Christopher Ball

UNC DPT c/o 2015

Multiple group hikes will be offered based on difficulty level on the weekends and last between 1-6 hours, cover 1-10miles with higher difficulty hikes lasting a greater length of time and duration. Initially senior hiking groups will contain a maximum of 6 participants per hiking group. To ensure adequate participant safety, a participant to volunteer ratio of 3:1 will be mandatory. Hikes will be lead by at least one skilled rehabilitation health professional and one volunteer with identical training as those participating in the community gardening program. These same volunteers will also scout and select the trails best suited to provide optimal safety, challenge and enjoyment. Initial group hikes will be completed at Dupont State Park, located 10 miles outside of Mills-River. This initial location offers extensive network of trails which are well maintained throughout the year, contain a hiking corridor/trail of larger width (>/= 10’) which allow for enhanced visibility and decreased risk of falls while also providing moderate to high levels of physical activity over variable terrains and degrees of incline whilst enjoying the natural environment in a social atmosphere with peers. The age range will be larger for the hiking groups (over 40 yo) to better facilitate attendance, adherence and prevention of multimorbidity, frailty and chronic disease in both the elderly-adult and middle-aged populations of Mills-river. Developing a framework for program evaluation works to ensure accountability and commitment on the part of all those involved with the prospective program to achieving measurable health outcomes. Results and findings from the initial pilot implementation period will serve as the foundation for adequate modification and innovation regarding greater outcome improvement or use of alternate outcome measures which are better positioned to detect program effects on a targeted population.35 The value of health and wellness programs proposed is best determined by the programs merit, cost-effectiveness and importance to the older-adult population and overall community of Mills-River.35 This health promotion program has been tailored both for the older-adult and the rural and underserved community. The independent program interventions and associated components have been described above in full detail along with supporting evidence of their potential benefit for the older adult regarding targeted conditions of frailty, inactivity, chronic disease and malnutrition.32 The proposed health promotion programs are direct service interventions with multiple components. As such methods of evaluation must first be ethical and consider the welfare of those involved and potentially affected.37 Methods of program and outcome evaluation should be realistic, feasible to complete and serve the information needs of intended users.35 The components making up the health promotion interventions encompass multiple levels of health behavior change and thus, should also have multiple components to best gather necessary information and thus, better accounting for program effectiveness and results that are reliable and accurate.35 increased coordination between primary care entities, public service officials, and allied health professionals and serves to benefit the development, implementation and evaluation of program and associated interventions. This emphasis on interdisciplinary participation fosters a larger and more diverse source of input, greater level of participation and increases the chances that the evaluation tools will be useful, creditable and allow those involved to clarify roles, responsibilities, ensure participant safety and avoid real or perceived conflicts of interest.37 Utilizing or implementing a turnstile at the community center entrance to sign in prior to the start of the session could easily achieve total attendance, participant adherance as well as overall attendance at the community center as a whole. Objectives which are quantified by ordinal-style data such as incidence of falls, program adherence, dietary and/or physical activity logs can be tied to routine program operations in a more ongoing fashion that involves all program staff, volunteers or stakeholders.36 Placing the community garden and conducting educational sessions at the community center was recommended to improve familiarity, and awareness of the centers recourses in their entirety. This continuity of location is hoped to bring greater comfort within the environment of the program interventions to better achieve program adherence of prospective older-adult participants whilst ensuring the results obtained during the evaluation are both reliable and valid.32