Translating PEARLS: Lessons Learned from Providers and Participants

Abstract

The Program to Encourage Active, Rewarding Lives (PEARLS) began 15 years ago when the director of our local area agency on aging (AAA) approached the University of Washington Health Promotion Research Center (HPRC). She was looking for a way to serve older adults with depression, including those served by the agency’s home and community-based services (HCBS) program. Depression in this population is high, when we analyzed data from 16,032 elders receiving HCBS in Washington State in 2005, two-thirds met criteria for clinical depression (1). This partnership between the university and local aging service providers created PEARLS, a brief, home-based program to teach people tools to effectively tackle the things in their lives that overwhelm them, and to in turn, improve their depressive symptoms. These tools include a seven-step approach to problem-solving and action planning to increase physical, social, and pleasant activities. PEARLS is a structured intervention delivered in 6 to 8 one-hour visits over the course of a 4- to 5-month period. Sessions are tapered from weekly to monthly to give participants an opportunity to practice and learn the skills. More information about the program can be found at www.pearlsprogram.org. The Program to Encourage Active, Rewarding Lives (PEARLS) reduced depression and improved quality of life in two randomized controlled trials (2, 3). Since then, UW HPRC continues to work with the local AAA and other sites to help translate the evidence-based program into everyday practice. The implementation challenges are striking given that PEARLS includes several ingredients for program success: it was designed with an adopting organization as a key partner, the model trains existing staff to deliver PEARLS so new staff do not need to be hired, and the program is successfully funded in some locations through several diverse funding streams. We have learned a lot from organizations and staff that deliver PEARLS through our monthly technical assistance calls and other dissemination research and activities. We have also learned a lot from program participants through PEARLS sessions, focus groups and interviews. A selection of key learnings is provided below, organized by Glasgow’s RE-AIM framework to help improve the success of evidence-based program delivery in “real-world” settings (4–6). This framework consists of five elements – reach, effectiveness, adoption, implementation, and maintenance – that present the overall public health impact of a program or policy. It is important for programs to perform well across each of these five elements in order to maximize overall impact (7).