A community-based health social partnership programme to enhance self-care management amongst older adults : a cluster randomised controlled hybrid implementation-effectiveness study

Abstract

Background: Service models employing health–social partnership is recognised as an important strategy to support ageing in place globally, but literature reported challenges in operational concerns. Objective: To evaluate the implementation and effectiveness of a community-based health–social partnership programme (C-HSPP) for community-dwelling older adults. Methods: This was a cluster randomised controlled hybrid type-2 design. Implementation outcomes included reach, effectiveness, adoption, implementation and maintenance. Self-efficacy served as the primary effectiveness measure. The 12-week C-HSPP intervention involved nurse assessments and interventions supported by social workers. Data were collected at baseline (T1), post-intervention (T2) and follow-up (T3). Results: Eight older adult centres were randomised into four matched pairs (intervention: 4, control: 4), with 755 older adults assigned to intervention (n = 381) and control (n = 374) groups. Implementation evaluation: revealed high programme reach amongst both providers and users, citing facilitators such as coordinated communication and structured protocols for the C-HSPP adoption. Key implementation challenges included the need for further role clarity within the interprofessional teams, varied degree of acceptability of home visits by users due to privacy concerns and logistic constraints, and the need for resource support for a health–social team to sustain the service. Significant group-time interaction effect was detected in self-efficacy at T3 (β = −0.928, P = .035), instrumental activities of daily living (IADL) at both T2 (β = −0.411, P = .032) and T3 (β = −0.437, P = .032), and reduced unplanned health service use at T2 (β = 0.493, P = .015), with better outcomes found in the intervention group. Conclusion: This study has provided a working framework to translate an evidence-based health–social partnership model in real-life settings, highlighting the essence of stakeholder engagement and interprofessional communication in aligning goals with service needs. Policy support for resource allocation is important to sustain the model in the community.