How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

Abstract

Background: A number of conceptual frameworks guide implementation and scale-up of evidence based (health promoting) interventions (EBIs). However, few studies delve into these frameworks to describe aspects of the delivery system--such as capacity building--that support successful scale-up. A standardized approach to capacity building is needed to develop new strategies and transfer successful strategies to new settings. Therefore, our objectives were to describe: (1) implementation strategies adopted by the central support system to build practitioners’ capacity to implement and scale-up a health promoting intervention (Choose to Move (CTM)), and (2) elements within capacity building strategies deemed essential to effectively implement CTM in diverse community contexts.Methods: CTM is a flexible, scalable, community-based health promoting physical activity (PA) and social connectedness intervention for older adults. In 2018-2020, eight health and social service societies, rural or remote municipalities, or community based organizations delivered CTM programs (n=22) that served older adults (n=322). We conducted in depth interviews with delivery partners (n=23), and a focus group with the central support system (n= 4) to assess key elements within capacity building strategies.Results: Capacity building strategies that delivery partners adopted were site selection/marketing, training, tools, technical assistance, peer networking, assessment and feedback. Essential elements that emerged within capacity building strategies were: a support system champion, activity coach skills, self efficacy and confidence; interactive assistance to answer questions and clarify materials. Key elements of central support that emerged were helping organizations-- adapt and tailor the EBI, leverage resources and strategies, maintain fidelity to the EBI, develop partnerships, train and monitor, learn from peers, increase awareness of older adult needs, increase PA programs for older adults and inform future organizational practices and processes. Central support provided a sounding board to organizations and were more successful if they were familiar with delivery partner resources and values, created buy-in and planned ahead.Conclusion: There is a key role for capacity building under the stewardship of central support units to promote implementation success. More clearly described capacity-building strategies that are designed and delivered to support implementation and scale-up would serve to advance the field, in future.