Table 2 Themes, sub-themes, and example quotes in relation to the participants’ perceived barriers, facilitators, mixed factors, or strategies

1. Holistic Wellbeing is central to healthy living

Lack of Motivation

Effort

Environment

Dietary

“I think the basic thing would be procrastination because often we know what needs to be done, it stops us from doing it. Sometimes we say I’ll do it next Monday, I’ll do it next week and then next week comes and then I have an excuse so to me is not so much unknowledge, but lack of willpower.” (P25, Chinese Male aged 52 years)

“sometimes when you’re at home, when you don’t have a trainer to help you, it’s just like, yeah, discipline is a problem, very much, you just laze – sort of laze off and like do everything so slowly that you know that you are cheating yourself but, it’s always like this internal struggle that you have, you know, yeah, so that’s mainly that.“ (P6, Chinese Female aged 39 years)

“I’m intentionally trying all ways to make a very conscious effort in exercising daily, eating healthily (whole grains, more fruits & vegs) as much as possible and even standing up or walking around after meals till my food digests so I won’t have a tummy.” (P5, Chinese Female aged 39 years)

“…you also have to be mentally fit right, so you must have the motivation and drive to maintain healthy lifestyle.” (P12, Chinese Male aged 54 years)

“…if you want to eat out, nutrition needs are pretty hard to get, healthy food at reasonable price.” (P12, Chinese Male aged 54 years)

“…our Singapore food doesn’t help with our diet because, although the HPB [Health Promotion Board] has this diet, half of it should be protein and one quarter of the carbs and one quarter of the fiber or something like that, a lot of times you go into a foodcourt, you go into a hawker centre, you see that 80% carb you know, then 10% fiber and 10% protein, sometimes no fiber, not even bean sprout are there, you know so yeah I think there’s something that has to change, we need to” (P32, Chinese Female aged 37 years)

“easier availability of unhealthy food in that sense, you know ordering food is so convenient, right? So that also prevents me from eating healthy.” (P24, Indian Male aged 38 years)

“I used to work out much more because gyms were so accessible, and then after the first lockdown, things just slowed down a lot because I couldn’t go to the gyms that I wanted, and now they allow only outdoor workouts which I don’t like because it’s just so hot in Singapore.” (P6, Chinese Female aged 39 years)

“Singaporeans are really lucky to have access to equipment and facilities around the estate at very affordable fees.” (P17, Chinese Female aged 45 years)

“The fact that I eat mostly at home and that helps me food-wise, making better and healthier choices when I’m at home….that helps me, be able to control what I eat and how I eat.” (P9, Indian Female aged 42 years)

“if I had a choice, I would want to eat healthier, order less.” (P24, Indian Male aged 38 years)

Lack of Time

Work-Life Balance

Social Influence

Activity in Daily Routine

“We are often too busy, there’s too many things we need to deal with so there’s no time to actually make conscious decisions, so we just end up eating whatever we want to eat and we just end up like sometimes we don’t have enough exercise.” (P15, Arab Female aged 37 years)

“I think in Singapore context, it is so easy to get food delivery, to go to the Kopitiam coffee shop just right below us, so it’s obvious the tight schedule of our daily work routine that we’re not able to commit that [healthier lifestyle choices].” (P36, Chinese Female aged 44 years)

“Sometimes I’m too stressed and too busy that I’m not able to commit to the exercise that I’ve actually scheduled”. (P31, Chinese Female aged 43 years)

“…sometimes because of time constraints, it is easier to prepare something that is already pre-prepared, for example frozen food, rather than to cook from scratch.” (P14, Chinese Female aged 35 years)

“Better allocate time for self instead of working all the time so that she can find time to exercise and go to bed earlier.” (P4, Chinese Female aged 42 years)

“healthy lifestyle means more work life balance, more rest time, less stress at work and spend more time with your family.” (P33, Chinese Female aged 45 years)

“Working only mon. to thu. - and making 3 days weekends the norm; leisure time is part of a healthy lifestyle” (P19, Indian Male aged 48 years)

“It may be good to have a 3–4 day work week so as to spend more time with family, cultivate happiness, relax and peace.” (P21, Chinese Male aged 47 years)

“Social pressure. So, a lot of things have to do with who you are with. Let’s say if you’re with a group of friends who like to eat hawker food and they like to over order. Then you end up with like ten plates of all sorts of things and you’re like, oh, you know, inside your Chinese, your Asian mind kicks in that I cannot waste the food. So, they end up eating all that stuff.” (P11, Chinese Female aged 37 years)

“It is also family, so I’ve been trying for many, many years to get my family to eat brown rice and not eat white bread right? And it’s not possible because they say Oh, you know I’m eating white rice for the whole my life.” (P12, Chinese Male aged 54 years)

“I love walking in the evening but kids are home and I can’t go long walks…maybe after their exams” (P1, Chinese Female aged 46 years)

“Let’s say if you’re with friends who exercise a lot, then you tend to go and exercise with them, you know but it’s a lot about getting the social network to do it with you well.” (P11, Chinese Female aged 37 years)

“I could wake up earlier to exercise before I start work.“ (P4, Chinese Female aged 42 years)

“exchange my travelling time for exercise time.” (P32, Chinese Female aged 37 years)

“in the morning, if I can squeeze some time, I might do some yoga before I start [work]. And then during lunch, normally I don’t cook so I try to walk out, go out, walk around a bit, buy my lunch, and then I come back and I continue working and then I make my own coffee. And then, at the end of the day, either someone from a family brings dinner home, if not I might try to fit in a walk so that I can just walk more and get my dinner.” (P4, Chinese Female aged 42 years)

“go back to physical shopping, which is a way that I make myself move around more physically” (P13, Chinese Female aged 49 years)

“not sit down for long hours after meals.“ (P5, Chinese Female aged 39 years)

Ageing

Psychological approaches

“…because all of us as we get older, we get quite a few additional pre-existing conditions, I wouldn’t say pre-existing conditions, but we get injuries and stuff like that, so you would need somebody who is actually trained to tailor a fitness experience for you, that will not aggravate your current existing injuries, you know. That’s I think one of the things why people don’t go for it, I know I would love to do HIIT, but every single time I try it, that’s it, my back goes, and you know what, never mind, forget it.” (P11, Chinese Female aged 37 years)

“I used to run a lot, so to me, getting old stops me from having exercising you know more rigorous way.“ (P20, Chinese Male aged 54 years)

“set fitness goals” (P14, Chinese Female aged 35 years)

“Meditation for good sleep” (P12, Chinese Male aged 54 years)

“Mentally, I try not to let anger or emotions eat into me through prayer.“ (P17, Chinese Female aged 45 years)

“Quality sleep to me is more important than duration of sleep. if there are some things on the mind before sleeping, can get them out by writing them down. With nothing bugging me in the mind, I can have a good restful sleep” (P13, Chinese Female aged 49 years)

Cost

Time management

“…they could just lower the price of brown rice and salad.” (P30, Chinese Female aged 39 years)

“…you know once it comes to food and more interesting exercise, then I think that’s where a lot of the cost element comes into play in our society today.” (P18, Chinese Female aged 48 years)

“I always hope that one day we can get healthier choices at a reasonable price.” (P32, Chinese Female aged 37 years)

“nutrition needs are pretty hard to get…healthy food at reasonable prices.“ (P12, Chinese Male aged 54 years)

“Exercise timing I think must plan beforehand.” (P35, Chinese Male aged 42 years)

“Develop a fixed schedule and stick to it.” (P12, Chinese Male aged 54 years)

2. Encouraging uptake of a mobile health intervention

User Type

Accessibility

Reaching people

Recruitment

“because my habit is I don’t wear a watch, so it’s very hard for me to – I tend to forget to bring the tracker out, so I tend to not log in anything. So, tracker is not good for those who are not used to wearing watches.” (P1, Chinese Female aged 46 years)

“I’m a bit of a tech dinosaur…I did not grow up with a phone, a smartphone, I’m just not used to things like this, and there are things like run tracker and all that, but I’m not – I don’t like running or cycling with a phone near me, especially running because it’s like extra weight, and I feel the one thing that prevents me from using Apps is that there’s an extra step of having to input the things.” (P6, Chinese Female aged 39 years)

“…it’s really those who are not keen or kind of less receptive of such app will be those who are not that tech savvy.” (P36, Chinese Female aged 44 years)

“…because it’s app-based, therefore it’s only useful if you are very comfortable using an app, or if maybe you’re already wearing tracker.” (P4 Chinese Female aged 42 years)

“what makes it [National Steps Challenge] a success, I think, number one is the user platform, that is accessible to everyone through the mobile phone and HPB [Health Promotion Board] even provides a free tracker if you don’t have a smartwatch that works with that, plus the logic is actually very simple.“ (P25, Chinese Male aged 52 years)

“some are actually quite good, like the one that is on the radio that’s like ‘quarter, quarter, half’, you know, and balance is easy and the one you just by listening to the jingle it kind of gets into your brain and then you start to notice, I actually started to look at how I ate.” (P11, Chinese Female aged 37 years)

“I tend to only participate when there is road show.” (P1, Chinese Female aged 46 years)

“It takes a lot of effort to go and find out about them [health promotion programmes].” (P11, Chinese Female aged 37 years)

“I feel that the government needs this so-called ‘propaganda’, don’t be discouraged if there’s not enough converts at the moment because I want to say this is actually a lifelong process, so if it is not successful or the pickup is not high for the first two years, just keep on doing. I think some hard converts will probably pick it up after 10 years later, maybe they feel that they are not ready to do exercise, but maybe 10 years later, you do it, so I think this ‘propaganda’ should continue because it’s very helpful, some people just need this persistent calling.“ (P10, Chinese Male aged 53 years)

“at the supermarket, because you see that is the place where you can catch me because I go there very often.” (P1, Chinese Female aged 46 years)

“I think people pay more attention to things that come to them in a space that they trust, that this information is useful to me, and this information is useful to my type of people so, engaging schools, if you are looking at younger crowd, engaging workplaces if you’re looking at the work crowds, getting connected with HPB [Health Promotion Board] and Ministry of Health to give the app the clout and the respectability it needs, because there are so many apps, and everything says that it’s going to change your life so, after you pay for it two weeks later, so you know it kind of [laughs] doesn’t work.” (P9, Indian Female aged 42 years)

“you need to go through some channels to encourage the people to use it, like maybe from the company or from doctors or what they encourage the patient or employee to use it and maybe they give them some incentive or something to make them use it, at least for the first time they try it out.” (P35, Chinese Male aged 42 years)

“It really comes to peer influence. Or maybe certain support groups to introduce such an app and how it would be able to integrate in their lifestyle, to make it see not as a chore but more of a convenience or helping them to be better every day.” (P36, Chinese Female aged 44 years)

Corporate Links

Incentives

Cost

“I have noticed that it is

based on tie ups between merchants and HPB [Health Promotion Board] so, for example, you can get points, if you buy a bubble tea, with less sugar, but you do not get points when you buy clean water from supermarket, which actually defeats the purpose.” (P14, Chinese Female aged 35 years)

“I think one of the previous HPB [Health Promotion Board] activity long ago I saw it was actually sponsored by Coca Cola, if you figured, I did not much after that.” (P5, Chinese Female aged 39 years)

“…the useful ones are not free, and yeah the free ones are just not feature rich enough for you, for you to want to continue using them much.“ (P6, Chinese Female aged 39 years)

“then they start charging, and the fee keeps increasing, the fee. Then I stop it.“ (P21, Chinese Male aged 47 years)

“people are motivated by it [health promotion programme in Singapore] because there’s no cost involved.“ (P24, Indian Male aged 38 years)

“seeing a professional in person is costly so if an app is providing the service at a cheaper rate that might help.“ (P1, Chinese Female aged 46 years)

3. Trying out a mobile health intervention is one thing, sticking to it long-term is another

Technical issues

Tracking

Tailoring

Technical features

“I also need to sync my watch to the app, and very often a lot of syncing has problems and then I sort of chuck it aside and stop syncing.“ (P3, Chinese Female aged 48 years)

“Step tracker is supposed to be that you clock the steps that you make by walking, not by shaking your hand [laughs] yeah, so that’s one very common way to abuse the system” (P2, Chinese Female aged 46 years)

“I find that because it’s inconsistent like Google Fit will give me a very different number from this one, so I stopped trusting any of them.“ (P18, Chinese Female aged 48 years)

“I have a weighing scale which is really good. It helps you to track fats and all this stuff, and break down by your, I don’t know bone density and whatever. I thought that helps.“ (P23, Chinese Female aged 46 years)

“I think another one that got me quite thrilled was this app that actually tracks your sleeping. And it seems really important for healthy lifestyles right? So it tracks the sleep that you’re getting just snoring if you’re having abnormalities in your breathing and apparently there is even an alarm that wakes you up at your lightest sleep level so that you wake up the freshest to start your new day. I think this is really cool.“ (P30, Chinese Female aged 39 years)

“Personally, I like the relative data, how am I compared to another person. A good example that I love to see is Singapore power right? And then, in the data they always had the national average and then the average in your neighborhood. I love that relative information, so every month or the day I can see my neighbors’ [energy usage].” (P10, Chinese Male aged 53 years)

“You know, oh, very important, the one that you can customize so you can actually, it is like having your own widgets inside the app that you will use, I mean not everyone’s going to have like heart problems or stuff like that” (P11, Chinese Female aged 37 years)

“most apps, at least on the App Store, very much they look towards on a global scale in a sense, there aren’t many of the food they eat locally right? It doesn’t really accurately show like how heavy it is and then how much calories it counts to me. So, I think, in that sense, it would be better if the app can actually have a more accurate portrayal of local food in that sense…the nutrition value is not accurately captured in the existing apps.” (P24, Indian Male aged 38 years)

“perhaps you need to lose weight and I think that health program will suit you, but I think if you have special needs, a special need tailored program, I think these general programs may not be that useful…I think a person needs tailored programs or they’ll not be that effective.” (P27, Chinese Male aged 47 years)

“having the choice, and perhaps the bespoke-ness is something that has, that is kind of lacking. It is a certain way, and if you can mould yourself to it, then it’s good and great, and if not, then that doesn’t work for you. And that’s where sometimes when people are unable to fit it into their lifestyle, they kind of abandon it.” (P9, Indian Female aged 42 years)

“For me, initially the initiative [National Steps Challenge] was quite good, but after a while I say, I need to clock like a number of steps within like three days or five days, and when I was disrupted by children. I tend to lose track, and you know, it defeated everything that I have put in the previous days, and I sort of felt like it was a bit wasted, so well I gave up… and then even my children, when they were participating with me as well, and they have some activities in school, and certain days they are quite busy, so we couldn’t really continue throughout that timeframe, so yeah after a while we found that it really – It doesn’t really suit our lifestyle, so we stopped.” (P3, Chinese Female aged 48 years)

“The app must be able solve that person’s issues and not charge a high price. No side advertisements, etc. Must be available all the time.“ (P3, Chinese Female aged 48 years)

“Can you tell me, you know… give me one small thing to do right now to help me clock 1000 steps. Then the app suggests something, you know just to give me ideas, like becoming very interactive.“ (P13, Chinese Female aged 49 years)

Burden

Social influence

Rewards and incentives

Incentivization

“I need to input my height, my weight, my symptoms and at the end of the app, bunch of doctors was giving me diagnosis. But what I realized, one thing is, they can’t dispense medication to me, so I still have to go down to the clinic. So what good is it?“ (P17, Chinese Female aged 45 years)

“to be honest I’m sorry but it’s just too much work for me to think like what is a food and everything else you know, in order to track how much calories I eat is also hard, so in the end that’s why I gave up.” (P18, Chinese Female aged 48 years)

“what will make you want to stay on the app longer is, also is prevalence, which is like, if everyone else has it, you feel that you want to have it as well, so it really works that way” (P6, Chinese Female aged 39 years)

“So for me how it is being useful is you had that bonding with your family, your friends, your kids, your husband, you know, whoever wants to join. So technically you are…you know, bringing them along to have a healthy lifestyle, walking or even jogging so you can actually complete either five or 10 kilometer walk and then you just have a map of how long you walk.“ (P26, Malay Female aged 38 years)

“you need to make the app popular so that word of mouth or that you get more and more people use it then.” (P35, Chinese Male aged 42 years)

“you get an incentive you get something like the $5 [shopping] voucher…yeah you can do it through the app, I mean I’ve been doing that before this pandemic and I thought you know it’s pretty good this incentive. So, I think if you give people incentive to do this healthy activity, you know, to get $5 $10 etc. I think people will be more motivated to go for it, and then I think that it works.“ (P28, Chinese Male aged 50 years)

“it’s very fulfilling, it’s like when I hit a goal, I get to redeem NTUC [supermarket] vouches for that yeah, so I feel that it’s like a means to keep myself healthy and motivated” (P5 Chinese Female aged 39 years)

“I have actually seen some people who shake their steps tracker in order to achieve that 10,000 steps a day so that they can get the vouchers that they want, in a way, it is cheating and defeating the purpose.“ (P14, Chinese Female aged 35 years)

“After I completed the challenge for the national steps thing right, I couldn’t redeem any more incentives, so I kind of lost steam a little bit.” (P5 Chinese Female aged 39 years)

I feel like more education on why exercise is important will be more important than just, oh you like hit 10k steps, you can get $5 voucher, like, that’s not going to be sustainable, I think, and it’s like just missing the point of it,”(P6 Chinese Female aged 39 years)

“if we can use it on something healthier and add on more points, so is like wow, I get motivated to even pick the healthier choices and so on and so forth.“ (P13, Chinese Female aged 49 years)

“I honestly feel that HPB’s [Health Promotion Board] model (free tracker coupled with incentives) is pretty effective and has seen a very good adoption rate” (P24, Indian Male aged 38 years)

“I feel that there must be some motivation, as to what motivation I don’t know, probably something that links to long term… we do something now but the benefit will come 30 years later somehow whatever, maybe your [pension] will give you 1% more. Something along that line yeah, but it is a delayed gratification because it lines up with these habits, but don’t do something immediately when someone does 10k step, I give you immediate $10 cash, no, no, no, maybe give a great voucher that years later, if your still around, 30 years later, for example.” (P10, Chinese Male aged 53 years)

“it will be a wonder if I can marry the both, meaning to say instant gratification and delayed gratification you can give me something small right now but yeah I know I’m banking into something in the future.” (P13, Chinese Female aged 49 years)

“So it’s like it gives you an incentive to do something useful for yourself, so maybe if you want people to take up this app it’s like you give them some NCD [no-claims discount] that can be up to 30% or something like that, on your insurance, over let’s say, if you do this over like two or three years, and you know you, you get 30% off [health] insurance.” (P11, Chinese Female aged 37 years)

Personalisation

“For example, today, what are the things I eat that I key in, then I hope that there can be some feedback and then what should I improve on in my next meal and then also like about the mental part how I am feeling today I will key in my moods and my feelings today, then is there any help. I mean suggestion on what can I do so, I hope that or some programs that I can attend to improve myself so use the apps have some type of feedback features would be good.” (P31, Chinese Female aged 43 years)

“What I want to see based on this app would be more on our achievements. Each time we use it, it gets better, it recognizes our achievement. Because you have to key in your bio data. The app certain, you know how fast you walk. Yes, so you’ll be more naturally motivated each time.” (P26, Malay Female aged 38 years)

“But I think this health app would need to kind of tailor made according to the different persona that we are actually focusing at. So if let’s say the persona group they are looking at right now is youngsters, or maybe let’s say tertiary students because the secondary school and tertiary ones are the ones that use more app-savvy tried to hook onto their phones and all. Then the app’s functions would able to address their different pain points, maybe stress at O level, you know what other sources they can tap on. Which can be a hyperlink to certain music to give me stress relief or some song playlist that I can actually run to do my exercises and help me to relieve stress at the same time.” (P36, Chinese Female aged 44 years)

Integration/Multi-service

“actually draw data from the various apps I think like one of your said just now, you can have many expert, yet the can I mean, I have to grant access, of course for the super app and let it draw the data from such other apps.” (P13, Chinese Female aged 49 years)

“a centralized database that allows a lot of sharing of information, so I don’t need to keep inputting whatever I am into the system over and over again.“(P18, Chinese Female aged 48 years)

“because there are several different health apps, if they could centralize something, so that it is one app with more things inside. That might be easier for us to keep track and take note, because right now there are several different apps for different things.“ (P15, Arab Female aged 37 years)

“I really hope that one day we have an app that can put everything together like can track your exercises like our steps your active hours, minutes, but yet at the same time, if I say you have some emotional problem anxiety issue, there is also pages for you to link there, or even have a tele-doctor or tele counsellor.” (P32, Chinese Female aged 37 years)

“Not just a health aspect, perhaps get also help on a broader perspective, also able to maybe work on areas like sustainability. Like…when I use my own container you know you have to reduce carbon footprint at the same time, maybe it’s like a one stone can kill many birds kind of proposal, I think that might actually help to prolong the usage of the app itself, where they actually serve more than one main key function.” (P36, Chinese Female aged 44 years)

Ease of use

“Make the app as user friendly as possible, download and set up the app for the person, provide proper training to use the app.” (P4, Chinese Female aged 42 years)

“Is it user friendly for most of us? Yes, but I think a large chunk of them will also be elderly folk and you need people to train them hopefully the kids but probably we need some coaches to train them as well.“ (P30, Chinese Female aged 39 years)

“the user interface has to be very, very simple, I mean once you download an app and you find there’s a learning curve, you’re more likely to just delete it in the next 5 s, so for it to be very simple to use yet very feature rich and very robust is, I think this is important.” (P6, Chinese Female aged 39 years)

Gamification

“different types of challenges different type of games to bring you to keep you on track on these activities, I thought that might be something useful.” (P33, Chinese Female aged 45 years)

Social support

“if you can issue challenges to a friend, like, I can challenge my friend to walk 10 K for this entire week you know things like that. I think it would be fun, you know, when a group of friends come together and an issue this kind of challenge, or maybe you can say that, together, as a group, if you achieve this, then you’ll get something.“

“I think for the rest of the group is really, have to come to peers influence. Or maybe certain support groups to was able to introduce such app yeah and how this APP would be able to integrate in their lifestyle, to make it as to actually see not as a chore but more of a convenience or in helping them to ya to be better every day.“