Digital Nutrition Intervention for Older Adults

Study Overview
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Brief Summary
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The digital divide or gap in technological access and knowledge, for older adults has worsened during the COVID-19 pandemic, leading to disruptions in services like congregate meal programs funded by the Older Americans Act. Seven San Antonio congregate meal sites remained partially open biweekly to distribute meals but no longer offer in-person nutrition education, physical activity classes, and social activities. The proposed project will test the efficacy of digital nutrition intervention with at-risk older adults who attend congregate meal center in areas of high poverty and digital exclusion. The study is uses a stepped-wedge cluster clinical trial. Key community partners with the Department of Health Services Senior Services Division and Older Adult Technology Services (OATS) will participate in the planning phase, research design, and implementation of the study. The study aims are: To test the impact of a technology-based intervention on the primary outcomes of food security and diet quality; To determine the effect of the intervention on secondary outcomes of technology knowledge and usage, physical activity, and social isolation and loneliness; To examine the long-term impact and sustainability of technology use on food security, diet quality, physical activity, and social isolation. If successful, the impact of this program could be applied throughout the national OATS network and to similar CMPs to bridge the digital divide beyond the COVID-19 pandemic

Detailed Description
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This project will target community-dwelling older adults who are congregate meal program (CMP) participants living in areas at-risk of the digital divide. The CMP is funded by the Older Americans Act and serves over 2000 San Antonio older adults who live 33% below the poverty level and 18% considered at high nutritional risk. During the pandemic, seven San Antonio sites in areas with high poverty and digital exclusion remain partially open biweekly to distribute meals but did not hold in-person nutrition education, physical activity classes, and social activities. The proposed project extends existing congregate meal programming infrastructure and partnerships with Older Adults Technology Services (OATS), a national leader in creating health service programs focusing on older adults. The goal of the proposed study is to remove the digital barrier to receiving essential, evidence-based nutrition programming online, utilizing OATS' five-week technology Essential Series, which has successfully educated thousands of older adults nationwide by providing support for technology and internet connectivity. This proposed nutrition intervention will enrolled congregate meal participants using a stepped-wedge cluster design with two cohorts to allow for sequential intervention enrollment with simultaneous control and intervention data collection timepoints. Key community partners within Department of Health Services Senior Services Division and OATS will participate in the planning phase, research design, and implementation of the study. Feedback from congregate meal participants in focus groups will guide the development of the intervention. The 20-week intervention will include 5 weeks technology training, including internet access and devices, followed by 15 weeks of a culturally tailored nutrition intervention via online sessions. The study will recruit 440 older adult from seven at-risk congregate meal sites. Data will be collected at baseline (T0), during the online intervention (T1), after the online intervention (T2) and 6 months post-intervention (T3). The successful outcome of our study will be impactful because of the potential broader application of this program throughout the national OATS network and to similar CMPs to bridge the digital divide through and beyond the COVID-19 pandemic.

Official Title
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A Technological Intervention to Improve Nutrition Among Older Adult Congregate Meal Participants During COVID-19

Conditions
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Nutrition Poor, Physical Inactivity, Social Isolation

Intervention / Treatment
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* Behavioral: Technology intervention
* Behavioral: Digital Nutrition Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 60 years of age Inadequate or no working technology device (computer, smart-phone, tablet), no or poor internet connectivity at home, or lack of knowledge and usage of technology Food insecurity or low diet quality Exclusion Criteria: Blind Terminal disease or illness Diagnosis of dementia or Alzheimer's disease Unable to read or write in English or Spanish

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: This intervention will use a closed-cohort stepped wedge design. In a stepped wedge design, the timing of the intervention is randomized by cluster, with sequential crossover of clusters from control to intervention until all clusters have received the intervention. With this design, each cluster contributes data when they are participating in the intervention and when they are not. This study will be a two-step stepped wedge design; each of the seven targeted centers will then be randomly assigned to one of two cohorts. Participants in Cohort 1 will receive the intervention first. Six months after baseline data have been collected, Cohort 1 participants will finish the intervention and crossover will occur as Cohort 2 participants begin the intervention. At the 12-month time point, the second cohort will complete the intervention. Data will be collected for both groups in each time period T0-T3.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cohort 1<br>Cohort 1 will start the intervention directly after randomization. | Behavioral: Technology intervention<br>* Older Adult Technology Services (OATS) 5-week technology intervention<br>Behavioral: Digital Nutrition Intervention<br>* 15-week nutrition intervention delivered completely online<br>|
| Active Comparator: Cohort 2<br>Cohort 2 will serve as the control while cohort 1 is in the intervention stage. Cohort 2 will start the intervention after cohort 1 concludes the intervention. | Behavioral: Technology intervention<br>* Older Adult Technology Services (OATS) 5-week technology intervention<br>Behavioral: Digital Nutrition Intervention<br>* 15-week nutrition intervention delivered completely online<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diet Quality as measured by the Healthy Eating Index | Two non-consecutive 24-hour dietary recalls will be collected and the Healthy Index will be calculated to determine diet quality. | Change in diet quality from baseline to 3 and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Food Security | Food security measured by the USDA's US Adult Food Security Survey Module | Change in food security from baseline to 3 and 6 months | 
| Physical Activity | Physical activity measured by the Physical Activity Scale for the Elderly (PASE) | Change in physical activity from baseline to 3 and 6 months | 
| Technology Use and Access | Technology use questionnaire from the National Health & Aging Trends Study | Change in technology use and access from baseline to 3 and 6 months | 
| Attitudes Towards Technology | Adapted from Attitudes Towards Computers Questionnaire (ATCQ) | Change in attitudes towards technology from baseline to 3 and 6 months | 
| Social Isolation | Social isolation measured by The Social Disconnectedness Scale and the Perceived Isolation Scale | Change in social isolation from baseline to 3 and 6 months | 
| Loneliness | Loneliness assessed by the 3-item UCAL Loneliness Scale | Change in loneliness from baseline to 3 and 6 months | 
| Malnutrition | Malnutrition measured by the Mini Nutrition Assessment Short-Form | Change in malnutrition from baseline to 3 and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical activity, Social isolation, Technology, Older adult, Nutrition, Food security