Implementation, Challenges, and Outlook of an Intergenerational, Layperson-led, Health Coaching Program (HealthStart): A Pilot Case Study
Background: As rapidly aging populations become a worldwide phenomenon, early detection and prompt management of chronic disease become essential to support healthy aging. Community-based health screenings, a key component of this strategy, often struggle with poor follow-up rates, limiting their long-term impact. Given the untapped potential of youth volunteers and the urgent need for a scalable approach to improve continuity of care post health screenings, we developed HealthStart: a structured, theory-based programme that empowers these older adults to take greater ownership of their health and their chronic conditions with the support of youth community health volunteers (youth CHVs). Objective: We describe the development, implementation, and early outcomes of HealthStart – an intergenerational, layperson-led health coaching programme – and summarize operational lessons to guide similar models in Asian communities. Methods: HealthStart adopted an intergenerational service-learning approach modelled on a self-determination theory-based layperson-led health coaching framework. Each HealthStart team consisted of one healthcare volunteer (HCV) and four youth CHVs. All volunteers underwent blended training and were assessed for layperson-led health coaching readiness. Between September 2022 and June 2023 in Singapore, youth CHVs empowered adult participants aged 40 years and older after their health screening to: (1) learn about their chronic diseases; (2) learn at least one digital health application; (3) enrol with a primary care provider; and (4) set a lifestyle goal (based on the SMART framework for goal setting) and achieve it. We employed an implementation-focused case study design using deszcriptive statistics and volunteer–participant feedback to evaluate #feasibility and outcomes. Results: Of 243 eligible individuals, 192 enrolled. Participants had a mean age of 67±9.6 years; 52% female; with majority of Chinese ethnicity, completed primary or secondary school education, resided in self-owned flats, and in 3-room public housing. Follow up rate with primary care increased from 42.7% (82/148) pre-programme to 84.5% (125/148) post-programme (χ2 = 43, p < 0.001). 58 HCVs were recruited, comprising 26 nurses, 6 doctors with the remainder as allied health professionals. A total of 33 were trained and deployed. The mean age of HCVs was 37 years old and 24 (72.7%) were female. 149 youth CHVs were recruited, 138 trained and 102 deployed. The mean age of the youth CHVs who were deployed was 24 years, and 75 (73.5%) were female. Reflections included the importance of volunteer competency and selection criteria, tiering of participant intervention, tapping on community assets, adoption of a social prescription framework, importance of alignment with population health policies, and cultivating intergenerational relationships. Conclusions: HealthStart demonstrates the #feasibility and acceptability of a structured, intergenerational, layperson-led health coaching model embedded in primary care. We identify key lessons learned in the conceptualization and implementation of the programme that may inform the design of similar volunteer-enabled initiatives for harnessing laypersons, an often-underutilized asset, to promote health in the community.