Remote Evidence-Based Health Promotion Programs During COVID: A National Evaluation of Reach and Implementation for Older Adult Health Equity

Abstract

Introduction. Evidence-based health promotion programs (EBPs) support older adults where they live, work, pray, play, and age. COVID-19 placed a disproportionate burden on this population, especially those with chronic conditions. In-person EBPs shifted to remote delivery via video-conferencing, phone, and mail during the pandemic, creating opportunities and challenges for older adult health equity. Method. In 2021–2022, we conducted a process evaluation of remote EBPs by purposively sampling diverse U.S. organizations and older adults (people of color, rural, and/or with disabilities). The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) + Equity framework was used to understand program reach and implementation, including FRAME to describe adaptations for remote delivery. Analyses include descriptive statistics and thematic analysis of participant and provider surveys and interviews, and joint display tables to compare learnings. Results. Findings from 31 EBPs through 198 managers/leaders and 107 organizations suggest remote delivery increases EBP reach by improving access for older adults who are underserved. For programs requiring new software or hardware, challenges remain reaching those with limited access to—or comfort using—technology. Adaptations were to context (e.g., shorter, smaller classes with longer duration) and for equity (e.g., phone formats, autogenerated captioning); content was unchanged except where safety was concerned. Implementation is facilitated by remote delivery guidelines, distance training, and technology support; and hindered by additional time, staffing, and resources for engagement and delivery. Conclusions. Remote EBP delivery is promising for improving equitable access to quality health promotion. Future policies and practices must support technology access and usability for all older adults.

Lessons From the Field. Chronic disease: Action for post‐pandemic wellness and health

“…MSU Extension found that entities whose mission is to serve high-need populations were often able to help recruit CDSMP participants from disparate groups. Our experience is in line with research that examined evidence-based programs implemented by 107 organizations to determine whether remote delivery could assist with reaching underserved populations (Steinman et al, 2023). We found that, as they described, working through diverse, trusted partners to implement programs in a variety of delivery formats assisted with increasing program participation and reaching underserved populations.…”

“…In-person workshops resumed after the pandemic; however, some people were unable or unwilling to attend the in-person classes for a variety of reasons (e.g., transportation problems, busy schedules, the physical and psychological pain and stress of leaving the home to attend a class, lack of CDSMP availability in rural areas; Steinman et al, 2023). Participants indicated that maintaining a variety of delivery methods would better meet their needs and make it easier for them to join, and our program effectiveness data indicate that our varied delivery methods continued to meet participants' needs.…”

“…Participants indicated that maintaining a variety of delivery methods would better meet their needs and make it easier for them to join, and our program effectiveness data indicate that our varied delivery methods continued to meet participants' needs. Other groups have also discovered that distancelearning-based lifestyle self-management classes can reach and help individuals not previously served (e.g., those unwilling/unable to attend in-person classes, those lacking transportation; Steinman et al, 2023). For example, one participant reported that she confined herself to one room in her home due to a decline in her health.…”

Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic

“…These shifts are unsurprising given the nature of program format, wherein some programs (e.g., Chronic Disease Self-Management Program) were often delivered in-person to groups of participants and others (e.g., HomeMeds) were delivered one-on-one or virtual ( 12 ). It should be noted that the COVID-19 pandemic led to innovations in program formatting (e.g., shifting to virtual models) ( 17 ). However, creating uniform data collection methods often lags behind changes in program implementation, and data reflecting program format were not consistently reported.…”

“…Furthermore, evaluation of recent data can help illustrate the impact of the COVID-19 pandemic on the implementation of these programs. Early in the pandemic, community programming was suspended, but as the pandemic progressed the use of remote delivery options, such as video-conferencing, phone and mail, were implemented for some but not all programs ( 17 ). The return to in-person program delivery varied greatly by state and type of site.…”