$ 0.037 6.71%

COMSA (CMS) Rank 3352

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Volume 24H 0 CMS
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Exploring the implementation of the Community for Successful Ageing

However, due to the complexity of its multiple BPS components, and in particular the relative novelty of the S program component SWING, it was at times challenging to understand how the program was to be operationalized and coordinated. Cohesion within partner organizations, as well as strong rapport with the community (ability to engage participants) were needed to create commitment to the program. Organizational factors played a key role in influencing trainers’ ability to elicit change among participants on the ground.

Lessons learnt identified on improving BPS programming across the different implementation stages can be transferred across multi-component programs driven by voluntary community partnerships. These programming approaches have led to explicit attempts to theorize and test the interconnections among BPS health constructs, and their effect on Quality of Life. Health is conceived as a holistic endeavour in the community development initiative of the wider Community for Successful Ageing program (ComSA CD) in Singapore. The program model theorizes that Biological self-care at older ages can be learnt and maintained.

In FDG2, in order to contrast perspectives directly, we mixed five senior trainers, participant volunteers and operational staff from Tsao Foundation. In FGD3 we talked to five volunteers who managed the day-to-day operations of the Resident Centers. Lastly, in FGD4 we involved three senior management staff from the Whampoa Community Club Management Committee (CCMC) [36] of the People’s Association, as they were key implementation partners.

Further research testing the optimal sequence (B component SCOPE followed by S component SWING versus P component GAB followed by S component SWING) and the magnitude of change on BPS and Quality of Life outcomes are needed. Such research will enable policymakers and implementers to unpack the ‘black box’ of complex, multi-component BPS health promotion programs, towards successful ageing in the community.

COMSA description

Unlike other countries, in Singapore, most grassroots bodies are under the purview of the People’s Association, a statutory governing board established in 1960 to manage citizen feedback and promote social cohesion. Grassroots leaders were therefore concerned whether doing so could undermine their role in promoting social cohesion, and ‘flood the inboxes’ of governmental agencies (FGD4, CCMC manager). The perceived program fit of ComSA CD was shaped by its alignment with partners’ organizational goals as well as how well partners understood the program.

COMSA description

Empirical validation of these theorized BPS interconnections was used to inform the design and sequence of the BPS program components [13]. Delivering the multiple components of the BPS program across the 13 community sites required a considerable amount of coordination and resource allocation. Required resources included manpower support from centre managers, program trainers, space as well as technical equipment. Herein, the program’s complexity meant that partners had to work more closely in aligning communication to coordinate the sequence of BPS components. However, constraints faced by the separated management structure of program trainers necessitated a degree of program adaptation.

COMSA description

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COMSA description

Another key lesson learnt thus refers to the importance of building cohesion and shared values among partners before implementation. Studies have shown how internalization of norms, through leadership and socialization, are critical to governing, ensuring accountability and resolving disputes in voluntary community partnerships [18, 40]. Leaders from a larger program committee can help to neutralize territorial anxieties, by identifying a common vision and win-win opportunities, and building a shared participant-centered culture. To increase sharing of ideas, resources and power, boundary-spanning leaders who can bridge partners’ perspectives and cultures may be more effective compared to leaders with a narrow range of expertise [16, 41]. One key finding from this study was that community partner’s’ convening power, and skills to elicit buy-in from residents was crucial to boost program participation [17].

Lessons learnt are therefore connected to eliciting better participants’ buy-in and a shared program vision. We worked closely with program implementers (SHC and MABG) to design the structure, content and composition of Focus Group Discussions (FGDs). The Psycho-Social (PS) sub-component of improving interpersonal communication on emotive issues is emphasised. According to the Normalization Process Theory, implementation consists of a set of feedback loops, and is not a linear process [24]. Implementing organizations can either negotiate organizational contexts according to the needs of the program or instead adapt the program to accommodate the organizational contexts.


COMSA description

Ms. Kaweckyj graduated from the American Dental Association-accredited dental assisting program at ConCorde Career Institute and has received a Bachelor of Arts in Biology and Psychology from Metropolitan State University. Tsao Foundation developed the logic framework of ComSA CD, and overall programming strategy, which was used as the basis to further develop the BPS program theory. Evaluation checklists could serve as a useful tool and communication aid for partners to reflect on program effects, their readiness for program adoption and implementation. Embedding these checklists within quality improvement cycles, to monitor, plan and innovate new joint improvement goals is likely to foster a spirit of learning and experimentation. Furthermore, coordination could be vastly improved by the introduction of shared information management systems such as web-based team calendars for scheduling or decision support tools [42].

It relates this process to positive ageing perceptions [12] and the psychological ability to appraise one’s life as meaningful and maintain one’s sense of identity, despite facing age-related adversity [1, 3]. Ability to engage in social participation and civic engagement is turn related to psychological and biological health, towards improving the community’s capacity to address needs of other older people [6].

  • One important aspect complicating the delivery of BPS components, was how the B, P and S components were intended to be experienced sequentially, and also that they required quite different modes of facilitation.
  • Appraising both the organizational contexts alongside the program’s characteristics and delivery during program planning and implementation will shape the success of its delivery.
  • We discuss each of these dominant themes in turn, in line with qualifying sub-themes and how they relate to identified program characteristics (novelty, complexity and observability), and ultimately map to implementation outcomes and lessons learnt.
  • Embedding these checklists within quality improvement cycles, to monitor, plan and innovate new joint improvement goals is likely to foster a spirit of learning and experimentation.
  • This sense of cohesion was suggested to be lacking in certain partner organizations, as commitment from the leaders did not necessarily trickle down to the centre managers (FGD3, RC manager).
COMSA description

These should include implementation indicators aligned to the key types of outcomes identified herein. This was especially important in the absence of formal accountability since most partners depended on volunteer-led support. This sense of cohesion was suggested to be lacking in certain partner organizations, as commitment from the leaders did not necessarily trickle down to the centre managers (FGD3, RC manager). Less committed centre managers were described as providing perfunctory support - ‘reducing themselves to locking and unlocking the centre’ for trainers while others even had problems doing so on time (FGD2, program staff). These were held at the Whampoa resident centre, community club and Tsao Foundation, with (A) program staff/ trainers, and (B) community partners (see Table1).

Referring to the implementation science literature, there are various stages that people undertake when they implement a new technology, or program. These include those related to planning (resources, outreach strategy of the program), engaging (participants to enrol in the program), executing, and reflecting/evaluating (e.g. about the program benefits and implementation strategy) [14]. How these stages are carried out are often influenced by context - or the complex adaptive system that forms the dynamic environment in which implementation is situated [15]. Finca Triunfo Verde (FTV) has worked extensively with Grounds for Health to implement a community-focused effort to test women for cervical cancer.

In this study, we illustrated how the implementation of ComSA CD was an overlapping process, consisting of a set of feedback loops, and therefore not a linear process [24]. The key implementers involved attempted to negotiate organizational contexts according to the program’s needs while adapting the program as it unfolded. The stages of implementation identified in our framework share conceptual similarities with implementation processes proposed by Carl May [37]. For example, the initial stage of creating commitment to the program requires making sense of the program and cognitive participation (to legitimize and persuade others to enroll).

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Brainstorming the program’s vision and strategy together, was therefore necessary to build trust, and ease changes to the working dynamics; most notably moving from curation to facilitation of collective action. Despite regular and constructive meetings, aligning communication between partners to ensure the operational demands and timeline of each BPS component complimented existing work schedules was at times challenging. This was particularly relevant for SWING, not only because it was intended to be delivered last, but also because it was a relatively novel component that required experimentation.

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Programs can also consider enlisting the help of public figures and opinion leaders (e.g. celebrities, charismatic program staff) to help promote the program. Monitoring and appraising the program’s effects were inherently related to sustaining commitment across BPS components. An obvious lesson learnt from these analyses points to the need for Developing comprehensive monitoring systems for program appraisal that can be shared and collected in an objective and standardized way.

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This is especially relevant for ‘tightly coupled’ programs such as ComSA CD, or multiple-component programs with a fixed sequence. Such program often require more coordination [24], communication, and adaptation to different organizational contexts [26, 38]. Another barrier was the separated management structure of program trainers, or how the B, and S component trainers were managed by different teams within Tsao Foundation from the P component trainers. Those running the P had additional work roles beyond delivery of guided auto-biographical sessions.

However, this varied from partner to partner, depending on the personal magnetism, commitment, and management of their volunteers such that they were cohesive and ‘willing to work’. To overcome resource limitations, new ways to harness participants as program champions in the community may be required.

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In sum, coordination efforts were defied by the complexity of the BPS program, which was somehow aggravated by more novel and unfamiliar aspects of programming, as described earlier. Outcomes relating to program adaptation and efficiency in resource utilization were qualified by partners’ abilities to come together and practically share the responsibilities and resources for the program. Lessons learnt are consequently connected to increasing adaptability of BPS sequence and building culture of shared values for working together. The analysis identified three core implementation stages that anchor experiences of organizational contexts and mechanisms, or factors that hinder or promote implementation. The stages are (1) creating commitment toward the program, (2) coordination and resource allocation, and (3) collaborative program appraising and monitoring.

‘Sharing Wellness and Initiatives Group’ (SWING) targets Social (S) and Socio-Communal (SC) health of older adults in terms of social support and civic engagement. It includes an 8 week participatory workshop to foster critical community assessment and thinking on community solutions, which are known operational domains for community development and capacity-building [31]. More details on the program structure, underpinning theory and content can be found elsewhere [13].

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