Implementation of an Evidence-Based Exercise Program for Older Adults in South Florida.

Introduction. This study aimed to examine how well an evidence-based physical activity program could be translated for wide scale dissemination and adoption to increase physical activity among community-dwelling older adults. Methods. Between October 2009 and December 2012, reach, fidelity, dosage, ease of implementation, and barriers to translation of EnhanceFitness (EF) were assessed. To assess effectiveness, a pretest-posttest design was used to measure increases in functional fitness (chair stands, arm curls, and the up-and-go test). Results. Fourteen community-based agencies offered 126 EF classes in 83 different locations and reached 4,490 older adults. Most participants were female (72%). Thirty-eight percent of participants did not complete the initial 16-week EF program. The 25% who received the recommended dose experienced an increase in upper and lower body strength and mobility. Further, participants reported high satisfaction with the program. Conclusion. EF was successfully implemented in a variety of settings throughout South Florida and reached a large number of older adults. However, challenges were encountered in ensuring that those who participated received a program dose that would lead to beneficial gains in functional fitness.

Recruiting and Engaging Older Men in Evidence-Based Health Promotion Programs: Perspectives on Barriers and Strategies.

Evidence-based health promotion programs are effective at reducing health risks and healthcare costs among older adults, but few men participate in the programs. This mixed methods study aimed to gain insight into the barriers to recruiting and engaging older men in evidence-based health promotion programs offered by the Healthy Aging Regional Collaborative of South Florida (HARC). Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate the findings. Themes among barriers to male participation included women outnumbering men in the implementation sites and programs, conflict between male gender roles and the programs, and preference for other activities. Themes among strategies included public support of programs by male community leaders, program advertisements featuring males, and adapting program content. Survey results supported themes identified in the focus group. Nearly 78% of the survey respondents agreed that the perception of exercise programs as feminine was a barrier and over 90% of the survey respondents believed program advertisements featuring men would increase male participation. Findings indicate that health promotion programs and recruiting strategies need to be tailored to the unique needs and preferences of older men to improve participation.

Intermediate outcomes of chronic disease self-management program offered by members of the Healthy Aging Regional Collaborative in South Florida.

Currently, 80% of adults over the age of 65 have at least one chronic disease. The Chronic Disease Self-management Program (CDSMP) focuses on increasing self-efficacy for managing chronic disease. Few studies have evaluated the effectiveness of CDSMP when offered by multiple agencies, as a collaborative effort, in community-based settings. Seven agencies delivered 108 CDSMP workshops at 81 sites from October 1, 2008, to December 31, 2010. A total of 811 participants were eligible for analysis. Participants completed surveys at baseline and week 6, the end of instruction. Controlling for agency effect and general health at baseline, the general linear model was used to assess the significance of outcomes at 6 weeks. Outcomes showing significant improvement included self-efficacy to manage disease (p = .001), self-efficacy to manage emotions (p = .026), time spent walking (p = .008), and perceived social/role activities limitations (p = .001). Findings showed that CDSMP is an effective program at improving self-efficacy, increasing physical activity, and decreasing limitations.

Factors associated with the completion of falls prevention program.

Falls and fear of falling can affect independence and quality of life of older adults. Falls prevention programs may help avoiding these issues if completed. Understanding factors that are associated with completion of falls prevention programs is important. To reduce fear of falling and increase activity levels, a Matter of Balance (MOB) and un Asunto de Equilibrio (ADE) workshops were offered to 3420 older adults in South Florida between 1 October 2008 and 31 December 2011. Workshops were conducted in English or Spanish over eight, 2-hour sessions. Participants completed a demographic and a pre-post questionnaire. Factors associated with program completion were identified using logistic regression. For MOB, females were more likely to complete the program (OR = 2.076, P = 0.02). For ADE, females, moderate and extreme interference by falls in social activities were found to affect completion (OR = 2.116, P = 0.001; OR = 2.269, P = 0.003 and OR = 4.133, P = 0.008, respectively). Different factors predicted completion of both programs. Awareness of these factors can help lower the attrition rates, increase benefits and cost effectiveness of program. Future research needs to explore why certain groups had a higher likelihood of completing either program.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

INTRODUCTION: The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). METHODS: Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N=682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. RESULTS: All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. CONCLUSION: Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

Domestic abuse against elder women and perceived barriers to help-seeking.

The study's (n = 447) purposes were to (1) describe relationships of abuser behavior to elder women's perception of barriers to help-seeking; (2) compare fit of model to participants' levels of abuse, race-ethnicity, age, and gender and relationship of identified close other; and (3) determine extent to which the model differentiated relationship of abuser to participant and level of abuse. Analyses identified six factors contributing to the overall barrier score, accounting for 84% of total variance (χ2/df = 1.527, CFI = .989, RMSEA = .034), including three internal and two external factors and a single abuser behavior factor that were invariant across participant characteristic; however, covariances did differ.

Evaluation of a community-based falls prevention program in South Florida, 2008-2009.

INTRODUCTION: Many older adults experience fear of falling, which may reduce participation in routine activities. A Matter of Balance (MOB) and Un Asunto de Equilibrio (ADE) workshops were offered in South Florida to reduce fear of falling and increase activity levels in older adults. The objectives of this study were to evaluate the effectiveness of the lay leader model of the programs in the first year of their implementation and to further report on participant outcome measures. METHODS: We analyzed reach, adoption, and implementation data for participants who attended workshops between October 1, 2008, and December 31, 2009, who were aged 60 years or older, and who had both baseline and posttest outcome data. Workshops were in English and Spanish and consisted of 8 two-hour sessions. Participants completed a 7-item baseline and posttest questionnaire that consisted of a falls management scale, a social activity item, and modified version of Physician-Based Assessment and Counseling on Exercise. We analyzed outcome data on multiple characteristics using a general linear model. A class evaluation questionnaire measured participant satisfaction. RESULTS: Results for 562 participants who provided both baseline and posttest data showed significant improvement on 6 of 7 questions for MOB and all questions for ADE (P < .001). The 391 participants who provided evaluation data indicated that the programs were effective, beneficial, and well organized. CONCLUSION: Lay leaders successfully implemented the programs in community settings. The programs were effective in reducing fear of falling among older adults.

Barriers to help-seeking for older women who experience intimate partner violence: a descriptive model.

PURPOSE: The paper describes a model of barriers to help-seeking (MBHS) for older women who experience domestic violence (DV). DESIGN AND METHODS: Data were collected from 134 women ages 45 to 85 years in 21 focus groups. Computer-assisted qualitative data analysis software (ATLAS.ti) was used to organize transcript analysis and provided access to the quotations upon which codes, themes, relationship maps, and other elements of the analysis were constructed. RESULTS: Twelve themes emerged that showed strong relationships with experience of DV and barriers to help-seeking concepts. The resulting model of barriers to help-seeking (MBHS) illustrates how identified internal and external factors interrelate with each other and with an abuser's behaviors to create help-seeking barriers. The model also reflects the determination that, for study participants, there was no discernable point where characteristics of the experience of DV ended and resistance to help-seeking began. IMPLICATIONS: Development of services specifically suitable to the needs and desires of older women who experience DV is vital. Professionals in all service segments must more fully understand the help-seeking barriers that older DV victims face. To this end, the research community is challenged to replace myths and stereotypes about the nature and prevalence of DV among older people with empirically derived knowledge.

Internal barriers to help seeking for middle-aged and older women who experience intimate partner violence.

There has been relatively little qualitatively or quantitatively published research to guide the field in identifying and addressing barriers to seeking help for older women who experience domestic violence. Women over the age of 45 have seldom been participants in research on domestic violence. This paper describes results from a qualitative study that focused on reactions to and internalization of abusive behaviors of an intimate partner. Twenty-one focus groups were conducted with 134 middle- aged and older women. Analysis of the data identified six factors that describe reactions to abusive behavior that become barriers to help seeking, including self-blame, powerlessness, hopelessness, the need to protect family, and the need to keep such abuse secret from others. These.

Planning for long-term care: concept, definition, and measurement.

PURPOSE: This study explores the development and testing of an instrument to measure long-term-care planning behavior. DESIGN AND METHODS: Researchers operationalized proposed constructs and response styles as statements in a questionnaire. A telephone survey involved 150 randomly selected residents of Miami-Dade County, Florida who were between the ages of 55 and 70. Responses underwent exploratory and confirmatory factor analyses and reliability testing. RESULTS: The trimmed long-term-care planning instrument of 23 items had five subscales with high internal reliability (coefficients >.70), a comparative fit index of.987, and a root mean square error of approximation of.050. Responses involved making choices about housing, readiness to use help from family and friends, maintaining one's health, saving and investing money, and not accepting the need to ask for help. IMPLICATIONS: Future research of long-term-care planning behaviors can use the instrument. Practitioners may use the instrument as a diagnostic inventory, alone or in combination with personalized educational interventions aimed at increasing awareness of and planning for future dependency and long-term-care assistance.