Community-Based Health-Social Partnership Programme (C-HSPP) for enhancing self-care management among older adults: protocol for a hybrid effectiveness-implementation trial

Abstract

Background: The global ageing population imposes increasing demands on healthcare and social systems. Integrating the health and social service sectors has been proposed as a preferred solution to support healthy ageing, yet implementation in real settings remains challenging. Using an implementation science framework, this protocol outlines a Type-2 hybrid effectiveness-implementation design to adopt localized strategies for a Community-Based Health-Social Partnership Programme (C-HSPP) and test its effectiveness in enhancing self-care management among older adults in the community.

Methods: This study has two primary foci: to evaluate both the effectiveness and the implementation outcomes of C-HSPP in a non-governmental organization that operates seven community elderly centres across Hong Kong. A cluster randomized controlled trial (CRCT) with a two-arm, matched-pair, pragmatic design has been adopted to evaluate the programme's effectiveness. Regarding implementation outcomes, the reach, adoption, implementation, and maintenance of the programme will be examined using multiple data sources with quantitative and qualitative data. The trial will include 732 older adults aged 60 or above from four matched pairs of community centres, with each paired centre randomly assigned to either the 12-week C-HSPP intervention or to the usual community services. The C-HSPP intervention features a comprehensive assessment-intervention-evaluation framework using the Omaha System with health-social case management. Data will be collected at three time-points: baseline, post-intervention, and three months post-intervention, with self-efficacy as the primary outcome and other health indicators as secondary outcomes. An effectiveness analysis will be conducted using mixed-effects models and generalized estimating equations, incorporating degrees-of-freedom corrections and adjustments for clustering. Regarding the implementation outcome analysis, quantitative data including service statistics and a satisfaction survey will be presented using descriptive analysis. Qualitative data involving interview transcripts will be analysed using directed content analysis.

Discussion: By simultaneously evaluating both clinical effectiveness and implementation outcomes, this study will validate the evidence-based intervention and identify facilitators and barriers in the implementation process. The findings will support the adoption of an effective evidence-based programme in real-world settings, provide insights on the implementation process to ensure its sustainability, and furnish evidence for policymakers to adopt an integrated health-social partnership programme in the community.

Trial registration: ClinicalTrials.gov, NCT05621720, First Posted on 2022-11-18.

Keywords: Community-dwelling older adults; Effectiveness-implementation hybrid design; Health-social partnership; Implementation science; Omaha system; Primary health care; Self-care.

Fig. 1

Flow diagram illustrating the progress of clusters and individuals through all phases of the C-RCT