Older Adult Volunteers' Experiences Delivering a Lay-Led Behavioral Activation Program for Depression Among Community-Dwelling Older Adults: A Mixed Methods Study.

Overview

abstract

OBJECTIVES: To evaluate coaches' experiences delivering a lay-led depression intervention (Do More, Feel Better; DMFB) during a Type I hybrid effectiveness-implementation RCT. METHODS: We conducted a process evaluation to assess DMFB feasibility, appropriateness, fidelity, and acceptability in 12 senior centers in Florida, New York, and Washington (USA). DMFB is streamlined Behavioral Activation delivered by older adult volunteers from senior center communities. Data sources included eligibility and exit interviews with surveys and external fidelity ratings of session recordings. RESULTS: The study sample included 45 older adults (M_age = 69.8, SD_age = 6.3), 85.3% women, 45.4% people of color, 24.1% low-income, 53.1% live alone. Feasibility: Of 66 individuals interested in serving as DMFB lay coaches, 45 (68.2%) were eligible, 34 (51.2%) were trained, 27 (40.1%) were certified, and 24 (36.4%) engaged 1 or more clients. Appropriateness: Eligible older adult volunteers had high capacity to serve as coaches (M = 5.3, SD = 0.8, 6-pt scale), bringing lived experience helping others, managing their mental health, good communication and organizational skills, and valuing volunteering. Fidelity: External global ratings were "very good" (M = 4.6, SD = 0.7, 5-pt scale); areas for improvement were managing time for PHQ-) administration and activity scheduling, and need for more person-centered communication. Acceptability: Coaches rated high confidence delivering DMFB (M = 4.7, SD = 0.6, 5-pt scale) and that they received adequate training (M = 4.5, SD = 0.6, 5-pt scale) and supervision (M = 4.6, SD = 0.6, 5-pt scale). Coaches found satisfaction helping others, connecting with clients, and applying DMFB to their mental health. CONCLUSIONS: This study adds to limited literature on implementation outcomes for lay-led community-based interventions for older adults. Preliminary findings document successful implementation.