Enhancing Engagement With Socially Disadvantaged Older People in Organized Physical Activity Programs

"I wouldn't have joined if it wasn't online": understanding older people's engagement with teleyoga classes for fall prevention

BACKGROUND

Yoga-based exercise is a promising strategy for promoting healthy ageing, with the potential to reduce falls and increase physical, cognitive and psychological wellbeing. Teleyoga (real-time yoga provided via interactive videoconferencing) can deliver yoga programs at scale, potentially reducing costs, increasing convenience, and reaching people who cannot attend studio-based classes. But better understanding of how older people perceive and engage with teleyoga is needed to optimise its design, implementation and promotion.

METHODS

This study built on a previous realist process evaluation of the SAGE yoga trial which is testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60 + years. In this second phase of evaluation we conducted focus groups with participants who had completed the SAGE program online and with the yoga instructors who were delivering it. We also conducted interviews with participants who had withdrawn from the trial. Six program theories developed in the earlier evaluation provided a framework for data analysis, supplemented by inductive coding and an analytical workshop.

RESULTS

Participants described physical and psychological benefits from the SAGE teleyoga program. While noting that teleyoga cannot facilitate hands-on correction or the same quality of observation or interaction as studio classes, participants were highly appreciative of their yoga instructors' strategies for optimising visibility, instruction, social connection and therapeutic alliance, and for adapting to constrained home environments. Some participants argued that teleyoga was superior to studio classes due to its accessibility and convenience, its lower exposure to potential embarrassment about physical appearance or capabilities, and a reduced sense of peer competition and distraction. Our program theories applied across studio and online modes of delivery.

CONCLUSION

Teleyoga increases accessibility for people in diverse locations and circumstances; it provides a psychologically safer space which combats self-consciousness and unwanted competitiveness; it may enhance embodiment and mindfulness for some; and it has the potential to be offered relatively cheaply at scale which could support free or reduced price classes for people on low incomes and pensions, thereby encouraging a wider population to engage in yoga for healthy ageing and fall prevention.

A blueprint for success: Using an implementation framework to create a medication history technician pilot program

BACKGROUND

Medication discrepancies at transitions of care may compromise patient safety. Trained pharmacy technicians can reduce harmful medication discrepancies at transitions of care by collecting medication histories.

OBJECTIVE

We describe how to create a program integrating medication history technicians (MHTs) into the hospital discharge process using implementation science.

PRACTICE DESCRIPTION

We created our MHT program at a Veterans Affairs (VA) hospital.

PRACTICE INNOVATION

We used an evidence-based framework and implementation science to tailor our MHT program to meet local stakeholder needs.

EVALUATION METHODS

We completed a literature review and review of current discharge practices. Then, we completed a workflow pilot, a needs assessment, and semistructured interviews with pharmacy technicians and pharmacists. We integrated these findings to identify barriers of MHT program implementation. Finally, we mapped these barriers to implementation strategies to create an MHT program implementation blueprint.

RESULTS

The literature review and review of current discharge practices revealed opportunities for our program to reduce medication discrepancies. We applied these findings to our proof-of-concept workflow pilot, which reduced medication discrepancy rates at discharge. When we explored barriers in the needs assessment, we learned that 4 of 6 pharmacy technicians had some training conducting medication histories, but 5 of 6 requested additional training for the new MHT role. We explored these and additional barriers in semistructured interviews. Four themes emerged: elements of pharmacy technician training, challenges to implementation, program logistics and workflow, and pharmacy technician self-efficacy. We mapped barriers to implementation strategies to create an MHT program implementation blueprint, including developing pharmacy technician training materials, modifying our workflow, creating program evaluation materials, and strategizing how to overcome anticipated and current implementation barriers.

CONCLUSIONS

We used implementation science to create a tailored MHT program. Others may adapt our implementation blueprint to fit local stakeholder needs.

Practical Recommendations for Maintaining Active Lifestyle during the COVID-19 Pandemic: A Systematic Literature Review

Diminished volumes of habitual physical activity and increased sedentary levels have been observed as a result of COVID-19 home-confinement. Consequences of inactivity, including a higher mortality rate and poorer general health and fitness, have been reported. This systematic review aimed to provide practical recommendations for maintaining active lifestyles during pandemics. In May 2020, two electronic databases (PubMed; Web of Science) were used to search for relevant studies. A total of 1206 records were screened by two researchers. Thirty-one relevant studies were included in this systematic review, in which the methodological quality was assessed. With regard to six studies, which explicitly dealt with physical activity during COVID-19, the evidence level is classified by three articles to level II, and in the other three to level VI. Regarding the physical activity recommendations in these papers, three of them were classified to a medium, and the same number to a weak evidence base. Of the 25 papers which refer to other pandemics and/or isolation situations, one was classified to evidence level I, four were ranged to level II, three to level III, one to level V, and the others to level VI. This systematic review revealed that reduced physical activity levels are of serious concern during home confinement in pandemic times. The recommendations provided by many international organizations to maintain active lifestyles during these times mainly target the general population, with less consideration for vulnerable populations (e.g., older adults, people with health issues). Therefore, personalized and supervised physical activity programs are urgently needed, with the option to group-play physical activity programs (e.g., exergames). These can be assisted, delivered, and disseminated worldwide through information and communication technology solutions. If it is permitted and safe, being active outside in daylight is advised, with an effort level of mild to moderate using the rating of perceived exertion scale. Relaxation techniques should be integrated into the daily routine to reduce stress levels. On the evidence base and levels of the included articles in this review, the results need to be interpreted with caution. Given that policies are different across regions and countries, further research is needed to categorize recommendations according to different social-distancing scenarios.