Adapting an older adult health promotion intervention for scale-up across British Columbia before and during COVID-19

By 2050, 30% of Canadians will be older adults. Therefore, healthy aging is a public health priority. Physical activity (PA) interventions promote healthy aging by decreasing chronic disease prevalence and preserving older adults’ mobility and independence. To improve population health, interventions need to be scaled-up to reach more older people and adapted for delivery in diverse settings. Yet, we know little about how to implement and adapt health promotion interventions for scale-up to meet the diverse needs of older adults. I used quantitative and qualitative methods to investigate how to adapt an older adult health promotion intervention (Choose to Move, CTM) for implementation and scale-up across British Columbia (BC), before and during COVID-19. Study 1 is a systematic review of older adult PA intervention studies (n=137) that evaluated implementation and/or scale-up. Few studies (n=11/137) were guided by implementation/scale-up frameworks, theories, or models and few studies (n=22/137) sought to relate quality of implementation to health impact of the intervention on participants. Only six interventions were scaled-up. Thoughtful, planned evaluation of implementation and scale-up was lacking. Study 2 describes a systematic process of adapting CTM, and the resultant adaptations made to CTM, in preparation for scale-up across BC. Based on CTM delivery partner and older adult participant input, we adapted CTM program content, context, and training modules to better meet their needs. Study 3 describes factors that influenced implementation of CTM in the home environment (CTM at Home) during BC’s 1st wave of COVID-19, and CTM at Home’s impact on older adult mobility and PA. Activity coaches (intervention deliverers) considered it feasible and acceptable to adapt CTM for virtual delivery across BC. Approximately two-thirds of CTM at Home older adult participants maintained or increased their mobility and PA at 3-months (post-intervention). Together, these studies enhance the knowledge base on the process of adapting older adult health promotion interventions in preparation for implementation and scale-up, before and during COVID-19. CTM at Home is a flexible program that has potential to be scaled-up across Canada to promote older adults’ health in general, or in response to other pandemics should they befall us in future.Medicine, Faculty ofExperimental Medicine, Division ofGraduat