Implementation and effectiveness of Choose to Move, adapted to reduce resource use

Abstract Overview

Background: Investment in scale-up and sustainment of effective health-promoting interventions is often hampered by competing demands on scarce health dollars. Reducing resource use (e.g., delivery costs) while maintaining program effectiveness is the ‘holy grail’. We adapted and scaled-up an evidence-informed, health-promoting program for older adults (Choose to Move; CTM) across four phases (2016-2024). For CTM Phase 4 (P4) we reduced resource use by decreasing program delivery hours by activity coaches.

Purpose: To assess implementation and effectiveness of the CTM P4 program.

Methods: We conducted a type 2 hybrid effectiveness-implementation study involving 137 CTM programs (1126 older adults; 59-74 years, 75+ years) delivered by 29 activity coaches. Pre- and post- (3 months) intervention, we assessed implementation (e.g., dose, fidelity) and older adults’ physical activity (PA), mobility, social isolation, and loneliness.

Results: CTM P4 required 40% fewer activity coach delivery hours than CTM P3. Implementation indicators demonstrated that P4 was delivered as intended. Post-intervention, PA (+1.5 days/week; 95% CI 1.3, 1.6), and mobility (+0.8; 95% CI: 0.4, 1.3), social isolation (+0.92; 95% CI: 0.67, 1.17), and loneliness scores (-0.24; 95% CI: -0.34, -0.13) improved in those <75 years. Among those ≥75 years, PA (+1.0 days/week; 95% CI, 0.7, 1.2), and mobility (+1.1; 95% CI: 0.4, 1.8), and social isolation scores (+0.47; 95% CI: 0.08, 0.86) improved post-intervention. Participant-level benefits were comparable to, and for some outcomes (PA and social isolation in those <75) greater than, those observed in P3.

Conclusions: CTM was co-designed as a flexible program, adapted over nine years based on user group needs and preferences. This flexibility allowed us to reduce activity coach delivery hours without compromising implementation or benefits of CTM on older adults’ health.

Practical applications: Supporting scalability and sustainability of evidence-informed health-promoting interventions is key to improving population health.

Funding: Canadian Institutes of Health Research

Additional Authors

Name: Lindsay Nettlefold

Affiliation: Active Aging Research Team, University of British Columbia

Presenting Author: no

Name: Zoe Szewczyk

Affiliation: University of Sydney

Presenting Author: no

Name: Adrian Bauman

Affiliation: University of Sydney

Presenting Author: no

Name: Joanie Sims Gould