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. 2024 May;25(3):475-491.
doi: 10.1177/15248399231175843. Epub 2023 Jun 6.

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

Lesley Steinman  1 , Erica Chavez Santos  1 , Kelly Chadwick  1 , Caitlin Mayotte  1 , Selisha Snowy Johnson  1 , Marlana Kohn  1 , James Kelley  1 , Paige Denison  2 , Clarissa Montes  3 , Lesha Spencer-Brown  4 , Kate Lorig  5
Affiliations

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

Lesley Steinman et al. Health Promot Pract. 2024 May.

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.

Keywords: aging; chronic disease; health equity; health promotion; process evaluation; technology.

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Figures

Figure 1
Figure 1
Concurrent Mixed-Methods Evaluation of Remote EBP Reach and Implementation: Methods Flowchart Note. EBP = evidence-based health promotion program.
Figure 2
Figure 2
Adaptations by Remote Format From Interview Data
Figure 3
Figure 3
Key Take-Aways From the Remote EBP Implementation Evaluation Note. EBP = evidence-based health promotion program.
Figure 4
Figure 4
Implications for Policy and Practice to Support Remote EBP Delivery for Older Adult Health Equity Note. BIPOC = Black, Indigenous, and People of Color; EBP = evidence-based health promotion program; LEP = Limited English Proficiency.
See this image and copyright information in PMC

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