Effective Peer Leader Attributes for the Promotion of Walking in Older Adults

'If you want something to happen, you have to do it yourself': Understanding rural Australian's perspectives of health volunteering

ISSUE ADDRESSED

Rurality is associated with poorer health outcomes and access to health services, yet a strength of rural living includes community cohesion indicated by high rates of volunteering. While volunteerism is an effective means to target health needs in resource-restricted contexts, research on volunteerism to address rural Australian health needs is limited. This research aimed to explore rural adults' perspectives of volunteerism in local activities and programs that had a direct health related benefit (health volunteering).

METHODS

Eight people from the Murray Mallee region of South Australia participated during April 2021, ranging in age from 32 to 75 years. Participants were invited to one-on-one interviews that occurred via a phone call or teleconference meeting, which were audio-recorded and transcribed verbatim to facilitate thematic analysis.

RESULTS

Seven main themes emerged. Participants identified that (1) health volunteering takes many forms, (2) health volunteering affords local ownership and accessibility, (3) health volunteers have particular skills and values, but also (4) gain social benefits and learn new skills. Rural health volunteering was also associated with (5) a variety of personal costs, and (6) there are several environmental barriers and (7) facilitators to rural health volunteering that should be considered when designing health programs.

CONCLUSION

Results provide insight into how rural communities can enhance the development and application of volunteering roles to support health volunteering. SO WHAT?: Including local champions, reducing the financial burden and developing support networks for volunteers are practical suggestions to enhance levels of volunteering for health in rural settings.

A qualitative longitudinal study of motivation in the REtirement in ACTion (REACT) physical activity intervention for older adults with mobility limitations

BACKGROUND

Physical activity (PA) is beneficial for older adults' health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory.

METHODS

Participants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis.

RESULTS

Perceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants' support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months).

CONCLUSIONS

Motivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants' capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans.

TRIAL REGISTRATION

The REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).

"More than just a walk in the park": A multi-stakeholder qualitative exploration of community-based walking sport programmes for middle-aged and older adults

In spite of the large-scale growth of walking sport (WS) programmes globally, limited research has explored the experiences of the key stakeholders involved in such programmes (i.e. decision-makers, facilitators, and players). We aimed to explore stakeholder experiences of community-based WS programmes to better understand the appeal of such sport options for middle-aged and older adults, and propose tentative recommendations for the feasibility and sustainability of these types of programmes. We conducted semi-structured interviews with 21 stakeholders who were involved with WS programmes in Australia as decision-makers, facilitators, and/or players. Data were analysed with reflexive thematic analysis. Four key themes pertaining to the WS experience were identified - 'a renewed lease of life', 'navigating ageing stereotypes', 'tension between organisational demands and players' needs', and 'WS facilitators as catalysts of success'. Specifically, we found that WS participation enabled a positive ageing discourse for middle-aged and older adults. WS players had to negotiate stereotypes that, at times, were perceived as participation barriers. We also noted some tensions between the demands of sport organisations and the needs of middle-aged and older adults regarding sport participation. Finally, we also noted the importance of the facilitators' role in increasing accessibility of, and long-term participation in, such programmes. We suggest that to offer feasible and sustainable community-based WS programmes across Australia, incompatibilities across various stakeholders' perspectives need to be addressed.

Intervention in Older Urban-Dwelling Veterans With Dysmobility: Protocol for a Pilot Feasibility Clinical Trial

BACKGROUND

The majority of older veterans do not meet the minimum healthy diet or physical activity recommendations despite known benefits. Identifying ways to increase adherence to programs that improve dietary quality and physical activity may reduce the risk of disability in older veterans. Peer-based interventions may be one method for facilitating lasting behavior change because peers often share a common culture and knowledge regarding problems their community experiences.

OBJECTIVE

This study aims to develop, pilot, and evaluate a theory-driven, 12-week, peer-led nutrition and exercise intervention that targets older veterans with dysmobility and assess its feasibility in 2 diverse urban areas with underrepresented populations.

METHODS

Community-dwelling veterans aged >65 years with self-reported dysmobility (defined as difficulty in at least 1 of the following: walking quickly across a street, walking a mile, ascending a flight of stairs, rising from a chair without the use of arms, or a fear of falling) from 2 Department of Veterans Affairs Geriatric Research, Education, and Clinic Centers (Baltimore, Maryland, and San Antonio, Texas) will be eligible to participate. First, this study will use validated mixed methods via web-based surveys (n=50 per site) to assess potential physical, social or environmental, and behavioral or lifestyle barriers that affect physical activity and dietary quality (phase 1). Next, we will use knowledge gained from these assessments and feedback from a focus group (n=10 per site) to adapt established Department of Veterans Affairs diet and exercise program materials to develop peer-led intervention materials and train peer leaders (n=3 per site). Finally, we will determine the feasibility and acceptability of the intervention to assess reach (recruitment and retention), adoption (satisfaction, perceived utility, attendance, and engagement), and implementation (fidelity of intervention), as well as the estimated magnitude and potential impact on selected outcomes (ie, diet quality and mobility) in 20 older veterans with dysmobility (n=10 per site).

RESULTS

The study was funded on January 1, 2022, with a projected data collection period of June 1, 2022, to December 31, 2023.

CONCLUSIONS

This study offers an innovative approach to identifying strategies that increase long-term adherence to lifestyle modification programs that improve dietary quality and physical activity in older veterans with dysmobility.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04994938; https://clinicaltrials.gov/ct2/show/NCT04994938.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/39192.

Leading the way together: a cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups

BACKGROUND

With a rapidly ageing society, healthy ageing has become a key challenge. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing amongst older adults. The purpose of the present study was to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5R^S). By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5R^S aims to cultivate a shared social identity amongst participants, which has in other contexts been associated with greater performance and well-being.

METHODS

A cluster randomised controlled trial was conducted to test the efficacy of the 5R^S group walking program on group identification, group cohesion, walking activity, and well-being, compared to a regular group walking program for older adults. Nineteen older adult walking groups (i.e., the clusters; N = 503; M_age = 69.23 years, SD = 6.68) all participated in a 12-week structured group walking program. Nine walking groups (n = 304) were randomly assigned to the intervention in which participants received the 5R^S program in addition to regular group walking.

RESULTS

5R^S was successful in strengthening the identity leadership qualities of the appointed peer leaders. Multilevel regressions showed that 5R^S succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity).

CONCLUSION

By harnessing the capacity of the group and its peer leaders, the 5R^S program offers a promising intervention to engage older adults in physical activity.

TRIAL REGISTRATION

The study was retrospectively registered as clinical trial on 9 September 2021 ( NCT05038423 ).

Mix-and-Match or Mismatch? Exploring the Perspectives of Older Adults About Zumba Dance and Its Potential Utilization for Dual-Task Training

Despite the popularity of Zumba dancing, research is scarce about its impact on older adults. Meanwhile, the integration of cognitive tasks with physical exercises, also known as dual tasking, is an evolving strategy to facilitate activities for older adults. This study investigated the perceptions of persons aged ≥55 years on Zumba and its potential to be incorporated into a dual-task program. We conducted a descriptive-qualitative study involving 44 Filipino older adults. Using content analysis, four themes were identified: moving toward match or mismatch, balancing benefits with burdens, dual tasking as innovative yet potentially challenging, and overcoming barriers with enablers. Although Zumba was perceived as an inclusive and beneficial activity, individual and contextual limitations could hinder its suitability. Moreover, dual tasking in Zumba was considered an innovative approach, although challenges should be addressed to promote its feasibility. Several strategies could enable the design and implementation of age-appropriate Zumba and dual-tasking programs for older adults.

Challenges to Engaging Older Adults in a Group-Based Walking Intervention: Lessons From the Residents in Action Trial

This qualitative research explored older adults' perceptions of participating in group-based walking programs set in independent-living retirement village contexts. Semistructured interviews were conducted with a subset of participants from the Residents in Action Trial. Data were analyzed through a combination of deductive and inductive thematic analysis. Findings were interpreted from a social identity perspective. Five themes were identified: (a) varying levels of social cohesion in retirement villages; (b) degree of shared identity between residents; (c) health, mobility, and preferred pace; (d) devotion to spouse; and (e) busy lives. When designing group-based walking interventions in retirement villages, it is important to consider community-level social cohesion and degree of relatedness between village residents. When attempting to build a sense of shared identity and relatedness between group members, researchers and policy makers should consider differing backgrounds, capabilities, schedules, and interests of participants.

Effectiveness of Peer-Led Wellbeing Interventions in Retirement Living: A Systematic Review

Retirement living (RL) communities may be an ideal setting in which to utilize peer-leaders to implement or support health and wellbeing interventions. To date, this literature has not been systematically summarized. The purpose of this study was to fill this gap with a particular focus on describing the extent to which interventions addressed each level of the social ecological model of behavior change. This review utilized established frameworks for assessing methodological quality of studies, including the CONSORT guidelines and RoB2 bias assessment for cluster randomized controlled trials. A total of 153 records were identified from database searches, and seven studies met inclusion criteria. Overall, there is emerging evidence that peer-led health and wellbeing programs in RL communities can positively impact both health behavior, such as increased physical activity or nutrition, and health status, such as lower blood pressure. The study quality was modest to very good, but only one study was deemed not to have a high risk of bias. Peers are generally cost-effective, more accessible, and relatable leaders for health interventions that can still produce impactful changes. Future studies are needed to better understand how to sustain promising interventions.

How can older peer leaders best support motivation for walking in physically inactive older adults? A self-determination theory perspective

OBJECTIVE

We aimed to determine what older adults perceive to be need-supportive behaviours of peer walk leaders, drawing primarily from Self-Determination Theory (SDT).

DESIGN

Experienced peer leaders (n = 13; Mage = 73.23, SD = 6.55) and walkers (n = 17; Mage = 72.88, SD = 5.79) were recruited from existing walking groups. Individuals who expressed an interest in becoming a peer leader (n = 18; Mage = 72.72, SD = 4.99) or walker (n = 20; Mage = 78.90, SD = 10.45) were recruited from retirement villages.

MAIN OUTCOME MEASURES

We conducted semi-structured interviews to identify leader behaviours that support autonomy, competence, and relatedness and analysed the data using framework analysis.

RESULTS

We identified eight main themes: eliciting walker interest, acknowledging and adapting to walkers' requirements, ensuring walkers feel comfortable, cared for, and socially integrated, supporting walker confidence, and promoting success experiences. Inexperienced leaders differed from other sub-groups in what they perceived to be supportive behaviours.

CONCLUSION

Future peer leaders could use the identified behaviours to help older adults feel motivated during group walks. New peer leaders can be educated about potential differences between what they describe as supportive and what walkers and experienced leaders perceive as need-supportive behaviours.

Volunteer Motivation and Retention of Older Peer Walk Leaders: A 4-Month Long Investigation

BACKGROUND AND OBJECTIVES

Peer volunteers offer a promising avenue for promoting physical activity in older adults. However, recruiting and retaining such volunteers are challenging. We aimed to examine longitudinally factors that determine whether older volunteer walk leaders will persist in their role.

RESEARCH DESIGN AND METHODS

We recruited older adults volunteering as walk leaders, from retirement villages in Perth, at the start of a 16-week walking intervention. Using a mixed-methods multiple case study design, informed by self-determination theory, we examined the motivational processes of three profiles: Dropouts, Completers, and Extenders. One male and 10 female (medianAge = 75 years, age range: 66-83 years) peer walk leaders were interviewed twice over 4 months, and data were analyzed using thematic analysis. Questionnaires provided information on volunteer characteristics, leadership confidence, and volunteer motivation.

RESULTS

Self-orientated goals, obligation and guilt, emotional exhaustion, lack of psychological need satisfaction, and perceived lack of support were barriers to volunteer persistence. Social confidence and relatedness satisfaction motivated volunteers to persist until program completion (Completers). Altruistic goals, using sustainable helping strategies, psychological need satisfaction, optimism, and enjoyment were important for continuing the role after the program (Extenders).

DISCUSSION AND IMPLICATIONS

Results describe how differences in volunteer motives, personal characteristics, and training may affect motivational processes that determine persistence as an older peer walk leader. We provide suggestions on selecting, training, and supporting older volunteer walk leaders to facilitate their retention.

Factors That Influence Walking Intervention Adherence for Older Adults Living in Retirement Communities

Walking interventions improve health outcomes among older adults. However, few clinical trials evaluate long-term behavior change adherence. The authors explored factors that influence walking adherence in older adults following their participation in a clinical trial. They conducted n = 7 focus groups with n = 23 participants enrolled in the parent study (ClinicalTrials.gov number: NCT03654807). The authors used content analysis to code data according to the social-ecological model. They found that supportive services (exercise classes) in retirement communities have multilevel impacts on adherence to walking activity. Residents from communities offering services continued walking because of increased confidence gained in the parent trial, while residents in communities without services were motivated by their functional improvements. Residents voiced frustration with retirement community physical activity programs that did not address the full spectrum of physical functioning. Findings support the need for retirement communities to account for various motivational factors in tailoring programs to promote increased physical activity for older adults.

Mobilising people as assets for active ageing promotion: a multi-stakeholder perspective on peer volunteering initiatives

BACKGROUND

Successful peer volunteering is central to many community-based, active ageing initiatives. This study synthesises the perspectives of a range of stakeholders involved in peer volunteering initiatives and provides recommendations as to how peer volunteers can be effectively mobilised as community assets.

METHODS

An evidence synthesis of qualitative data from (a) the evaluation of ACE (Active, Connected, Engaged), a feasibility trial of a peer volunteering active ageing intervention, and (b) interviews with volunteers and managers of third sector organisations providing peer volunteering programmes. Data were analysed using directed content analysis.

RESULTS

Ten managers, 22 volunteers and 20 ACE participants were interviewed. The analysis identified six main themes, 33 higher and 22 sub themes. Main themes were: (i) Motives, (ii) Benefits, (iii) Skills and Characteristics, (iv) Challenges, (v) Training Needs, (vi) Recruitment and Retention. Altruism, changes in life circumstances, opportunities to reconnect with the community and personal fulfilment were the main reasons for volunteering. Volunteering was described as being personally rewarding, an avenue to acquire new skills and knowledge, and an opportunity for increased social connections and physical activity. Good peer volunteers are committed, reliable, have a good sense of humour, good interpersonal skills and are able to relate to participants. When pairing volunteers with participants, shared interests and geographical proximity are important to consider. Clarity of role, level of time commitment, regular feedback, recognition of effort and strong networks for on-going support are important strategies to facilitate volunteer retention.

CONCLUSIONS

The findings of this study support the value of peer volunteering as a strategy for mobilising community assets in promoting active ageing. To ensure success and longevity, these schemes require appropriate funding and efficient administrative support.

Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders

BACKGROUND

Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions.

METHODS

Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n = 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges.

RESULTS

Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising.

CONCLUSIONS

Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice.

"It's Better Together": A Nested Longitudinal Study Examining the Benefits of Walking Regularly With Peers Versus Primarily Alone in Older Adults

The authors examined whether purposeful walking with peers at least once a week contributes to better behavioral and health outcomes in older adults than primarily walking alone. The authors used a longitudinal cohort design and recruited participants aged 60 years and older (N = 136) at the start of a 16-week walking intervention. Participants who walked on average at least once a week in the final 8 weeks of the intervention were included in the analysis (N = 79; 66 females, Mage [SD] = 77.73 [6.91]). The authors found that autonomous motivation, walking self-efficacy, functional capacity, body fat, and physical activity improved more in the walking with peers group compared with the walking alone group, after controlling for whether participants lived alone/with others and their health status. The results extend current literature by providing longitudinal evidence for the added benefits of regular peer-accompanied walking in older adults and highlight the importance of investing in peer-supported interventions.