"We can adapt it to our needs" : tailoring Choose to Move for Chinese older adults living in the Metro Vancouver Regional District

Chronic conditions are more common as people age. There are various causes to chronic conditions so strategies to prevent and treat multiple health conditions and promote health are needed. Physical activity (PA) is a viable evidence-based intervention to prevent and treat chronic conditions and prevent pre-mature mortality. Yet, only 13% of older adults meet the recommended PA guidelines. Community-based PA interventions improve older adult physical activity but little is known on how PA interventions can be adapted to meet the needs of a growing segment of the Canadian population: ethnic minority older adults. This thesis aimed to describe why and how coordinators and activity coaches adapted Choose to Move implementation strategies and content for use with Chinese older adults. The socio-ecological model and Framework for Reporting Adaptations and Modifications-Enhanced guided this focused ethnography. Framework analysis was used to analyze interviews (n=12), ethnographic observations (n=11) and meetings minutes (n=38). Connection with other organizations, service structure, time required to deliver the intervention, participant characteristics and drop out influenced both adapted implementation strategies and content. Factors that influenced adapted implementation strategies only included partnership with the project team, available resources, social networks and volunteer characteristics. Factors that influenced adapted content only included activity coach competency, desire for variety, spoken language, literacy and engagement and motivation. Adapted implementation strategies included adding a referral network, adding activity inventories, sharing recruitment resources, adding volunteers, recruitment through other departments, condensing recruitment material, switching to other screening tools, volunteer training, recruitment during the delivery phase and extending the implementation period. Adapted content included group-based goals, adding guest speakers to group meetings, visual goal-setting, peer-led movement breaks, adding group meeting activities, hosting group meetings during intake, reiterating goals and objectives, extending check-ins, providing additional resources and cancelling components or programs. The findings from this study contribute to the scarce literature on adapting evidence-based PA interventions for Chinese older adults and may inform future intervention adaptations and delivery. Those who deliver evidence-based interventions to ethnic minority older adults should consider socioecological factors when planning for adapted implementation and delivery.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat