Defining Translational Significance in Gerontology

Innovation in Aging requires a statement from authors on translational significance. This requirement forces authors to consider the implications of their research for changing some component of aging. How does the research address a challenge posed by aging bodies, minds, relationships, or societies? The editorial board has developed criteria for assessing translational significance. Translational research must meet at least one of three criteria. It (i) must predict or explain a health or behavioral outcome, (ii) be advanced enough in deployment or development to assess these effects, and (iii) have a clear pathway to large-scale program delivery or change in clinical practice. The criteria rule out some kinds of submissions, such as scale development, single-case studies, or reviews of literature. We use these criteria to structure each article’s required translational significance statement. Rethinking translation may help focus research across the full set of GSA journals.

Using Process Evaluation Results to Compare Peer and Adult Leader Delivery of the Paws (Peer-Education about Weight Steadiness) Club Program

To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.

I Can for Kids: Experiences and Perceived Outcomes of a Summer Food Program for Low-Income Households at Risk of Food Insecurity in Calgary, Alberta, Canada

Objectives The prevalence of household food insecurity increases in the summer when school meals are no longer accessible, which can negatively impact children's health and wellbeing. Summer food programs, such as I Can for Kids (IC4K) in Calgary, Alberta, Canada, aim to reduce food insecurity in low income households with school-aged children during the summer months. Qualitative studies have not yet examined whether or how grocery gift cards (GGC) can reduce experiences of food insecurity among low-income households. We explored recipients’ and agency staff experiences and perceived outcomes of receiving or distributing GGC from IC4K. Methods This study used qualitative descriptive methodology. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Semi-structured interviews were conducted between August and November 2020 with 38 primary caregivers (i.e., GGC recipients) and 17 agency staff who distributed GGC. Directed content analysis was used to analyze the data from each set of interviews using a deductive-inductive approach. Codes were combined into themes that summarized GGC recipients’ and agency staff's experiences and perceived outcomes of receiving or distributing GGC, and feedback to improve program delivery. Results Three themes were generated from the data. The first theme was Financial Relief and reflected increased self-efficacy, improved diet quality, and reduced household stress from receiving GGC. The second theme was Social Connectedness and described enriched family relationships, enhanced rapport between staff and recipients, and increased recipient social capital. The last theme was Program Enhancements and described feedback to improve program delivery by extending program duration, increasing strategic direction to staff on GGC distribution, and additional promotional efforts to increase awareness of GGC availability. Conclusions GGC recipients and agency staff perceived that GGC offered financial relief and enhanced social connections for recipients, and suggested areas for program improvements. Study findings can inform improvements to summer food programs that deliver GGC to reduce food insecurity among low-income households in the summer. Funding Sources Funding provided by the O'Brien Institute for Public Health at the University of Calgary.

Assessing Program Delivery from the Perspective of Service Providers: the Ontario Early Years Centres’ School Readiness Program

This paper assesses the School Readiness program as delivered in two Ontario Early Years Centres (OEYCs) in Toronto. Information about program goals and delivery methods gleaned from interviewing three Child Development Consultants who ran the program in the last year is analyzed within the context of existing scholarship on and practices in early childhood learning and development. The interviewers' observations and comments form the basis for the assessment of the effectiveness of the OEYC School Readiness program. An important part of assessing effectiveness is determining whether the OEYCs and program workers have set clearly defined learning outcomes for program participants and how, if at all, the program measures these outcomes. In assessing program effectiveness, one of the factors considered is to what extent the OEYCs acknowledge and address the needs of an important demographic: immigrant children (and their support network of parents/caregivers and families). The observations and recommendations made in this study are intended to help service providers in the OEYCs develop a best practice model for program delivery, including arriving at a better sense of how they conceive of school readiness.

Assessing Program Delivery from the Perspective of Service Providers: the Ontario Early Years Centres’ School Readiness Program

This paper assesses the School Readiness program as delivered in two Ontario Early Years Centres (OEYCs) in Toronto. Information about program goals and delivery methods gleaned from interviewing three Child Development Consultants who ran the program in the last year is analyzed within the context of existing scholarship on and practices in early childhood learning and development. The interviewers' observations and comments form the basis for the assessment of the effectiveness of the OEYC School Readiness program. An important part of assessing effectiveness is determining whether the OEYCs and program workers have set clearly defined learning outcomes for program participants and how, if at all, the program measures these outcomes. In assessing program effectiveness, one of the factors considered is to what extent the OEYCs acknowledge and address the needs of an important demographic: immigrant children (and their support network of parents/caregivers and families). The observations and recommendations made in this study are intended to help service providers in the OEYCs develop a best practice model for program delivery, including arriving at a better sense of how they conceive of school readiness.

Fidelity Assessment Checklist Development for Community Nursing Research in Early Childhood

Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between “very good” to “excellent,” with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.

An Internet-Based Intervention for Cardiovascular Disease Management Integrated With Primary Care Electronic Health Records: Mixed Methods Evaluation of Implementation Fidelity and User Engagement

Background Growing evidence supports the benefits of eHealth interventions to increase patient engagement and improve outcomes for a range of conditions. However, ineffective program delivery and usage attrition limit exposure to these interventions and may reduce their effectiveness. Objective This study aims to evaluate the delivery fidelity of an eHealth intervention, describe use patterns, compare outcomes between low and high users, and identify mediating factors on intervention delivery and receipt. Methods This is a mixed methods study of an internet-based intervention being evaluated for effectiveness in a randomized controlled trial (RCT). The intervention comprised medication and cardiovascular disease (CVD) risk data uploaded from the primary care electronic health record (EHR); interactive, personalized CVD risk score estimation; goal setting and self-monitoring; an interactive social forum; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records. Results Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes. Conclusions A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use.

Situational Approach to Suicide Prevention Among Australian Males: The Role of Unemployment

This article contends that the prevention of suicide, particularly in Australia, needs to be re-imagined, by expanding a medical/crisis response to take into account social factors that contribute to the incidence of suicide and suicidal ideation. The particular area of unemployment/underemployment provides one such example of the social determinants of suicide, and argues that the nuances of gender and Aboriginality need also to be accounted for in research and program delivery. This analysis has been dubbed the ‘Situational Approach to Suicide Prevention’.