Impact of Youth Community Health Volunteers on Community Health Screening Program Outcomes for Older Adults: Mixed Methods Evaluation Study

Abstract

Background: Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. HealthStart is a Self-Determination Theory (SDT)-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health and digital coaching, and posthealth screening follow-up. Youth community health volunteers (YCHVs) were taught principles of motivational interviewing, health coaching, and the social determinants of health through a program model anchored in principles of intergenerational and service learning. YCHVs, guided by health care volunteers, served as health and digital advocates for participants over a 3-month postscreening period. Objective: This study aims to evaluate the effectiveness and acceptability of the HealthStart program, a structured, layperson-led intergenerational health coaching intervention. Methods: This study used a convergent parallel mixed methods design. A total of 192 older adult participants’ (mean age 66.9, SD 9.6 years) quantitative data were collected through pre- and postprogram surveys between September 2022 and January 2024. Follow-up with primary care provider (PCP) was the primary outcome; secondary outcomes include health goal attainment, self-efficacy, and digital and health literacy among older adults, and acceptability among all stakeholders. PCP follow-up and health goal attainment were self-reported, while self-efficacy was measured using the Patient Activation Measure-13. Health and digital literacy were assessed with an adapted questionnaire and the eHealth Literacy Scale (eHEALS), respectively. A total of 36 semistructured interviews were conducted with 13 older adults, 17 YCHVs, and 6 health care volunteers in the qualitative study between November 2023 and January 2024, which were qualitatively analyzed using thematic analysis. A joint analysis was conducted to generate meta-inferences. Results: The follow-up rate among PCPs increased significantly from 42.7% to 84.5% (P