Performing Department
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Non Technical Summary
Over 85% of older adults have one or more chronic health conditions, and about 11% are at risk for or have subjective cognitive decline. Additionally, 20% of older Americans reside in rural areas, where isolation can exacerbate health challenges. Behavioral factors account for at least half of one's health status and are key to delaying and preventing the onset of chronic health conditions. Compared to urban counterparts, rural areas have fewer health behavior facilitating resources to contribute to better health and well-being. Underscoring this challenge is that most of rural Illinois are healthcare shortfall areas, where the ratio of healthcare providers is lower than non-rural areas. Thus, low-cost, rural wellness programs fill an important gap in health education programming that contribute to people living healthier lives. However, many available programs are costly (e.g., training, licenses, equipment) and programs like these are not easily disseminated in rural areas due to limited resources. University of Illinois Extension Educators developed Wits Workout (WW), a holistic, lay leader led, wellness series for older adults designed to enhance behaviors that contribute to good health. It has shown potential for widespread implementation, is low-cost, and easy to replicate. The aims of this project are to 1) evaluate the processes and outcomes of implementing a lay leader facilitator model for widespread implementation of WW across rural Illinois; 2) assess participant outcomes on social engagement and satisfaction, and self-efficacy to practice healthy behaviors; and 3) develop, beta-test, and implement a WW Spanish version for older Hispanic/Latino rural residents.
Animal Health Component
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Research Effort Categories
Basic
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Applied
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Developmental
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Goals / Objectives
Thus, the overall aims of this project are as follows. 1) Lay leader training programs are an important factor in increasing the reach and capacity of WW and we will evaluate the processes and outcomes of implementing the lay leader facilitator model for widespread implementation of WW across rural Illinois; 2) Using a pre and post-program participant evaluation design, we will assess the extent to which WW increases social engagement and social satisfaction, decreases feelings of social isolation and loneliness, and improves self-efficacy to practice healthy behaviors that contribute to positive health related outcomes); and 3) Using a panel of subject matter experts, we will develop, beta-test, and implement a WW Spanish version to older Hispanic/Latino residents in rural communities.Objectives, Activities, Outcomes and TimelineThis project has three related objectives across the three year project period based on the RE-AIM and PRISM frameworks.Year 1: Activities and Outcomes 1) Develop, implement, and evaluate (i.e., program processes, outcomes, program fidelity) a lay leader training program for WW. Reach and Adoption: At least 7 lay leaders will be recruited and trained to facilitate WW English across the 7 rural counties. Implementation: Program fidelity will be evaluated at 7 program delivery sites twice during the 12-week program. Lay leaders experience and satisfaction with the lay leader training will be evaluated with a survey and debrief discussion at the end of the lay leader training.2) Evaluate WW (English) program reach, efficacy (i.e., participant outcomes), adoption, implementation (i.e., program processes), and maintenance. Reach and Adoption: WW will be delivered in 7 sites to 15 participants/sites (N=105) with a participant completion rate of 70% based on attending 9 of 12 sessions. Efficacy: At least 60% of participants in WW English and WW Spanish will evaluate the program as increasing opportunities for social engagement and rate the program as intellectually stimulating. At least 75% of participants will rate their interactions with lay leaders as "good" or "excellent" and at least 75% of participants will rate the program content as "good" or "excellent". In a pre to post-program evaluation, at least 50% of participants will report their general self-efficacy improved. Implementation, Efficacy, and Maintenance: At least 2 in person and/or virtual focus groups will be conducted one month after completing WW to assess satisfaction with program elements (i.e., content, format, program length, lay leader satisfaction, overall satisfaction) and assess the extent to which participants are still engaging in healthy behavior activities.3) Using a panel of subject matter experts, we will develop, pre-test, and implement a Spanish version of WW to rural communities. Implementation: A six-member panel of subject matter experts will evaluate WW English and adapt the curriculum to ensure it is culturally tailored for Hispanic/Latino audiences. The panel will assess the English program content collaboratively to discuss and determine which units can be culturally tailored for Hispanic/Latino audiences. The panel will also contribute activity ideas to supplement units that are culturally tailored to Hispanic/Latino audiences, as needed. Modifications to the program content and facilitator's guide will be made according to the feedback from the panel, co-investigators, and participants.Year 2 Activities and Outcomes1) Reach and Implementation of WW Spanish Lay Leader Training: Reach: At least 2 bilingual lay leaders will be recruited and trained to facilitate WW in Spanish in at least 2 sites across the 7 rural counties. Reach and Implementation of WW English Lay Leader Training: At least 5 lay leaders will be recruited and trained to facilitate WW English in 5 additional sites in the 7 rural counties. 2) Reach and Implemenation of WW Spanish: WW Spanish will be deliverd in 2 rural counties to 15 participants/site (N=30) with a 70% or more of participants completing the program based on attending 9 of 12 sessions. Reach and Implemenation of WW English: WW English will be delivered in at least 5 sites to 15 participants/site (N=75) with a participant completion rate of 70% based on attending 9 of 12 sessions. Implementation and Efficacy: At least 60% of participants in WW English and WW Spanish will evaluate the program as increasing opportunities for social engagement and rate the program as intellectually stimulating. At least 75% of participants will rate their interactions with lay leaders as "good" or "excellent" and at least 75% of participants will rate the program content as "good" or "excellent."Implementation, Efficacy, and Maintenance: At least 3 in person and/or virtual focus groups (1 for WW Spanish and 2 WW English) will be conducted one month after completing WW to assess satisfaction with program elements (as stated in Y1) and assess the extent to which participants are still engaging in healthy behavior activities.Year 3 Activities and Outcomes1) Reach and Implemenation of WW Spanish: WW Spanish will be delivered in 1 rural county to 15 participants/site (N=15) with a participants completion rate of 70% or higher based on attending 9 of 12 sessions. Implementation and Efficacy: At least 60% of participants in WW Spanish will evaluate the program as increasing opportunities for social engagement and rate the program as intellectually stimulating. At least 75% of participants will rate their interactions with lay leaders as "good" or "excellent," and at least 75% of participants will rate the program content as "good" or "excellent." 2) Implementation, Efficacy, and Maintenance: At least one in person and/or virtual focus group will be conducted one month after completing WW to assess satisfaction with program elements (as stated in Y1) and assess the extent to which participants are still engaging in healthy behavior activities.
Project Methods
Participant Outcomes (Efficacy): A pre and post program evaluation survey will assess changes in participants' health and quality of life, knowledge, awareness, skills, general self-efficacy, and intent for action (see Logic Model - activities, short term outcomes and long-term outcomes). Demographic information will be collected and includes age, sex, race/ethnicity, education, and marital status. Participant outcomes assessed include: 1) loneliness (8-item UCLA Loneliness Scale; Hays & DiMatteo, 1987); 2) Satisfaction with Social Roles and Activities scale (Hahn et al., 2016); 3) general self-efficacy is measured with the General Self-efficacy scale (Gruber-Baldini et al., 2017; Salsman et al., 2019); 4) health related quality of life will be measured with the HRQOL (Centers for Disease Control and Prevention, 2018); and 5) positive affect and well-being will be measured with the Neuro-QOL Positive Affect and Well-Being scale (Salsman et al., 2013). See activities, outputs, short-term outcomes, and long-term outcomes in the logical model (Figure 1).Satisfaction, Knowledge, Awareness and Intent for Action (Efficacy): Key measures for satisfaction, knowledge, awareness and intent for action and their targets are as follows. One item measures overall satisfaction: 1) The extent to which participants judge the program as meeting their needs (0= strongly disagree; 5= strongly agree); 2) Intent to use the resources/skills in WW is measured with one item where 0= strongly disagree and 5= strongly agree; and 3) The extent to which participants are likely to take action by sharing knowledge or recommending the program to others is measured as 0=not at all likely and 5=extremely likely. The objective is to achieve ratings of ≥4.0 for these items. Adherence to the program is assessed through attendance records where completion of the program is rated as attending 9 of 12 sessions (≥70%). See activities activities and short-term outcomes (Figure 1).Participant Focus Groups (Efficacy): Virtual focus groups will be conducted one month following the program to gain insights into participant outcomes and their experience with WW. Key insights gained from focus groups include what effects of WW on their health behavioras, health, and quality of life, what worked, what didn't, and what could be improved within WW. See activities, outputs, short-term outcomes and long-term outcomes (Figure 1).Assessment by Expert Panel of Culturally Adaptation WW Program: The expert panel will engage in ongoing assessment of WW activities that are appropriate for cultural adaption for WW Spanish (Figure 1 - activities, outputs, and short-term outcomes). They will engage in up to 10 meetings in which they will discuss and decide via consensus building activities appropriate for WW Spanish and they will suggest new activities for WW Spanish. WW Spanish will be pre-tested with a a bilingual Extension team member who will facilitate activities from WW Spanish. Byers and Hofer will coordinate this process. The expert panel and bilingual Extension volunteers will serve as participants. The volunteers and the expert panelists will assess both the program content and the delivery of the program content during the pre-test. During the pre-test, the facilitator and all participants (volunteers, expert panel and co-investigators) will take note of what works, what does not work, and what should be improved regarding the program content and delivery of the program content.Bilingual Leader Survey to Assess Program Processes (Efficacy ): Bilinqual WW Spanish lay leaders will complete a survey that assesses key program processes and satisfaction with the lay leader training program and the WW Spanish program Figure 1 - activities and short-term outcomes). Specific measures and targets are below. Lay leaders will rate the success of the program, how socially engaged participants were, how enjoyable activities were, even if some were challenging, and the clarity of the activity instructions. These items will be rated on a 0-5 scale where 0= strongly disagree; 5= strongly agree).Lay Leader Training Debrief and Focus Groups (Efficacy and Implementation): We will debrief with lay leaders at the end of the lay leader training to assess their satisfaction with the training program learn about what worked, what did not work and what can be improved with the lay leader training (Figure 1 - activities, outputs, short-term outcomes). We will also conduct focus groups with the lay leaders after the conclusion of the workshops to learn more about the feasibility and acceptability of the program at the organizational level including the program format, training, and facilitator's guide, and to identify key barriers and facilitators to program delivery.Program Fidelity Checks: All Wits Workout leaders will be observed teaching two sessions of WW (Figure 1 - activities, short-term outcomes). After the first observation, the fidelity evaluator will debrief with the facilitator and will follow up with a written evaluation that includes strengths, areas of improvement, and suggestions for increasing fidelity in their teaching. A second observation will occur within several weeks of the first observation to achieve continuous process improvement.Analysis Plan: Surveys data will be analyzed with SPSS (version 29). Repeated measures Analaysis of Covariance (ANCOVA) will be used to assess changes in health, self-efficacy, quality of life, knowledge, and awareness. Frequencies and means will be calculated to assess program satisfaction and experience (i.e., process) elements. Focus groups will be autotaped and transcribed verbatim. Reflexive thematic analysis will be used to analyze the data. (Braun & Clark, 2019). Themes will be discussed and finalized with the research team.