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IntroductionOlder adults are often faced with a multitude of physical and social challenges that impede their ability to age healthily. To tackle this issue, the use of trained lay volunteers as health advocates has become increasingly popular; however, their perceptions and experiences remain to be explored. This study aimed to explore the experiences of youth community health volunteers (YCHVs) who participated in HealthStart, a community health coaching programme for older adults in Singapore.MethodsWe conducted purposive sampling and carried out semi-structured interviews with 16 YCHVs and eight healthcare volunteers. Data were analysed thematically using deductive and inductive coding.ResultsWe generated four themes: (1) structured training, resources, and in-person mentorship helped YCHVs effectively support older adults in their health journeys, (2) facilitators and barriers influenced older adults’ receptiveness to YCHVs, (3) YCHV motivations to volunteer, and (4) YCHVs becoming trained health advocates and contributing to preventive health strategies. Findings illustrated the facilitators and challenges experienced by YCHVs and the contributions they can make to preventive health strategies.ConclusionThe exploration of YCHVs’ motivation and experience can potentially improve the uptake, acceptability, and satisfaction of using trained youth health advocates in community health coaching programmes for older adults.

Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. HealthStart is a Self-Determination Theory (SDT)-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health and digital coaching, and posthealth screening follow-up. Youth community health volunteers (YCHVs) were taught principles of motivational interviewing, health coaching, and the social determinants of health through a program model anchored in principles of intergenerational and service learning. YCHVs, guided by health care volunteers, served as health and digital advocates for participants over a 3-month postscreening period. This study aims to evaluate the effectiveness and acceptability of the HealthStart program, a structured, layperson-led intergenerational health coaching intervention. This study used a convergent parallel mixed methods design. A total of 192 older adult participants' (mean age 66.9, SD 9.6 years) quantitative data were collected through pre- and postprogram surveys between September 2022 and January 2024. Follow-up with primary care provider (PCP) was the primary outcome; secondary outcomes include health goal attainment, self-efficacy, and digital and health literacy among older adults, and acceptability among all stakeholders. PCP follow-up and health goal attainment were self-reported, while self-efficacy was measured using the Patient Activation Measure-13. Health and digital literacy were assessed with an adapted questionnaire and the eHealth Literacy Scale (eHEALS), respectively. A total of 36 semistructured interviews were conducted with 13 older adults, 17 YCHVs, and 6 health care volunteers in the qualitative study between November 2023 and January 2024, which were qualitatively analyzed using thematic analysis. A joint analysis was conducted to generate meta-inferences. The follow-up rate among PCPs increased significantly from 42.7% to 84.5% (P<.001). A total of 66.2% (92/139) of the participants achieved their health goals, and 81.3% (113/139) reported satisfaction with the program. There were no significant pre-post differences in Patient Activation Measure-13, knowledge, and eHEALS scores. However, a statistically significant correlation was found between postcycle eHEALS scores and the number of follow-up visits (P=.003). The qualitative findings substantiate HealthStart's Theory of Change and its SDT underpinnings. Participants' narratives highlighted the 3 SDT psychological needs, increased autonomy, competence, and relatedness, which are associated with sustained behavior change and health engagement. An increase in the PCP follow-up rate was influenced by individually tailored goal setting and relationship-building that leveraged motivational interviewing to support intrinsic motivation. The program's primary outcome was, to some extent, influenced by digital health onboarding and possibly improvements in health literacy. Participants' self-efficacy could have been enhanced with a structured social prescription framework. HealthStart demonstrated the feasibility of using YCHVs and SDT principles to improve PCP follow-up rates and promote healthier lifestyles through digital enablement among older adults participating in community health screening.

With an aging global population, there is a growing emphasis on community-based approaches to preventive health for older adults. While Community Health Volunteers have been found to be effective in empowering older adults to manage their chronic conditions, there is limited research on the role of Youth Community Health Volunteers (YCHVs) and little is known about how older adults perceive their role and effectiveness. This qualitative study explores older adults' experiences and perceptions of a YCHV-led health coaching program following community health screening in Singapore. We conducted one-to-one semi-structured interviews with 19 older adults who had participated in HealthStart, a YCHV-led health coaching program. Purposive sampling was used to ensure representation across diverse demographic backgrounds and varying levels of program engagement. Interviews were carried out between November 2023 and January 2024 in community centers, healthcare facilities, or via telephone/Zoom, and explored participants' experiences with the program, perceptions of YCHVs, and health-related outcomes. We analyzed data thematically using deductive and inductive coding. We generated five themes: (1) How YCHV facilitation contributed to prevention outcomes, (2) YCHV facilitation techniques, (3) Intrinsic factors influencing older adults' receptivity towards YCHVs, (4) Older adults' perceptions of YCHVs, and (5) YCHVs' potential to be further empowered as health advocates. Findings provided insights into health behaviors of older adults, the perceived role of YCHVs in influencing these behaviors, and potential and opportunities to strengthen YCHVs' capacity as health advocates. Engaging YCHVs as preventive health advocates for older adults appeared both acceptable and promising. This study highlights the potential for YCHV scale-up, while emphasizing the need for targeted training in behavior change and referral to community resources. Beyond individual health gains, such initiatives may help address ageist attitudes, foster intergenerational solidarity, and complement primary care efforts.

As rapidly aging populations become a worldwide phenomenon, early detection and prompt management of chronic disease become essential to support healthy aging. Community-based health screenings, a key component of this strategy, often struggle with poor follow-up rates, limiting their long-term impact. Given the untapped potential of youth volunteers and the urgent need for a scalable approach to improve continuity of care post health screenings, we developed HealthStart: a structured, theory-based program that empowers these older adults to take greater ownership of their health and their chronic conditions with the support of youth community health volunteers (CHVs). This study aimed to describe the development, implementation, and early outcomes of HealthStart-an intergenerational, layperson-led health coaching program-and summarize operational lessons to guide similar models in Asian communities. HealthStart adopted an intergenerational service-learning approach modeled on a self-determination theory-based layperson-led health coaching framework. Each HealthStart team consisted of 1 health care volunteer (HCV) and 4 youth CHVs. All volunteers underwent blended training and were assessed for layperson-led health coaching readiness. Between September 2022 and June 2023 in Singapore, youth CHVs empowered adult participants aged 40 years and older after their health screening to (1) learn about their chronic diseases, (2) learn at least one digital health app, (3) enroll with a primary care provider, and (4) set a lifestyle goal (based on the Specific, Measurable, Achievable, Realistic/Relevant, and Time-bound [SMART] framework for goal setting) and achieve it. We used an implementation-focused case study design using descriptive statistics and volunteer-participant feedback to evaluate feasibility and outcomes. Of 236 eligible individuals, 192 enrolled. Participants had a mean age of 67 (SD 9.6) years; 52.1% (n=100) of participants were female, with a majority of Chinese ethnicity, having completed primary or secondary school education, residing in self-owned flats, and living in 3-room public housing. Follow-up rate with primary care increased from 42.7% (82/148) preprogram to 84.5% (125/148) postprogram (χ21=43; P<.001). In total, 58 HCVs were recruited, comprising 26 nurses and 6 doctors, with the remainder as allied health professionals. A total of 33 were trained and deployed. The mean age of HCVs was 37 years old, and 24 (72.7%) were female. Furthermore, 149 youth CHVs were recruited, 138 trained, and 102 deployed. The mean age of the youth CHVs who were deployed was 24 years, and 75 (73.5%) were female. Reflections included the importance of volunteer competency and selection criteria, tiering of participant intervention, tapping on community assets, adoption of a social prescription framework, importance of alignment with population health policies, and cultivating intergenerational relationships. HealthStart demonstrates the feasibility and acceptability of a structured, intergenerational, layperson-led health coaching model embedded in primary care. We identify key lessons learned in the conceptualization and implementation of the program that may inform the design of similar volunteer-enabled initiatives for harnessing laypersons, an often-underused asset, to promote health in the community.

Achieving consistent follow-up rates in community-based health screenings is a challenge. Fewer than 75% of patients receive follow-up care in cancer screening programs in the United States. One in four people screened in community health screenings had not returned for a doctor’s follow-up after a year in Singapore. This issue is compounded by the severe shortage of healthcare workers - the World Health Organisation (WHO) estimates a projected global shortage of 18 million health workers by 2030. HealthStart is a self determination theory (SDT) based intervention that aims to increase the engagement and follow-up rates of older adults attending a chronic disease community health screening by developing, training and empowering lay volunteers as health advocates that accompany them in their post-screening journey over a three month period. Collaboratively organised by TriGen, a charity organisation, and the Singapore General Hospital (SGH) Population Health and Integrated Care Office (PHICO), a team that oversees care integration initiatives in Southeast Singapore, this ground-up initiative was designed to augment Singapore’s HealthierSG programme, the local government’s policy to shift the focus towards preventive health by reshaping the population’s health-seeking behaviours and lifestyle through collaborative care.  The primary outcome of the programme was residents’ enrolment with a family physician. To complete the programme, each resident had to additionally complete a local Health Promotion Board (HPB) booklet detailing the condition they were newly diagnosed with, learn a digital health application and set a lifestyle goal and achieve it. This was accomplished alongside volunteers who were equipped with knowledge on chronic diseases, awareness of the local community healthcare system, principles of health coaching and motivational interviewing in the pre-programme training, under the pedagogical framework of intergenerational and service learning. HealthStart reached out to 201 older adults via 30 healthcare workers and 99 lay volunteers over two health screenings conducted in 2022 and 2023 respectively. An exact McNemar's test determined a statistically significant difference in the proportion of residents having primary care follow-up pre-intervention (55.4%) versus post-intervention (84.5%), χ2 = 43, p <0.001. Mean post-programme score for a twelve question chronic disease knowledge questionnaire was 8.9. Digital health application uptake rate and lifestyle goal attainment rate were 66.2% each. 80.9% of residents were satisfied with the programme. Qualitative feedback from residents and volunteers reflected the programme's positive impact in empowering residents to take better care of their health, facilitating post-screening continuity of care and fostering intergenerational relationships. Operational lessons from programme implementation include the requirement for resident suitability criteria, lay volunteer competency criteria, value of an individual-tailored service, benefit of personalised reports, need to bridge communications between community services and importance of incentivisation for primary care enrolment and health goal attainment. HealthStart leverages on a synergy gained from the energy and creativity of lay volunteers coupled with the experience of healthcare professionals to address gaps in the health of the older adult population. Ultimately, fostering health engagement across all ages and promoting social connectedness across generations is key to developing concerted and sustainable advancements in population health.