Title I: Modernizing Definitions and Programs Under the Administration on Aging

The recent reauthorization of the Older Americans Act adds language and definitions to current issues facing the aging population. Specifically, Title I includes definitions related to program adaptation and coordination, workforce and long-term care issues, nutrition and social isolation, as well as family caregivers. Different from the last authorization, these definitions span beyond the individual experience to include other entities impacted by an aging society, such as the workforce and families. Overall, the Title I reauthorization seeks to modernize policy to reflect the current influx of the older adult population and its consequences.

Using baseline target moderation to guide decisions on adapting prevention programs

Tom Dishion, a pioneer in prevention science, was one of the first to recognize the importance of adapting interventions to the needs of individual families. Building towards this goal, we suggest that prevention trials be used to assess baseline target moderated mediation (BTMM), where preventive intervention effects are mediated through change in specific targets, and the resulting effect varies across baseline levels of the target. Four forms of BTMM found in recent trials are discussed including compensatory, rich-get-richer, crossover, and differential iatrogenic effects. A strategy for evaluating meaningful preventive effects is presented based on preventive thresholds for diagnostic conditions, midpoint targets and proximal risk or protective mechanisms. Methods are described for using the results from BTMM analyses of these thresholds to estimate indices of intervention risk reduction or increase as they vary over baseline target levels, and potential cut points are presented for identifying subgroups that would benefit from program adaptation because of weak or potentially iatrogenic program effects. Simulated data are used to illustrate curves for the four forms of BTMM effects and how implications for adaptation change when untreated control group outcomes also vary over baseline target levels.

Adaptação Cultural de Intervenções Preventivas em Saúde Mental Baseadas em Evidências

Resumo A adaptação cultural de intervenções preventivas em saúde mental baseada em evidências tem sido largamente praticada ao redor do mundo. No Brasil, estudos com esse foco são raros. Tal processo deve ser sistemático para alcançar, por um lado, a preservação dos componentes centrais da intervenção original e, por outro, a sensibilidade cultural para com a cultura adotante de modo a respeitar a sua identidade, valores e necessidades. Realizou-se uma revisão narrativa acerca de modelos de adaptação cultural de intervenções preventivas importadas - Planned Intervention Adaptation (PIA) Protocol; Strengthening Families Program Adaptation Model (SFP_Ad); e ADAPT-ITT - cujas etapas e características foram analisadas. Conclui-se que a adaptação cultural de programas preventivos em saúde mental deve basear-se em estudos empíricos, práticas colaborativas e sensibilidade ética. Estudos futuros devem investigar o custo-benefício do investimento na adaptação cultural de intervenções internacionais versus o desenvolvimento de intervenções locais, para os quais são necessárias capacidades diversas.

Lessons Learned in the Implementation of HealtheSteps: An Evidence-Based Healthy Lifestyle Program

Health eSteps is a pragmatic, evidence-based lifestyle prescription program aimed at reducing the rates of chronic disease, in particular, type 2 diabetes. A process evaluation was completed to assess the feasibility of the implementation of HealtheSteps in primary care and community-based settings across Canada. Key informant interviews (program providers and participants) were conducted to identify facilitators and barriers to implementation and opportunities for future program adaptation and improvement. Forty-three interviews were conducted across five regions in Canada (15 sites ranging from remote, rural, suburban, and urban). Transcripts were analyzed using a qualitative naturalistic inquiry approach with several facilitating factors identified: pragmatic program design, in-line goals with sites’ mandates, and access to ongoing support. Barriers were related to administrative challenges such as booking space, personnel changeovers, and scheduling participants. Findings from this analysis revealed insights on program delivery, design, and importance of site champions. Key lessons learned focused on two areas: infrastructure support and program implementation. The application of these learnings from the HealtheSteps program may inform the development of strategies that can optimize program adaptation and support while reducing real and perceived barriers experienced, thus increasing the success of translation of the evidence-based diabetes program to different points of care.

Moving From Knowledge to Action in Partnership: A Case Study on Program Adaptation to Support Optimal Aging in the Context of Migration

This case study explored how a researcher–community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners’ perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners’ opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.