JMIR Publications

ABSTRACT

Background:

Evidence-based health promotion programs (EBPs) were developed to reach older adults where they live, work, pray, and play. When COVID-19 placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in-person, less is known about outcomes when delivered remotely.

Objective:

To evaluate changes in remote EBP participants’ health and well-being in a national mixed-methods outcome evaluation between 2021-2022.

Methods:

We used the RE-AIM + equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organization, staff, and older adults traditionally underserved including people of color and rural-dwellers. We included five EBPs for self-management, falls prevention, and/or physical activity: videoconferencing (Chronic Disease Self-Management Program (CDSMP), Diabetes Self-Management Program (DSMP), Enhanced Fitness (EF)), phone plus mailed materials (Chronic Pain Self-Management (CPSMP)), and self-directed mailed materials (Walk with Ease (WWE)). Participant and provider quantitative data included validated surveys and in-depth interviews and open-ended survey questions. We used descriptive statistics to characterize the sample and magnitude of change, and paired t-tests and Fisher’s Exact to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated integration of quantitative and qualitative findings.

Results:

586 older adults and 37 organizations providing EBPs participated in the evaluation; 50% of older adults provided follow-up outcome data. EBP participants had mean(SD) age 65.4(12.0), 83.4% female, 36.3% person of color, 39.1% lived alone, 34.3% financial hardship, mean(SD) 2.5(1.7) chronic conditions) Overall, remote EBP participants had statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and tech anxiety. CDSMP participants had statistically significant improvements in health (p=0.003, mean change=0.32(95% CI 0.117,0.530)), energy (fatigue) (p=0.033, mean change=0.73(95% CI 0.061,1.408)), sleep quality (p=0.010, mean change=0.89 (95% CI 0.216,1.561)), and self-efficacy (p=0.019, mean change=-0.53(95% CI -0.970,-0.091)). CPSMP participants significantly improved their energy (fatigue) (p=0.013, mean change=1.11 (95% CI 0.248,1.968)) and pain (p=0.017, mean change=0.97 (95% CI 0.186,1.763)). DSMP participants had better health (p<0.001, mean change=0.41 (95% CI 0.259,0.552)). EF participants had better sleep quality (p=0.001). WWE participants had better health (p=0.018, mean change=0.25 (95% CI 0.046,0.454)). Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced social isolation and loneliness; and better access to programs. Three in four providers felt that effectiveness was maintained when switching from in-person to remote delivery.

Conclusions:

Findings suggest participating in remote-delivered EBPs can improve health, social, and tech outcomes of interest for older adults, providers and policymakers. Future policy and practice can better support remote EBPs to improve access for all older adults and delivery organizations. Clinical Trial: Not applicable