Abstract

BackgroundBy 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders.MethodsPositive-Minds–Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs.ResultsParticipants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency’s ability to address the health and well-being of elders, capacity-building strategies such as a “train-the-trainer” initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital.ConclusionsAugmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs.Trial registrationClinicalTrials.gov, NCT02317432.

Highlights

  • By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group

  • We addressed two main questions: first, do Communitybased organizations (CBOs) staff perceive the clinical trial as building their capacity to implement Positive-Minds–Strong Bodies (PM-SB) in CBOs? Second, what do CBO staff identify as barriers to implementation after the clinical trial ends, and what strategies can be used to overcome them? Findings highlight recommendations to ensure long-term PM-SB adoption by CBOs in the future and, more broadly, help improve Evidence-based interventions (EBI) implementation in CBOs

  • We found a high level of self-reported individual capacity in conducting the intervention and low heterogeneity, indicated by the percentage of respondents that strongly agree or agree with these statements (1 or 2 on Likert scale)

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Summary

Introduction

By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group This population has an increased risk of mental and physical disability with significant barriers to access care. Even when symptoms are recognized, elders may not access services because of a lack of providers who can serve linguistic minorities, transportation difficulties, and limited knowledge of where to go [17]. When these conditions are untreated, they lead to substantial incapacity and increased risk of disability [5, 18, 19]

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