Nutrition Poor, Physical Inactivity, Social Isolation
Conditions
Keywords
Technology, Older adult, Nutrition, Food security, Physical activity, Social isolation
Brief summary
The digital divide or gap in technological access and knowledge, for older adults has worsened during the COVID-19 pandemic, leading to disruptions in services like congregate meal programs funded by the Older Americans Act. Seven San Antonio congregate meal sites remained partially open biweekly to distribute meals but no longer offer in-person nutrition education, physical activity classes, and social activities. The proposed project will test the efficacy of digital nutrition intervention with at-risk older adults who attend congregate meal center in areas of high poverty and digital exclusion. The study is uses a stepped-wedge cluster clinical trial. Key community partners with the Department of Health Services Senior Services Division and Older Adult Technology Services (OATS) will participate in the planning phase, research design, and implementation of the study. The study aims are: 1. To test the impact of a technology-based intervention on the primary outcomes of food security and diet quality; 2. To determine the effect of the intervention on secondary outcomes of technology knowledge and usage, physical activity, and social isolation and loneliness; 3. To examine the long-term impact and sustainability of technology use on food security, diet quality, physical activity, and social isolation. If successful, the impact of this program could be applied throughout the national OATS network and to similar CMPs to bridge the digital divide beyond the COVID-19 pandemic
Detailed description
This project will target community-dwelling older adults who are congregate meal program (CMP) participants living in areas at-risk of the digital divide. The CMP is funded by the Older Americans Act and serves over 2000 San Antonio older adults who live 33% below the poverty level and 18% considered at high nutritional risk. During the pandemic, seven San Antonio sites in areas with high poverty and digital exclusion remain partially open biweekly to distribute meals but did not hold in-person nutrition education, physical activity classes, and social activities. The proposed project extends existing congregate meal programming infrastructure and partnerships with Older Adults Technology Services (OATS), a national leader in creating health service programs focusing on older adults. The goal of the proposed study is to remove the digital barrier to receiving essential, evidence-based nutrition programming online, utilizing OATS' five-week technology Essential Series, which has successfully educated thousands of older adults nationwide by providing support for technology and internet connectivity. This proposed nutrition intervention will enrolled congregate meal participants using a stepped-wedge cluster design with two cohorts to allow for sequential intervention enrollment with simultaneous control and intervention data collection timepoints. Key community partners within Department of Health Services Senior Services Division and OATS will participate in the planning phase, research design, and implementation of the study. Feedback from congregate meal participants in focus groups will guide the development of the intervention. The 20-week intervention will include 5 weeks technology training, including internet access and devices, followed by 15 weeks of a culturally tailored nutrition intervention via online sessions. The study will recruit 440 older adult from seven at-risk congregate meal sites. Data will be collected at baseline (T0), during the online intervention (T1), after the online intervention (T2) and 6 months post-intervention (T3). The successful outcome of our study will be impactful because of the potential broader application of this program throughout the national OATS network and to similar CMPs to bridge the digital divide through and beyond the COVID-19 pandemic.
Interventions
BEHAVIORALTechnology intervention
Older Adult Technology Services (OATS) 5-week technology intervention
BEHAVIORALDigital Nutrition Intervention
15-week nutrition intervention delivered completely online
Sponsors
National Institute of Nursing Research (NINR)
Older Adult Technology Services
City of San Antonio Department of Human Services
Agile Analytics, LLC
The University of Texas at San Antonio
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
This intervention will use a closed-cohort stepped wedge design. In a stepped wedge design, the timing of the intervention is randomized by cluster, with sequential crossover of clusters from control to intervention until all clusters have received the intervention. With this design, each cluster contributes data when they are participating in the intervention and when they are not. This study will be a two-step stepped wedge design; each of the seven targeted centers will then be randomly assigned to one of two cohorts. Participants in Cohort 1 will receive the intervention first. Six months after baseline data have been collected, Cohort 1 participants will finish the intervention and crossover will occur as Cohort 2 participants begin the intervention. At the 12-month time point, the second cohort will complete the intervention. Data will be collected for both groups in each time period T0-T3.
Eligibility
Sex/Gender
ALL
Age
60 Years to 120 Years
Healthy volunteers
Yes
Inclusion criteria
* 60 years of age * Inadequate or no working technology device (computer, smart-phone, tablet), no or poor internet connectivity at home, or lack of knowledge and usage of technology * Food insecurity or low diet quality
Exclusion criteria
* Blind * Terminal disease or illness * Diagnosis of dementia or Alzheimer's disease * Unable to read or write in English or Spanish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diet Quality as measured by the Healthy Eating Index | Change in diet quality from baseline to 3 and 6 months | Two non-consecutive 24-hour dietary recalls will be collected and the Healthy Index will be calculated to determine diet quality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Physical Activity | Change in physical activity from baseline to 3 and 6 months | Physical activity measured by the Physical Activity Scale for the Elderly (PASE) |
| Technology Use and Access | Change in technology use and access from baseline to 3 and 6 months | Technology use questionnaire from the National Health & Aging Trends Study |
| Attitudes Towards Technology | Change in attitudes towards technology from baseline to 3 and 6 months | Adapted from Attitudes Towards Computers Questionnaire (ATCQ) |
| Food Security | Change in food security from baseline to 3 and 6 months | Food security measured by the USDA's US Adult Food Security Survey Module |
| Loneliness | Change in loneliness from baseline to 3 and 6 months | Loneliness assessed by the 3-item UCAL Loneliness Scale |
| Malnutrition | Change in malnutrition from baseline to 3 and 6 months | Malnutrition measured by the Mini Nutrition Assessment Short-Form |
| Social Isolation | Change in social isolation from baseline to 3 and 6 months | Social isolation measured by The Social Disconnectedness Scale and the Perceived Isolation Scale |
Countries
United States
Outcome results
None listed