Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol

• Published in: PloS one Vol. 19; no. 1; p. e0296438
• Main Authors: Piamjariyakul, Ubolrat, McKenrick, Susan R, Smothers, Angel, Giolzetti, Angelo, Melnick, Helen, Beaver, Molly, Shafique, Saima, Wang, Kesheng, Carte, Kerri J, Grimes, Brad, Haut, Marc W, Navia, R Osvaldo, Patrick, Julie Hicks, Wilhelmsen, Kirk
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-01-2024; Public Library of Science (PLoS)
• Subjects: Accuracy; Adults; Aged; Aged, 80 and over; Appalachian Region; Biology and Life Sciences; Confidentiality; Consent; Design; Earth Sciences; Evaluation; Feasibility; Female; Females; Health aspects; Health care disparities; Humans; Male; Medical care; Medicine and Health Sciences; Nursing schools; Older people; People and Places; Program Development; Program Evaluation - methods; Quality control; Quality Improvement; Quality management; Ratings; Rural areas; Social interactions; Social Sciences; Surveys and Questionnaires; Systematic review; Workers; Appalachian Region; United States; West Virginia; United States > US; Appalachia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0296438

Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months.
The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation.
This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations.
Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73).
The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.