What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale?
<h4>Background</h4>Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For C...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0268164 |
| _version_ | 1797828121363218432 |
|---|---|
| author | Heather A McKay Heather M Macdonald Lindsay Nettlefold Katie Weatherson Samantha M Gray Adrian Bauman Karim M Khan Joanie Sims Gould |
| author_facet | Heather A McKay Heather M Macdonald Lindsay Nettlefold Katie Weatherson Samantha M Gray Adrian Bauman Karim M Khan Joanie Sims Gould |
| author_sort | Heather A McKay |
| collection | DOAJ |
| description | <h4>Background</h4>Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases.<h4>Methods</h4>We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older (≥ 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2.<h4>Results</h4>Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p<0.001), and was maintained at 6- and 18-months. In all participants, social isolation and loneliness decreased during the intervention, but increased during follow-up. Mobility improved during the intervention in younger participants only. Health-related quality of life according to EQ-5D-5L score did not change significantly in younger or older participants. However, EQ-5D-5L visual analog scale score increased during the intervention in younger participants (p<0.001), and this increase was maintained during follow-up. Across all outcomes, the median difference in effect size, or voltage drop, between Phase 3 and Phases 1-2 was 52.6%. However, declines in social isolation were almost two times greater in Phase 3, compared with Phases 1-2.<h4>Conclusion</h4>Benefits of health-promoting interventions-like CTM-can be retained when implemented at broad scale. Diminished social isolation in Phase 3 reflects how CTM was adapted to enhance opportunities for older adults to socially connect. Thus, although intervention effects may be reduced at scale-up, voltage drop is not inevitable. |
| first_indexed | 2024-04-09T12:59:11Z |
| format | Article |
| id | doaj.art-708779a6f2da464bb367f352e8e57d02 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T12:59:11Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-708779a6f2da464bb367f352e8e57d022023-05-13T05:31:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01185e026816410.1371/journal.pone.0268164What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale?Heather A McKayHeather M MacdonaldLindsay NettlefoldKatie WeathersonSamantha M GrayAdrian BaumanKarim M KhanJoanie Sims Gould<h4>Background</h4>Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases.<h4>Methods</h4>We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older (≥ 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2.<h4>Results</h4>Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p<0.001), and was maintained at 6- and 18-months. In all participants, social isolation and loneliness decreased during the intervention, but increased during follow-up. Mobility improved during the intervention in younger participants only. Health-related quality of life according to EQ-5D-5L score did not change significantly in younger or older participants. However, EQ-5D-5L visual analog scale score increased during the intervention in younger participants (p<0.001), and this increase was maintained during follow-up. Across all outcomes, the median difference in effect size, or voltage drop, between Phase 3 and Phases 1-2 was 52.6%. However, declines in social isolation were almost two times greater in Phase 3, compared with Phases 1-2.<h4>Conclusion</h4>Benefits of health-promoting interventions-like CTM-can be retained when implemented at broad scale. Diminished social isolation in Phase 3 reflects how CTM was adapted to enhance opportunities for older adults to socially connect. Thus, although intervention effects may be reduced at scale-up, voltage drop is not inevitable.https://doi.org/10.1371/journal.pone.0268164 |
| spellingShingle | Heather A McKay Heather M Macdonald Lindsay Nettlefold Katie Weatherson Samantha M Gray Adrian Bauman Karim M Khan Joanie Sims Gould What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? PLoS ONE |
| title | What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? |
| title_full | What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? |
| title_fullStr | What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? |
| title_full_unstemmed | What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? |
| title_short | What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? |
| title_sort | what is the voltage drop when an effective health promoting intervention for older adults choose to move phase 3 is implemented at broad scale |
| url | https://doi.org/10.1371/journal.pone.0268164 |
| work_keys_str_mv | AT heatheramckay whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT heathermmacdonald whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT lindsaynettlefold whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT katieweatherson whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT samanthamgray whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT adrianbauman whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT karimmkhan whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale AT joaniesimsgould whatisthevoltagedropwhenaneffectivehealthpromotinginterventionforolderadultschoosetomovephase3isimplementedatbroadscale |