JMIR Publications

ABSTRACT

Background:

Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. HealthStart is a Self-Determination Theory (SDT)-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health coaching, and post-health screening follow-up. YCHVs were taught principles of motivational interviewing, health coaching, and the social determinants of health through a program model anchored in principles of intergenerational and service learning. YCHVs served as health advocates throughout the participants’ journeys, guided by healthcare volunteers.

Objective:

This study evaluated the effectiveness and acceptability of the HealthStart program, a structured, layperson-led intergenerational health coaching intervention.

Methods:

Convergent parallel mixed-methods analysis was employed. A total of 192 participants’ quantitative data were collected through pre- and post-program surveys. Follow-up with primary care provider (PCP) was the primary outcome; secondary outcomes include health goal attainment, self-efficacy, and digital and health literacy among older adults, and acceptability amongst all stakeholders. PCP follow-up and health goal attainment were self-reported, while self-efficacy was measured using the Patient Activation Measure-13 (PAM-13). Health and digital literacy were assessed with an adapted questionnaire and the eHealth Literacy Scale (eHEALS), respectively. Qualitative data were collected from 36 semi-structured interviews, which were analyzed using thematic analysis. A joint analysis was conducted to generate meta-inferences.

Results:

The follow-up rate among PCPs increased significantly from 42.7% to 84.5% (p<0.001). A total of 66.2% (92/139) of the participants achieved their health goals, and 81.3% (113/139) reported satisfaction with the program. There were no significant pre-post differences in PAM-13, knowledge, and eHEALs scores. However, a statistically significant correlation was found between post-cycle eHEALS scores and the number of follow-up visits (p = 0.003). The qualitative findings substantiate HealthStart’s Theory of Change and its SDT underpinnings. Participants’ narratives highlighted the three SDT psychological needs—increased autonomy, competence, and relatedness—which are associated with sustained behavior change and health engagement. An increase in PCP follow-up rate was influenced by individually tailored goal setting and relationship-building that leveraged motivational interviewing to support intrinsic motivation. The program’s primary outcome was, to some extent, influenced by digital health onboarding and possibly improvements in health literacy. Participants’ self-efficacy could have been enhanced with a structured social prescription framework.

Conclusions:

HealthStart demonstrated the feasibility of utilizing laypersons and SDT principles to improve PCP follow-up rates and promote healthier lifestyles among older adults participating in community health screening. Clinical Trial: -