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

• Published in: Health promotion practice 2024-05, Vol.25 (3), p.475-491
• Main Authors: Steinman, Lesley, Chavez Santos, Erica, Chadwick, Kelly, Mayotte, Caitlin, Johnson, Selisha (Snowy), Kohn, Marlana, Kelley, James, Denison, Paige, Montes, Clarissa, Spencer-Brown, Lesha, Lorig, Kate
• Format: Article
• Language: English
• Subjects: Access; Adults; Aged; Chronic illnesses; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Evaluation; Evidence-based medicine; Evidence-Based Practice; Female; Health disparities; Health Equity; Health promotion; Health Promotion - methods; Health Promotion - organization & administration; Humans; Implementation; Male; Middle Aged; Older people; Pandemics; Program Evaluation; SARS-CoV-2; Staffing; Technology; Telemedicine - organization & administration; Underserved populations; United States; Video conferencing; Wellness programs
• ISSN: 1524-8399; 1552-6372
• DOI: 10.1177/15248399231175843

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.