range from public health campaigns to patient education or from medical devices to healthcare applications, each having the potential to facilitate disease prevention, management, and treatment adherence (Fogg 2009).

The ageing population is a demographic that stands to benefit significantly from thoughtfully designed health interventions (Høy et al. 2007; Kornadt et al. 2020). As this group often contends with multiple chronic conditions, mobility challenges, and cognitive changes, interventions that cater to their distinct needs can enhance their autonomy, health management, and overall well-being (De Coninck et al. 2021; National Council on Aging 2021). Consequently, narrative personas for this demographic must be designed with consideration for the age-related physiological, psychological, and social shifts that influence healthcare usage and the needs of older people (LeRouge et al. 2013).

To date, no narrative review has critically examined the literature on the use of personas in elderly-targeted healthcare interventions, leaving a significant gap in understanding their application and impact on patient outcomes. This review aims to address this gap by critically exploring the role of personas within healthcare design, particularly in addressing the challenges posed by an aging population. While existing literature suggests that personas can enhance the effectiveness of health interventions, there remains a need for a comprehensive assessment of how these narrative tools are utilized in health communication and design for elderly populations. By synthesizing current research, this narrative review highlights both the strengths of persona use in elderly healthcare design and the challenges that persist, particularly in areas such as standardization, validation, and adaptability. Ultimately, this review aims to set the stage for future research and innovation, helping to refine and advance healthcare interventions tailored to the unique needs of the elderly population.

2 Methodology

This narrative review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework (Moher et al. 2009), Ferrari’s (2015) guidelines for narrative reviews, and the PICO (Population, Intervention, Comparison, Outcomes) framework (Eriksen and Frandsen 2018). These frameworks were selected to provide a rigorous, systematic, and transparent approach to the review process, while accommodating the complexity and diversity of data in healthcare research.

The PRISMA framework (Moher et al. 2009) was chosen for its emphasis on procedural transparency and replicability in systematic reviews. In this study, PRISMA was applied to structure the stages of literature identification, screening, eligibility, and inclusion, ensuring consistency in reporting and facilitating replicability. Ferrari’s (2015) narrative review methodology was selected for its ability to integrate findings from diverse study designs. This approach was particularly appropriate for synthesizing literature on the multidisciplinary application of personas, which spans both qualitative and quantitative research. Narrative reviews prioritize the critical integration of findings across varied contexts, highlighting patterns, gaps, and challenges without restricting the analysis to a meta-analytical scope.

The investigation was guided by the following primary research questions: (1) What evidence exists in the literature for the creation of personas in elderly healthcare, and to what extent are these personas standardized to ensure consistency and effectiveness? (2)What critical gaps remain in the current literature regarding the standardization and validation of persona narratives, and how do these gaps impact the practical application of personas in healthcare for elderly patients?

These questions were further refined using the PICO framework (Eriksen and Frandsen 2018) to ensure a structured and focused approach. The population of interest in this study includes elderly patients,^[1] aged 65 and older, who are the focus of these healthcare interventions. The investigation centers on the use of persona narratives as an intervention, examining how these personas are created and standardized across different studies to enhance healthcare delivery and communication strategies for the elderly. No direct comparison is made, as the study aims to assess the current state of evidence and identify gaps in the standardization and validation of persona narratives, rather than compare them to alternative interventions. The outcomes of interest include the effectiveness of personas in improving health communication, patient engagement, satisfaction, adherence to treatments, and overall health outcomes, as well as identifying critical gaps in the literature that could impact the practical application of personas in elderly healthcare.

To address these questions, a comprehensive search was conducted across Scopus, PubMed, and Web of Science. The search spanned the inception of these databases to July 2024 and used a combination of Medical Subject Headings (MeSH) and free-text terms, including “personas,” “elderly,” “ageing,” and “patient-centered care.” Boolean operators were employed to maximize both precision and breadth in the results. No restrictions were imposed on study design, geographical location, or publication date, ensuring inclusivity.

Studies were included if they were peer-reviewed, available in full text, published in English, and specifically focused on personas in healthcare for elderly patients. Publications not meeting these criteria were excluded. Following the initial retrieval, duplicate entries were manually annotated and removed using ZOTERO software (Vanhecke 2008). The PRISMA framework was applied at this stage to document the flow of studies through the selection process, as illustrated in Figure 1. This ensured that the dataset was comprehensive, accurate, and focused on addressing the research questions.

Figure 1:

Prisma flowchart of the screening process.

3 Results

The database search identified a total of 206 publications. After applying the inclusion criteria, 14 studies were deemed potentially relevant and were included in the review, each providing valuable insights into the use of personas in healthcare for elderly patients. These studies span a range of healthcare contexts, with the most common areas being geriatric and elderly care (n = 4), followed by hospital and primary care (n = 3), and e-Health (n = 3). Other areas covered include chronic and specialized care (n = 2) and multimorbidity (n = 2). This variety in healthcare contexts might suggest the broad applicability of personas in addressing the needs of elderly populations across different medical fields.

Geographically, the majority of studies were conducted in the United States, accounting for a significant proportion of the research (n = 5). Two studies were conducted in Canada and two in the United Kingdom, with additional research taking place in Italy (n = 1) and Germany (n = 1). Three studies were multinational, involving research across 11 high-income countries, reflecting a focused interest in the use of personas in elderly care within these regions. While this suggests the relevance of personas in various healthcare settings, the concentration of research in high-income countries highlights the need for further exploration in a broader global context.

The chronological distribution of the studies reveals that the exploration of personas within elderly care is a relatively recent focus in the literature. The majority of the studies were published between 2019 and 2024, with four studies emerging in 2019, five in 2021 and two in 2024. In contrast, earlier years saw much less activity, with only one study each from 2011, 2017, and 2018. This pattern indicates that the use of personas in elderly healthcare has significantly gained momentum over the past few years, reflecting a growing interest in patient-centered design approaches tailored to this demographic.​

In terms of study design, the review found that both qualitative and quantitative methodologies were equally represented, with 6 of the 14 studies employing qualitative approaches and 6 using quantitative methodologies. Additionally, 2 studies utilized mixed methods, combining both qualitative and quantitative data.​ This distribution indicates a balanced emphasis on both qualitative and quantitative research in understanding and developing personas for elderly patients, with a few studies also integrating mixed methods to provide a more comprehensive analysis.

Qualitative studies often relied on narrative interviews and focus groups to gather in-depth insights into patient experiences. Agapie et al. (2020), Bhattacharyya et al. (2019), and Reeder et al. (2011) created personas for digital health platforms and IT solutions, addressing challenges like medical literacy, caregiving, and technological barriers. Husain et al. (2024) and Lokker et al. (2021) focused on social and digital disparities, crafting personas that reflected intersecting disadvantages and pathways for accessing reliable health resources. Perego et al. (2024) explored the psychosocial needs of hereditary angioedema patients, using personas to design supportive interventions.

Quantitative studies employed survey-based and statistical methods to develop data-driven personas. Schäfer et al. (2019) and Holden et al. (2017) used metrics like digital and health literacy levels to segment elderly users into personas with distinct support needs. Tanenbaum et al. (2018) developed personas to examine readiness for diabetes device use, while Figueroa et al. (2021) and Papanicolas et al. (2021b) analyzed cross-national patterns of healthcare utilization, creating personas that illustrated differences in care pathways and resource use. Papanicolas et al. (2021a) also identified spending patterns among frail elderly populations to inform persona development.

Mixed-methods studies provided a holistic approach, integrating qualitative and quantitative data to inform persona development. Williams et al. (2021) combined participatory workshops with demographic analysis to create the “Smartline” platform for elderly residents in social housing. Valaitis et al. (2019) employed co-design workshops and iterative feedback to develop the Health TAPESTRY program, ensuring the personas captured both narrative depth and statistical validity.

57 % of studies relied on primary data collection methods to gather specific, detailed information about the experiences, behaviors, and needs of the target population. The total number of respondents involved across the studies was approximately 1,366 participants, reflecting a considerable scale of data collection and participant engagement. This relatively large sample size enhances the reliability of the insights drawn from these studies, though it also highlights the diversity of methodologies and populations considered, which could affect the comparability of results.

While these studies contribute valuable insights into the application of personas in elderly healthcare, some gaps and limitations were identified. Notably, there is a recurring issue of methodological variability and a lack of standardization in persona development processes, which may limit the generalizability of the findings. Additionally, while the studies cover a broad range of healthcare contexts, there are still areas, such as the long-term validation of personas in practice, that remain underexplored. The characteristics and specific details of the selected articles are provided in Table 1.

4 Discussion

The increasing application of personas in elderly healthcare is a reflection of a broader shift towards patient-centered design, recognizing the need to tailor healthcare interventions to the specific needs and experiences of elderly patients. The studies included in this review consistently underscore the numerous benefits of utilizing personas in healthcare settings for elderly populations. Personas serve as a powerful tool to enhance the understanding of elderly patients by capturing the diversity and complexity of their healthcare needs. This is particularly important in contexts where a one-size-fits-all approach to healthcare is insufficient. By incorporating detailed narratives that reflect the psychological, social, and emotional dimensions of elderly patients, personas help healthcare providers to tailor interventions more effectively. For instance, personas have been shown to improve communication between healthcare providers and elderly patients by facilitating a deeper empathy and understanding of patients’ experiences (Holden et al. 2017; Reeder et al. 2011; Schäfer et al. 2019). This improved communication can lead to increased patient engagement, better adherence to treatment plans, and ultimately, more positive health outcomes (Agapie et al. 2020; Holden et al. 2017). For instance, Holden et al. (2017) introduced “Alice,” a 75-year-old living alone with limited health literacy, to guide the development of simplified educational materials and empathetic communication strategies for elderly patients with heart failure. Similarly, Schäfer et al. (2019) employed “Karl,” an 80-year-old with mild cognitive impairment, to design digital health tools with intuitive interfaces and visual prompts. Agapie et al. (2020) created “Frank,” an 82-year-old recovering from surgery, to refine patient portals by simplifying medical terminology and incorporating caregiver-accessible dashboards.

Furthermore, personas offer a structured way to incorporate patient feedback into the design of healthcare services and interventions. By aligning healthcare solutions with the specific needs and preferences of elderly patients, personas contribute to the development of more user-friendly healthcare technologies and services (Bhattacharyya et al. 2019; Husain et al. 2024). Several studies highlight the role of personas in designing digital health platforms that are more accessible to elderly users, thereby reducing the digital divide and promoting greater inclusion in the use of healthcare technologies (Agapie et al. 2020; Bhattacharyya et al. 2019; Williams et al. 2021). Bhattacharyya et al. (2019) employed personas to design a digital health advisor for frail elderly patients with chronic conditions. Archetypes like “Margaret,” a widowed 78-year-old with limited digital literacy and reliance on her children for health management, guided the development of features such as large fonts, voice-guided navigation, and medication reminders to ensure usability. Similarly, Agapie et al. (2020) utilized personas like “Frank,” an 82-year-old recovering from heart surgery, to inform patient portals for elderly individuals and caregivers. Frank’s difficulties with navigating online records and medical jargon led to caregiver-accessible dashboards and simplified language, making the portals more inclusive. Williams et al. (2021) developed the “Smartline” platform for elderly residents in social housing using personas like “Elsie,” an 85-year-old facing social isolation. Elsie’s needs shaped features such as a communication tool for connecting with healthcare providers and culturally sensitive, accessible design elements for diverse literacy levels. These examples demonstrate how personas like “Margaret,” “Frank,” and “Elsie” translate user needs into actionable design features, bridging the digital divide and enhancing healthcare technology accessibility for elderly populations.

Additionally, personas can help identify potential barriers to care that may not be immediately apparent, such as the need for culturally sensitive communication strategies or the importance of considering cognitive decline in the design of healthcare interfaces (Holden et al. 2017; Schäfer et al. 2019). Another significant advantage of using personas is their ability to guide the development of interventions that are proactive rather than reactive. By anticipating the needs and challenges that elderly patients may face, healthcare providers can design interventions that prevent issues before they arise, leading to more efficient and effective care delivery (Lokker et al. 2021; Reeder et al. 2011; Tanenbaum et al. 2018). This is particularly valuable in managing chronic conditions, where early intervention can significantly improve patient outcomes and reduce the burden on healthcare systems (Aldrich and Benson 2008; Papanicolas et al. 2021a; Perego et al. 2024).

Moreover, the use of personas fosters a more holistic approach to healthcare design, one that integrates medical, social, and psychological aspects of patient care. This comprehensive approach ensures that healthcare interventions address not only the physical health needs of elderly patients but also their emotional well-being, social connections, and overall quality of life. Such an approach is crucial in elderly care, where the intersection of multiple factors often dictates patient outcomes (Holden et al. 2017; Husain et al. 2024; Reeder et al. 2011; Valaitis et al. 2019).

However, this review also reveals significant challenges, particularly regarding the standardization and validation of these personas, which are crucial for ensuring their effectiveness and consistency across different contexts. The creation of personas in elderly healthcare, as evidenced by the studies, often draws on a mix of qualitative and quantitative data, emphasizing the importance of capturing the rich, lived experiences of elderly patients. For instance, studies integrating qualitative insights (e.g. Agapie et al. 2020; Bhattacharyya et al. 2019; Husain et al. 2024; Lokker et al. 2021), such as narrative interviews and focus groups, underscore the potential of personas to reflect the nuanced and often complex realities of elderly patients’ healthcare journeys.

These qualitative approaches are crucial in ensuring that personas go beyond surface-level characteristics, capturing the deeper psychological, social, and emotional dimensions that are essential for designing interventions that truly resonate with elderly patients (e.g. Figueroa et al. 2021; Holden et al. 2017; Tanenbaum et al. 2018). However, while qualitative methods offer depth, they also introduce challenges related to representativeness and generalizability. The reliance on small, context-specific samples can lead to personas that, while richly detailed, may not adequately represent broader populations or different cultural contexts.

This issue is particularly pronounced in studies where the personas are based on data from specific high-income countries, raising concerns about the applicability of these personas in more diverse or global healthcare settings. The geographical concentration of research, predominantly in the United States, Canada, and Europe, further underscores the need for a more inclusive approach that considers the varying needs of elderly populations in different regions.

Moreover, the integration of quantitative data in persona creation, often through methods such as cluster analysis or survey-based segmentation, offers a way to address some of these representational challenges by grounding personas in broader population-level data. This approach can enhance the generalizability of personas, making them more applicable across different settings. However, the reviewed studies also reveal that the use of quantitative data is not without its limitations. The risk of oversimplification is a recurring theme, with some studies cautioning that quantitative methods may reduce the complexity of elderly patients’ experiences to mere statistical profiles, potentially overlooking critical aspects of their healthcare needs (Schäfer et al. 2019; Williams et al. 2021).

Another significant concern that emerges across this analysis is the lack of standardization in persona creation and validation. Despite the methodological rigor demonstrated in the studies, there is little consensus on the best practices for developing and validating personas. This lack of standardization can lead to inconsistencies in how personas are applied in practice, potentially undermining their effectiveness (Zuiderent-Jerak 2007). For example, if personas are created using inconsistent or poorly defined criteria, the interventions designed around these personas may fail to meet the intended outcomes, as they may not fully capture the diversity and complexity of elderly patients’ needs.

Validation is another critical area where the literature reveals substantial gaps. While the creation of personas is often detailed and methodologically sound, few studies address the validation of these personas in a systematic way. Validation is essential for ensuring that personas remain relevant and accurately reflect the target population’s needs over time (Barnes and Konia 2018). Without rigorous validation, personas risk becoming static representations that fail to evolve with changing healthcare environments and patient needs. This is particularly concerning in fields like digital health, where rapid technological advancements can quickly render personas obsolete if they are not regularly updated (Smith 2020).

Furthermore, the literature highlights the need for more culturally sensitive and adaptable personas (Cabrero et al. 2016). Many of the studies focus on specific cultural or regional contexts, raising questions about the generalizability of the findings to other populations. As the global population ages, the development of personas that are adaptable to different cultural contexts will be increasingly important. This is particularly relevant in multinational studies, where the challenge lies in creating personas that can effectively inform interventions across diverse healthcare systems and cultural backgrounds. In summary, while there is robust evidence supporting the use of personas in elderly healthcare, the current literature reveals critical gaps in the standardization and validation of these tools, highlighting the need for more consistent and rigorous approaches to persona development, ensuring that they are both representative and adaptable to the evolving needs of elderly patients. Despite the limitations and variability in current approaches to persona development, this review has synthesized evidence from a diverse range of studies focused on elderly healthcare. The insights gathered have allowed for the creation of comprehensive, evidence-based guidelines that can inform policy-making and help standardize persona development processes. By integrating findings from various research efforts, these next sections aims to contribute to the enhancement of patient-centered care, ensuring that healthcare interventions are both effective and equitable.

5 Conclusions

The use of research-based personas in healthcare design, particularly for elderly populations, underscores the growing emphasis on patient-centered approaches that are attuned to the nuanced needs of this demographic. To our knowledge, this is the first narrative review that synthesizes and critically assesses literature on the use of healthcare personas for elderly patients, demonstrating how they are instrumental in enhancing the effectiveness of health interventions by facilitating a deeper understanding of elderly patients’ psychological, social, and emotional dimensions. These tools help bridge the gap between clinical objectives and patient experiences, leading to more personalized and accessible healthcare solutions.

However, this review also highlights significant challenges, particularly in the areas of standardization and validation of persona narratives. The variability in persona development processes across different studies can hinder the generalizability and consistency of healthcare interventions. Moreover, the concentration of research in high-income countries suggests a need for more inclusive approaches that consider the diverse cultural and socio-economic contexts of elderly populations globally.

To maximize the potential of personas in elderly healthcare, future research should prioritize the development of standardized and validated frameworks for persona creation. Such frameworks should incorporate both qualitative and quantitative data to ensure that personas are not only representative of the target population but also adaptable to different cultural contexts. By addressing these gaps, healthcare interventions can become more effective, equitable, and responsive to the evolving needs of the elderly, ultimately leading to improved health outcomes and quality of life for this growing demographic.

This narrative review, while structured using the PRISMA framework for transparency and consistent criteria, might inherently include the subjectivity typical of narrative reviews. The review’s restriction to English-language studies, while ensuring accessibility, may limit the global applicability of our findings. Important insights from non-English sources may have been overlooked, which could affect the comprehensiveness of our conclusions. Additionally, while SCOPUS, PubMed, and Web of Science were chosen for their breadth and relevance, these databases might not encompass all pertinent studies, particularly those in specialized or regional publications. However, this review’s goal was to provide a broad overview and identify critical gaps, setting the stage for future comparative studies to build on these findings.