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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.

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.

Background Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. Methods Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients’ reported satisfaction and clinical outcomes were also assessed. Results Two hundred twenty-six healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1 and 62.4% respectively. One hundred six patients participated in TriGen. There was a significant increase in Kogan’s Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5–16.2, p  <  0.001) and 8.3 (95%CI: 6.2–10.3, p  <  0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates ( p  = 0.006) and emergency department visits ( p  = 0.004) during the 6-month period before and after the program. Fifty-one patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. Conclusion TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.

This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives.

Introduction During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES. Materials and methods A questionnaire assessing digital literacy, social connectedness, wellbeing and quality of life was administered. Socio-demographic variables, pre-existing internet-enabled, and willingness to participate in a home-based DLP was also collected. Logistic regression was used to identify demographic factors associated with digital literacy, smartphone ownership, and willingness to enroll in a DLP. Serial mediation analysis was also performed using a structural equation model framework. Results A total of 302 participants were recruited. Female gender, older age, lower education levels were associated with lower digital literacy. Those who owned a smartphone tended to be younger and better educated. Older adults who were better educated, of Chinese descent (the ethnic majority in Singapore), and who had lower digital literacy, were most willing to enroll in the digital literacy education program. Social-use digital literacy had a positive indirect effect on well-being (b^=0.037,95%CI=[0.007,0.101]) and Quality of life (b^=0.004,95%CI=[0.001,0.010]), mediated by social connectedness and loneliness. In contrast, instrumental-use digital literacy had a negative indirect effect on well-being (b^=-0.030,95%CI=[-0.080,-0.008]) and Quality of life (b^=-0.003,95%CI=[-0.008,-0.001]), mediated by social connectedness and loneliness. Discussion The results suggest there are demographic barriers to participation in DLPs and highlight the benefit of focusing on enhancing social-use digital literacy. Further study is needed to evaluate how well specific interventions to improve social-use digital literacy help to reduce social isolation and loneliness, and ultimately improve wellbeing and quality of life.

Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen’s efficacy by investigating healthcare undergraduates’ attitude towards IPE. Methods: Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen’s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback. Results: 79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was removed. There was no difference in pre- and post-intervention RIPLS total and subscale scores. 91.6% of respondents agreed they better appreciated the importance of interprofessional collaboration (IPC) in patient care, and 72.8% said MDMs were important for their learning. Thematic analysis revealed takeaways including learning from and teaching one another, understanding one’s own and other healthcare professionals’ role, teamwork, and meeting undergraduates from different faculties. Conclusion: We validated the RIPLS in Singapore and demonstrated the feasibility of an interprofessional, student-initiated home visit programme. While there was no change in RIPLS scores, the qualitative feedback suggests that there are participant-perceived benefits for IPE after undergoing this programme, even with the perceived barriers to IPE. Future programmes can work on addressing these barriers to IPE.