Journal Article

Impact of Youth Community Health Volunteers on Community Health Screening Program Outcomes for Older Adults: Mixed Methods Evaluation Study

Chee, Alicia Shi Yao, Kwan, Yu Heng, Huang, Xiaoting, Tey, Angeline Jie-Yin, Razaki, Muhammad Razzan, Kwan, Audrey Shu Ting, Jasman, Jed, Lim, Jie Xin, Mujtaba, Juliana Shariq, Lim, Si Qi, Cheng, Jasmine Yee Ru, Sim, Elliott Weizhi, Ng, Kennedy Yao Yi, Liow, Chee Hsiang, Teo, Lynn Pei Zhen, Yow, Ka Shing, Lim, Meng Han, Cheong, Thaddeus Chi En, Khoo, Yihan, Low, Lian Leng, Ngiam, Nerice Heng Wen

2025

Overview

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.

• Publisher: Journal of Medical Internet Research,JMIR Publications Inc,JMIR Publications
• Subject: Adolescent / Aged / Aged patients / Care and treatment / Community health services / Community Health Workers / Consumer & Patient Education and Shared-Decision Making / E-Health / Health Services Research and New Models of Care / Evaluation / Female / Health aspects / Health Services Research / Health Services Research and Health Care Utilization in Older Patients / Humans / Internet Access and Digital Technology Use in an Elderly Population / Male / Mass Screening / Medical screening / Methods / Middle Aged / Motivational Interviewing / Original Paper / Participatory Design and Participatory Research / Participatory Medicine & E-Patients / Patient Engagement and Empowerment / Patient-Clinician Relationship / Program Evaluation / Training / Volunteers