An evidence-informed and stakeholder co-designed physical and community mobility intervention for older adults facing health inequities: the EMBOLDEN study

Article type
Authors
Neil-Sztramko S1, Teggart K1, Phillips S1, Sherifali D1, Fitzpatrick-Lewis D1, Newbold B1, Coletta G1, Alvarez E1, Kuspinar A1, Raina P1, Ganann R1
1McMaster University
Abstract
Background: Physical mobility and social participation are requisite for independence and quality of life as one ages. Barriers to mobility lead to social isolation, poor physical and mental health, all of which are precursors to frailty. To date, most mobility-enhancing interventions for older adults have been designed by researchers with little-to-no consultation with older adults or service providers, and delivered in controlled settings. Thus, translation and scalability is often impractical.
Objectives: Using an evidence-informed public health approach, the purpose of EMBOLDEN (Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design) is to combine research evidence, local context, and community needs and preferences to co-design an intervention targeting physical and community mobility, improving diet quality, social participation and system navigation.
Methods: An environmental scan that identified four neighborhoods with high health inequity was used to map existing relevant health and social programs and identify gaps. In parallel, an umbrella review was conducted to identify high-quality evidence of effective interventions targeting physical activity and/or nutrition in community-dwelling older adults. Five databases were searched using a comprehensive search strategy. Title/abstract screening, full text review, critical appraisal (using AMSTAR2) and data extraction were performed independently by two reviewers. Key findings across reviews were compiled and will be reported to key stakeholders to inform intervention design. Qualitative persona-scenario interviews with older adults and service providers will be used to understand experiences, gaps, and priority features.
Results: The environmental scan identified key assets and gaps to be explored in the co-design process. The umbrella review identified 34 systematic reviews describing heterogeneous group-based physical activity and multi-modal interventions. No reviews focused on nutrition only. Review findings were compiled to identify the best available evidence of effectiveness across five categories of outcomes: aerobic capacity, muscular strength, physical function, balance, and falls. Qualitative data collection and analysis are underway. Our next aims are to work with partners to co-design the evidence-informed intervention, implementation and evaluation plan.
Conclusions: Collaborating with community partners and using multiple sources of evidence helps to bring important contextual information to the design of a community-based intervention. Our goal is to implement a feasible intervention that meets the needs of the community with potential for long-term sustainability.
Patient or healthcare consumer involvement: Older adults and local health and social service providers are members of our research team and were involved in preparing the research proposal. A larger group of stakeholders are engaged monthly as members of a Strategic Guiding Council and provide important input into each phase of the research.