Discussion
infection
INFECTION
While healthy aging for all is widely accepted public health agenda, few multi-faceted, multi-level health equity interventions promoting health and wellness exist, especially ones targeting relatively healthy older adults residing in an urban, low-income community in a non-Western country. In Korea, public health centers typically offer provider-driven, individual-level, health behavior monitoring or modification programs for people who are willing to participate [We designed the HWePS to develop and rigorously test the effectiveness of an intervention that simultaneously engages older people and neighbors (as CLHLs) and enlists community-level resources and strengths to promote the health and wellness of older people in a low-income urban community during COVID-19. If effective, the intervention, as a preventive, integrated community care model, may add great value to current efforts to reduce health disparities among urban, lower-income older populations with double (age- and income-related) risks for inequality. First, instead of a professional-driven model, the intervention is an older person-led, community-engaged, professional-support model. As a theory-driven, evidence-based public health model, the HWePS will address health inequality by empowering older adults to recognize that they are responsible for their own health, understand their own health status and risks using a decision-support tool, develop with a nurse coach their own plan for self-care skill-building, and practice it daily with peer support enhanced by ICT tools. Second, the intervention educates and empowers participating CHNs for the “visiting community service center service” program in Seoul [Third, peer support is a key mechanism to promote health equity for the community [There are several expected challenges. One major challenge is the ongoing COVID-19 pandemic; public health measures to stop the infection’s spread could negatively influence various parts of the intervention implementation process (e.g., participation and retention rates) [Another challenge is that the multi-channel heath information delivery service is designed to be an essential communication channel between the community and the wellness center during COVID-19. However, the basic unidirectional communication approach with limited feedback channels may reduce the intervention effects. While the components and duration of the 12-week (self-)care management intervention are based on existing evidence from successful intervention studies, they may not be enough to motivate older adults to continue healthy lifestyles for prolonged periods. A “companion” program has been organized at the wellness center and is designed as a self-help club in the community run by older people who have completed the 12-week intervention along with support from CLHLs. It is beyond the scope of this intervention study, but the research team plans to assess the effects of the companion program. There are also limited resources, time, and political/administrative networks and support for implementing the community-wide healthy aging initiative in ways that could lead to more meaningful changes. For example, while participants have expressed income-based health-related social needs, there are limited income-earning opportunities available in the community for older people; changing upstream social/structural determinants of health inequality is hard to address in this equity intervention study. If the intervention is effective, we will help facilitate the public health center’s continuation of the HWePS program in the intervention area, promoting it as a signature program for improving the living conditions of the area, and support the program’s dissemination to other areas of Jungnang-gu and beyond; we will also encourage the Community Residence Council to enact bylaws making a new health committee under its purview.