Older adults’ experiences of a community wellness program (Connect 60+) that focused on physical activity and social connections: a qualitative exploratory study

Introduction

The World Health Organization (World Health Organization 2015) defines healthy aging as the process of maintaining the functional ability that enables wellbeing in older age. However, the nature of the COVID-19 pandemic has forced many older adults to remain at home rather than engage in healthy aging behaviours of being functionally (both physically and socially) active out in the community (Brooke and Jackson 2020; Gaertner et al. 2021). This has significant health and cost implications for older populations and for health services, because of global population growth (Reich et al. 2020). In 2020, there were approximately 4.2 million (16%) Australians aged ≥65 years, and this number is expected to grow to between 21 and 23% by 2066 (Australian Government: Australian Institute of Health and Welfare 2021).

Exercise is an established, evidence-based, healthy aging strategy (Ylitalo et al. 2020) that is recommended for prevention of chronic illness, functional decline and falls (Chodzko-Zajko et al. 2009; Palmer et al. 2018). However, <50% of older adults engage in the recommended amount of at least 150 min per week (Bull et al. 2020). Social connectedness is another healthy aging strategy that enables wellbeing, and reduces the risk of premature mortality and negative health outcomes, such as depression and anxiety (Holt-Lunstad et al. 2015; Courtin and Knapp 2017), and has been identified as central to an individual’s perception of their wellbeing (Diener and Seligman 2004; Santini et al. 2020). However, approximately 25% of older adults are reported to be socially isolated, meaning this also negatively impacts on their health and wellbeing (National Academies of Sciences, Engineering, and Medicine 2020).

Community-based healthy aging programs have the potential to fill these gaps in a holistic manner. Community hubs can offer a convenient, local space for older adults to engage in healthy aging strategies of exercise and socially connecting with others (Markle-Reid et al. 2018; Salman et al. 2021). Older adults are much more likely to continue with, and make social connections, in a physical activity program they enjoy (Creighton et al. 2022). In a synthesis of research on community hubs performed between 2000 and 2020, it was found that community hubs offer a range of services throughout the community; however, of the 18 studies reviewed, six of these were aimed at social care for older adults with chronic illness or disability, and none of them included physical activity (Manis et al. 2022). Another review suggested that physical activity was particularly good for vulnerable older people, as it improved their functional ability; however, it also noted that physical activity alone did not reduce loneliness (Shvedko et al. 2018). Therefore, both social interaction and physical activity is required. Expert consensus around the world supports use of The World Health Organization’s ‘Integrated Care for Older People’ (ICOPE) approach, which highlights the importance of health and social care interventions being delivered at all service levels, including in the local community (Briggs and de Carvalho 2018).

A recently developed program aimed to fill this gap through designing a wellness program through a partnership between researchers, older members of a community hub and health professionals. This community-based research partnership led to the design and pilot of a wellness program (Connect 60+) for community-dwelling older adults at risk of social isolation and declining levels of physical activity during the COVID-19 pandemic (Naseri et al. 2022). It was aligned with international recommendations for healthy aging (Abbasi et al. 2021). A quantitative program evaluation demonstrated that participants increased the frequency of social connections and exercise completed per week (Naseri et al. 2022). However, it was also important to seek participants’ feedback to identify their experiences of the program, including their perspectives about possible barriers and enablers to its success, to assist future implementation and program growth (Greenhalgh and Papoutsi 2019). More broadly, examining older adults’ perspectives on wellness programs can enhance understanding of how these programs could be used to promote healthy aging strategies (Talley et al. 2019).

The objective of the study was to explore the lived experiences of older community-dwelling adults who participated in Connect 60+, a wellness program that promoted engagement in exercise and social connectedness, at a community hub. We aimed to understand the impact of the program on participants’ engagement in healthy aging strategies of exercise and social connectedness, and to identify the barriers and enablers for older adults engaging in these strategies.

Methods

Results

Semistructured phone interviews were completed with eight women and five men (age range 65–86 years). Four of the participants had joined the Connect 60+ program online, the rest attended the hub in person. Seven participants lived in the local hub neighbourhood. The demographic information of participants is presented in Table 1. A total of 13 interviews were completed, after which saturation was reached, with all the main variations of the phenomena recurring and no new themes being identified (Liamputtong 2013). A thematic map schematically demonstrating theme relationships and coding exemplars is presented in Fig. 1. Main themes that captured participants’ experiences were identified, and within these themes both positive and negative experiences were found. These assisted to understand barriers and enablers to participants’ engagement in the program.

Fig. 1.

Thematic map demonstrating theme relationships and coding examples.

Discussion

This study found that older adults reported their experiences of the wellness program as being very positive and, in some cases, it facilitated sustained change in their motivation to engage in physical activity and make social connections, and even seek out new activities. Healthy aging strategies, such as exercise, are importan,t because increasing one’s level of physical activity can help prevent chronic disease, functional decline and falls (Palmer et al. 2018; Naseri et al. 2020). As <50% of older adults engage in recommended amounts of physical activity, increasing participation is an important means of improving healthy aging in the older population (Piercy et al. 2018; Bull et al. 2020).

Participants were also motivated to increase social connections, which is important to address social isolation and loneliness as risk factors for reduced function (York Cornwell and Waite 2009; Shankar et al. 2017; Robins et al. 2018). Although social isolation and loneliness are connected, they are not the same thing. Social isolation refers to an objective lack of social interaction and networks, and loneliness describes the subjective feeling of not having one’s social needs met (Berg-Weger and Morley 2020; Van As et al. 2022). The Connect 60+ program offered participants an environment to create relationships, which in turn helped them develop the confidence to build relationships outside the program. Other research has found older adults prioritise social connections as a wellness strategy (Reich et al. 2020; Santini et al. 2020). Older people have also previously reported that they value social activities as a way to be connected to the community in a friendly atmosphere that is based on trust and security (Salman et al. 2021).

Participants who attended in person reported that a key enabling feature of Connect 60+ was its accessibility. The low cost, friendly staff and convenient location, near a main street with cafes, shops and buses, were factors of success. The participants spoke positively about the group facilitators at the hub. The low cost was especially important, as older adults tend to have a lower or fixed income compared with other sections of the community (Ylitalo et al. 2020), making some exercise programs inaccessible. Previous studies have also found that affordable and accessible community hubs enable older adults to get involved in their local community (Palmer et al. 2018; Ylitalo et al. 2020).

Participants commented that the program encouraged and motivated them by providing physical activity that they found enjoyable (Dacey et al. 2008). However, there was one participant who found the exercise too vigorous for them, which was a barrier to engagement. Older adults have reported previously that barriers to engaging in exercise include feeling that exercise is too difficult, health problems that impact on participation and low self-efficacy (Hill et al. 2011). Most participants also became motivated to learn about healthy aging, which increases self-efficacy to engage in healthy aging strategies (Notthoff et al. 2017). By addressing the domains of wellness, Connect 60+ included multiple determinants of health known to sustain healthy aging and independence (Strout et al. 2016, 2018; Tuason et al. 2021).

During the past few years of the COVID-19 pandemic, social isolation, loneliness, reduced levels of physical activity and difficulties in maintaining care have been identified as major health risks for older adults (Gaertner et al. 2021). However, even during mandated lockdowns, it is important to maintain a normal routine for one’s physical health and general wellbeing (Strout et al. 2016; Bentlage et al. 2020). One way to stay connected during these times is via technology (Chen and Schulz 2016). Although only a small number of participants joined online, this study showed that technology can assist people to engage with and join activities from a community hub. However, some participants reported difficulty with the online experience, which highlighted the importance of maximising accessibility for a positive user experience and supporting older adults in using technology during online wellness activities (Chen and Schulz 2016; Silvius et al. 2020). A report showed that in 2018, approximately 40% of older adults had not used the internet in the 3 months prior. Reasons for this included not feeling confident with the technology (Australian Bureau of Statistics 2020).

Strengths and limitations

A strength of the present study was the methods of triangulation used to increase the trustworthiness of the study (Nowell et al. 2017). Data were collected from a range of sources and analysed by three researchers. The primary researcher was also involved in the running of the weekly program, keeping an audit trail that increased the dependability of findings (Creswell and Miller 2000; Nowell et al. 2017). Member checking ensured that participants’ experiences were truly captured (Creswell 2014, p. 201), and in the final stages of manuscript drafting, a simplified copy of the results section was sent to three participants to confirm that it was a fair and accurate representation of their experiences of the program. A limitation of the study was that telephone interviews were completed 12 months after the study, due to limitations caused by COVID-19 pandemic restrictions impacting on research timelines. This may have affected participants’ recall of their experiences either in a positive or negative manner. However, participants were enthusiastic to describe the impact of the program on their experiences in the 12 months following its completion, as well as their original experiences when undertaking the program. This added richness to the understanding of how their experience during the program had impacted on their lives.

A genuine rapport was built during the program between the primary researcher and the participants, which was important to enable participants to feel safe to share their views (Braun and Clarke 2013). However, this may also have been a limitation, as participants may have felt reluctant to provide negative responses (Ramcharan 2013). There were only a small number of online participants compared with those who did the program in person, which limits the finding to this study and may not be generalisable to older community-dwelling people. However, purposive sampling was used to gain insight across the sample and maximise our understanding of the data in this study (Braun and Clarke 2013).

Conclusion

Connect 60+ was successful in supporting participants to engage in healthy aging strategies for being physically active and socially connected. The study contributes valuable evidence towards developing innovative programs that support older adults to continue to enjoy good health and remain socially connected as they age in their community (Manz et al. 2018; Salman et al. 2021). Although participants concurred strongly that the program was a positive experience and had a positive impact on their lives, there were some barriers to engagement. Strategies to address barriers include encouraging more men to join, optimising online technology for a better user experience, ensuring exercises are suited to all fitness levels, and continuing to provide a broad range of wellness and social activities to suit more preferences. This study demonstrated that wellness programs delivered from a community hub can enable physical activity and social connections due to the accessibility, variety of activities, and providing a welcoming environment in the local community.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of interest

The authors declare no conflicts of interest.

Declaration of funding

The authors have not received funding for this study. Professor Anne-Marie Hill receives career support through a National Health and Medical Research Council of Australia Investigator EL2 Grant.

Author contributions

CN, AMH and TW conceptualised the study design and research protocol with ongoing expertise and support from JB, SV, HO and LG. AMH, CN and TW led trial management. TW and CN led data collection and management, and site procedure, in consultation with LG. TW and CN led statistical analyses. TW led the drafting of all sections of the manuscript in consultation with CN, AMH and SV. All authors critically revised the manuscript for important intellectual content, and read and approved the final version of the manuscript.