Abstract
Achieving consistent follow-up rates in community-based health screenings is a challenge. Fewer than 75% of patients receive follow-up care in cancer screening programs in the United States. One in four people screened in community health screenings had not returned for a doctor’s follow-up after a year in Singapore. This issue is compounded by the severe shortage of healthcare workers - the World Health Organisation (WHO) estimates a projected global shortage of 18 million health workers by 2030.
HealthStart is a self determination theory (SDT) based intervention that aims to increase the engagement and follow-up rates of older adults attending a chronic disease community health screening by developing, training and empowering lay volunteers as health advocates that accompany them in their post-screening journey over a three month period. Collaboratively organised by TriGen, a charity organisation, and the Singapore General Hospital (SGH) Population Health and Integrated Care Office (PHICO), a team that oversees care integration initiatives in Southeast Singapore, this ground-up initiative was designed to augment Singapore’s HealthierSG programme, the local government’s policy to shift the focus towards preventive health by reshaping the population’s health-seeking behaviours and lifestyle through collaborative care.
The primary outcome of the programme was residents’ enrolment with a family physician. To complete the programme, each resident had to additionally complete a local Health Promotion Board (HPB) booklet detailing the condition they were newly diagnosed with, learn a digital health application and set a lifestyle goal and achieve it. This was accomplished alongside volunteers who were equipped with knowledge on chronic diseases, awareness of the local community healthcare system, principles of health coaching and motivational interviewing in the pre-programme training, under the pedagogical framework of intergenerational and service learning.
HealthStart reached out to 201 older adults via 30 healthcare workers and 99 lay volunteers over two health screenings conducted in 2022 and 2023 respectively. An exact McNemar's test determined a statistically significant difference in the proportion of residents having primary care follow-up pre-intervention (55.4%) versus post-intervention (84.5%), χ2 = 43, p <0.001. Mean post-programme score for a twelve question chronic disease knowledge questionnaire was 8.9. Digital health application uptake rate and lifestyle goal attainment rate were 66.2% each. 80.9% of residents were satisfied with the programme. Qualitative feedback from residents and volunteers reflected the programme's positive impact in empowering residents to take better care of their health, facilitating post-screening continuity of care and fostering intergenerational relationships.
Operational lessons from programme implementation include the requirement for resident suitability criteria, lay volunteer competency criteria, value of an individual-tailored service, benefit of personalised reports, need to bridge communications between community services and importance of incentivisation for primary care enrolment and health goal attainment.
HealthStart leverages on a synergy gained from the energy and creativity of lay volunteers coupled with the experience of healthcare professionals to address gaps in the health of the older adult population. Ultimately, fostering health engagement across all ages and promoting social connectedness across generations is key to developing concerted and sustainable advancements in population health.