Impact of the Health-Smart Holistic Health Program: A CBPR Approach to Improve Health and Prevent Adverse Outcomes for Black Older Adults

Abstract

Black older adults experience poorer health and health-related outcomes than their non-Hispanic White counterparts. Novel, tailored strategies to promote health and prevent adverse health-related outcomes that are aligned with the preferences and values of Black older adults are needed given the limited effectiveness of “one-size-fits-all” approaches. The present study evaluated the impact of a 9-week, community-based participatory research-informed program called the Health-Smart Holistic Health Program for Seniors that aimed to improve health and prevent adverse outcomes among Black older adults by targeting body mass index (BMI), loneliness, food insecurity, and physical and psychological health-related quality of life. Participants (N = 139) were community dwelling, economically disadvantaged Black older adults living in an underserved area. Results indicated that from pre-intervention to post-intervention there were (a) significant decreases in BMI, loneliness, and food insecurity and (b) significant increases in the participating seniors’ psychological and physical health-related quality of life. Most of these changes were maintained at a 3-month post-intervention follow-up. These results have implications for similar efforts attempting to prevent adverse health outcomes among Black older adults, a high-risk and understudied group. Such efforts should be tailored and should address factors at multiple levels.

Keywords

African Americans/Black Americans prevention health promotion

Black older adults are extraordinarily resilient given the structural impediments that they experience (Chae et al., 2021). These structural impediments include a lifetime of experiencing many forms of discrimination such as overt and covert acts of racism (LaFave et al., 2022) and residing in food swamps and deserts (i.e., neighborhoods with few options for healthy foods; Cooksey Stowers et al., 2020). Despite their resilience, Black older adults have been disproportionately impacted by adverse health conditions (Assari, 2018; Millett et al., 2020; Phillips et al., 2021), such as obesity (Ogden et al., 2017), low health-related quality of life (Hayes-Larsonet al., 2021), and loneliness (Chatters et al., 2020). These adverse health conditions place Black older adults at risk for poor health outcomes, such as premature mortality; the life expectancy for Black adults in the United States is lower than that of any other racial/ethnic group (Harper et al., 2021). The term “double jeopardy”—that is, being both older and Black—has been used to describe how the effects of structural impediments (e.g., discrimination and poor access to healthy foods) and age (e.g., age-related loneliness and social isolation) interact to produce negative health indicators (e.g., diminished psychological and physical health-related quality of life, increased body mass index [BMI]) that contribute to premature mortality among Black older adults (Chatters et al., 2020).

The impact of this double jeopardy on the mental and physical health-related indicators and life expectancy of Black older adults highlights an urgent need for novel strategies to improve health and prevent adverse health outcomes, such as premature mortality, among this population. There is an urgent need for novel strategies as many health promotion efforts targeting Black older adults have been limited in their ability to recruit these individuals (Graham et al., 2018). Less than 10% of participants in health promotion trials are Black adults above 18 years of age (Awidi & Al Hadidi, 2021; Fouad et al., 2016; Nazha et al., 2019). There is clear evidence that mistrust serves as a significant barrier to recruitment and engagement in health promotion efforts for Black Americans (Graham et al., 2018; Mitchell et al., 2020; Portacolone et al., 2020). This mistrust stems from a long history of undertreating and mistreating Black Americans by health promotion specialists (Cuevas et al., 2019; Cuevas & O'Brien, 2019). When efforts are successful in the recruitment of Black older adults, they are further limited by their effectiveness. That is, they do not produce meaningful changes in the outcomes of interest.

It has been suggested that “one-size-fits-all” efforts are to blame for the lack of meaningful changes in the outcomes of interest (Minivielle, 2018; Wippold, Frary et al., 2021). That is because one-size-fits-all efforts often do not take into account the needs of the target population (Wippold et al., 2020; Wippold & Frary, 2021) and are not intentionally tailored to incorporate the cultural values and preferences of Black older adults. Specifically, one-size-fits-all interventions do not attend to surface-level and deep-level structures (Resnicow et al., 1999). Surface-level structures include intentional matching of the effort’s materials and messages to the target population, such as including a picture of a Black older adult on recruitment material and implementing the intervention in a location frequently used by Black older adults. Deep-level structures refer to the effort’s ability to incorporate the values of the target population, such as culturally tailoring the intervention. Surface-level structures increase receptivity (i.e., recruitment), whereas deep-level structures increase cultural salience (Resnicow, 1999). Evidence suggests that efforts that are intentional about incorporating the surface-level and deep-level structures of Black adults are likely to produce health-promoting results (Wippold, Frary et al., 2021).

The concerns with recruitment and effectiveness can be circumvented by health promotion and prevention efforts that are committed to attending to these structures and fostering a community–academic partnership. There have been calls for the formation of community–academic partnerships aimed at promoting health among communities impacted by health disparities (Tucker et al., 2016, 2017b), such as Black older adults (Tucker et al., 2017a, 2017c). This type of partnership is the foundation of community-based participatory research (CBPR), a health promotion framework that is rooted in an equitable partnership between the target community (i.e., community partners) and the health promotion specialists (i.e., research partners; Israel, 2013; Israel et al., 2010). This partnership influences the development, implementation, assessment, and dissemination of the health promotion effort and its findings. Research-based in CBPR attends to the unique context of the target population including socio-cultural aspects, capacity, and readiness for change. These in turn influence the partnership process, which involves the equal decision making of community and academic partners (Belone et al., 2016; Wallerstein et al., 2008). This partnership process informs the mediating mechanisms of the effort (i.e., processes), in addition to the outputs. These mediating mechanisms and outputs must be aligned with the values (i.e., surface-level and deep-level structures) of the community. The processes and outputs impact intermediate (e.g., empowerment) and long-term (e.g., health equity and community transformation) change within the community.

Due to the emphasis on community involvement in the development and implementation of the health promotion effort, CBPR has been identified as a viable paradigm to alleviate health disparities (Wallerstein & Duran, 2006) because efforts based in CBPR are more likely to circumvent concerns with recruitment given that they are supported by members of the community and are transparent; thus, these efforts are likely to foster trust between the participants and the researchers. Additionally, these partnerships inherently recognize that members of the target community are the true experts on their health. Given this recognition and the involvement of the community partners in every aspect of the research process, efforts rooted in CBPR are more likely to be aligned with the values and preferences of the target community.

Current Study

The purpose of this study was to test the effectiveness of the Health-Smart Holistic Health (HSHH) Program for Seniors, a community–academic partnered intervention designed to promote health and prevent adverse health outcomes among Black older adults living in an underserved area by reducing BMI, social isolation, and food insecurity and increasing psychological and physical health-related quality of life. The HSHH Program for Seniors is rooted in an ecological approach that targets interpersonal (e.g., social isolation), intrapersonal (e.g., loneliness), and systemic (e.g., food insecurity) factors that increase the risk for poor mental and physical health outcomes among Black older adults (Chatters et al., 2020; Schulz et al., 2020). The HSHH Program for Seniors is also rooted in findings that group-based health promotion efforts will help foster health among older African Americans (Wippold, Tucker, et al., 2021). The hypotheses of the present study were:

1. From pre-intervention to immediately post-intervention, there will be significant decreases in participants’ BMI, loneliness, and food insecurity and significant increases in their psychological and physical health-related quality of life

2. These changes will be maintained at the 3-month post-intervention follow-up.

Methods

Participants

Participants in this intervention (N = 139) were underserved and/or low-income older Black adults living in Jacksonville, Florida’s Health Zone 1, the health zone in Jacksonville with the highest poverty rates (30%) and highest rates of the most common chronic diseases (Duval County, 2012). Additionally, Health Zone 1 has the highest percentage of racial/ethnic minority residents (81.2%) and the highest percentage of Black residents (85%) of the six health zones in the city (Duval County, 2012).

In order to be a participant in the HSHH Program for Seniors, potential participants had to (a) live in Health Zone 1 of Jacksonville, (b) be at least 60 years old, (c) be able to communicate orally in English and understand English written at an eighth grade level, (d) be food insecure and/or socially isolated, and (e) give written informed consent to participate. Older adults could be excluded or withdrawn from the intervention due to any of the following: (a) self-reported medical treatments with major side effects, such as chemotherapy, radiation, or hemodialysis; (b) self-reported medical conditions such as unstable angina, severe pulmonary problems, and/or severe musculoskeletal or neurological problems; or (c) blood pressure ≥ 180/120 mmHg, unless the participant obtained written medical clearance to participate or continue participating in the intervention).

Participants were between the ages of 60 and 92 years (M = 69.17, SD = 7.13). Most participants (85.6%) self-identified as women. The majority of participants (66.9%) reported having no spouse or partner. Most participants (80.6%) did not work and had a household income under $29,000.

Measures

Demographic And Health Information Questionnaire

The Demographic and Health Information Questionnaire was designed by the research team to obtain the following information from participants: age, gender, race/ethnicity, annual household income, highest level of education completed, marital status, employment status, and weight- and obesity-related information and diseases.

Campaign to End Loneliness Measurement Tool

The Campaign to End Loneliness (CELMT; Campaign to End Loneliness, 2014) is a 3-item tool used in the Campaign to End Loneliness that measures the gap between the number and quality of relationships respondents would like and the number and quality of relationships that they actually have. Items are rated on a five-point Likert scale ranging from 0 = Strongly Agree to 4 = Strongly Disagree. A sample item is, “I have enough people I feel comfortable asking for help at any time.” Item scores are summed to attain a total score ranging from 0 to 12, with lower scores indicating lower levels of self-reported loneliness. The Cronbach’s alpha of this measure was .78.

World Health Organization Quality Of Life—Brief Form

The World Health Organization Quality of Life—Brief Form (WHOQOL-BREF; World Health Organization, 1998) is a 26-item measure that assesses respondents’ self-reported health-related quality of life. Two domains of the WHOQOL-BREF were used in this study: (1) the physical health-related quality of life and (2) the psychological health-related quality of life domain. Items are rated on a four-point Likert scale ranging from 1 = Very Poor/Very Dissatisfied/Not at all to 5 = Very Good/Very Satisfied/An Extreme Amount. Sample questions include “How much do you need any medical treatment to function in your daily life?” (physical) and “How much do you enjoy life?” (psychological). The mean score of items within each domain is used to compute the domain score. Domains are scaled in a positive direction; higher scores indicate higher quality of life. The Cronbach’s alpha for the physical health-related quality of life domain was .87, and for the psychological health-related quality of life domain was .77.

USDA Adult Food Security Survey Module

The USDA Adult Food Security Survey Module (USDA AFSSM; United States Department of Agriculture, 2017) is a 10-item self-report questionnaire comprising questions referring to conditions and behaviors related to participants’ access to healthy food or experiences of food insecurity. Participants are provided with statements about food eaten in the household in the 12 months prior to answering the survey. A sample statement is, “In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn’t enough money for food?” Most questions include language that assures that the reported behavior or condition occurred because of financial limitations reflected in “because we couldn’t afford [that]” or “because there wasn’t enough money for food.” The Cronbach’s alpha of this measure was .89.

Procedure

Approval to conduct this intervention was obtained through the institutional review board (IRB) at the university where the first author of this study, who also serves as the principal investigator (PI) of the larger intervention study, is based. Prior to the development and implementation of the intervention, a needs assessment was conducted, and meetings were held with pastors and church leaders to help tailor the intervention to the culture, preferences, and values of the community.

Study Staff

Study staff included trained Black community members who served as community scientists and were responsible for recruiting, enrolling, and consenting study participants, and for administering study questionnaires. Clinical staff at the local community health center collected biometric data from the study participants. Additionally, community members were hired and trained to serve as Health Empowerment Coaches (HECs) and were responsible for implementing the 9-week health promotion intervention evaluated in this study. HECs were nominated by participating church groups.

HECs participated in a 24-hr training conducted by the PI and research team, which provided comprehensive information on and detailed instructions for implementing the intervention. Each HEC was given a copy of the Health-Smart Training Manual and was expected to receive at least an 80% score on the training competency evaluation at the end of the training. In addition to these trainings, HECs received weekly phone-based training and consultation regarding study implementation issues, facilitated by the PI and research team.

Recruitment, enrollment, and data collection

The study was advertised in Health Zone 1 via flyers posted in community centers, clinics, and participating churches. Enrollment took place at one of two university-affiliated community clinics. If participants consented to participate, they signed a consent form, completed baseline questionnaires, and had their biometric data taken. Participants were given a $40 gift card for completing enrollment procedures and were informed that they would receive an $80 gift card at each of the post-intervention and 3-month post-intervention data collection sections.

Intervention

The HSHH Program for Seniors is a community–academic partnered intervention program aimed to prevent adverse health outcomes by reducing BMI, social isolation, and food insecurity, and increasing psychological and physical health-related quality of life among Black older adults living in Health Zone 1 of Jacksonville, Florida. The intervention program consisted of five main components: (a) a Health-smart goal-setting session; (b) Health-smart group discussion sessions; (c) group physical activities; (d) Health-smart expert panels; and (e) access to free, healthy food at church-based food pantries.

Health-Smart Goal Setting Session . During this session, each HEC met individually with participants to help set Health-smart goals. Each participant set at least one healthy eating goal and one physical activity goal, such as eating fruits, vegetables, and healthy grains or foods low in fat, sugar, and salt; drinking more water; engaging in moderate to intense physical exercise; and getting enough sleep. Prior to this session, the participant completed the healthy eating and physical activity subscales of the Motivators of and Barriers to Health-Smart Behaviors Inventory, an inventory for identifying a participant’s strongest motivators for and barriers to eating a healthy breakfast, eating healthy foods for snacks, drinking healthy drinks (i.e., drinking water and low/no sugar beverages), and engaging in physical activity (Tucker et al., 2011). The participant and HEC used the results from this inventory to help identify goal behaviors.

Health-Smart Discussion Sessions . Participants attended 9-weekly 2-hr HEC-facilitated Health-Smart group discussion sessions that involved five to 10 participants. Each week focused on one of the following topics: healthy eating and related behaviors, physical activity behaviors that are culturally relevant, stress and depression management, adequate sleep, and social skills for making social connections. These group discussions were complemented by the health-smart DVD (i.e., a culturally sensitive DVD designed by the PI featuring culturally diverse young and older adults and children, as well as mental and physical health care providers talking about health-smart Behaviors, barriers to these behaviors, and strategies for overcoming these barriers).

Group or Individual Physical Activities . The HECs encouraged the participants in their respective group sessions to engage in physical activity (e.g., walking 10,000 steps per day) individually or with members of their participant group, family, or community for at least a total of 150 min a week. The HECs shared the health benefits of engaging in physical activity and the psychological benefits of engaging in these activities with others (e.g., making meaningful social connections) with participants. Participants had tried an average of 1.3 new physical activities by the end of the intervention.

Health-Smart Expert Panels . Participants were given the opportunity to attend health-smart expert panels where they were able to anonymously submit questions to the experts on these panels. Experts included doctors, dieticians, and mental health experts as well as community members who were engaging in health-smart behaviors. Dozens of participants attended these expert panels.

Church-Based Food Pantries . Ten churches located throughout Health Zone 1 were recruited to operate health-smart food pantries. Participants were able to access free, healthy foods such as fresh fruits and vegetables, whole grains, beans, and legumes through these sites. The food pantries were used 2,737 times, including use by participants of the intervention and those who did not participate in the program, but were members of the church.

Results

A one-way repeated measures multivariate analysis of variance was conducted to examine the impact of the HSHH Program for Seniors intervention on BMI, loneliness, food insecurity, and psychological and physical health-related quality of life across the three time points: baseline (time point 1), immediately post-intervention (time point 2), and 3 months post-intervention (time point 3). Data were first inspected to identify excessive variations in skewness or kurtosis with index values between |2| considered within the acceptable range (Field, 2000, 2009; Gravetter & Wallnau, 2014; Trochim & Donnelly, 2006). No excessive indices of skewness or kurtosis were identified; thus, no transformations were deemed necessary. Next, data were examined to ensure sphericity using Mauchley’s test of sphericity. BMI (X² (2) = 5.16, p = 0.08), physical health-related quality of life (X² (2) = 3.48, p = .17), and psychological health-related quality of life (X² (2) = 9.70, p =.62) did not violate this assumption. Loneliness (X² (2) = 6.99, p < 0.05) and food insecurity (X² (2) = 19.91, p < 0.001) did violate this assumption; thus, the Greenhouse–Geisser corrected degrees of freedom were reported for these outcomes.

There was a statistically significant multivariate difference in the outcome variables across time, F (10, 129) = 5.54, p < 0.001; Wilk’s Λ = 0.699, partial η² = 0.301. Given this statistical significance, individual univariate tests were examined. All univariate tests were statistically significant: BMI (F (2, 276) = 6.60, p < 0.01, partial η² = 0.05), physical health-related quality of life (F (2, 276) = 5.72, p < 0.01, partial η² = 0.04), psychological health-related quality of life (F (2, 276) = 11.90, p < 0.001, partial η² = 0.08), loneliness (F (1.90, 262.92) = 5.96, p < 0.01; partial η² = 0.04), and food insecurity (F (1.72, 243.12) = 6.92, p < 0.001, partial η² = 0.05).

Pairwise comparisons using a Bonferroni correction indicated a significant difference in mean scores of BMI, physical health-related quality of life, psychological health-related quality of life, and loneliness from time point 1 to time point 2. These scores at point 2 were maintained at time point 3, which indicates sustained improvement over time; that is, there was a statistically significant improvement in these outcomes from time point 1 to time point 2. For these outcomes, time point 3 was not statistically different than time point 2, though remained statistically different than time point 1. These Bonferroni comparisons indicated a non-significant change from time point 1 to time point 2 for the food insecurity, though there was significant difference between time point 1 and time point 3 (see Table 1 for mean estimates).

Table 1

Mean Estimates with Pairwise Comparisons Using a Bonferroni Correction

Outcomes	Time	Mean	SE
BMI	1	32.37	.56
	2	31.93^a	.57
	3	31.75^a,b	.56
Physical health-related quality of life	1	10.48	.27
	2	11.07^a	.28
	3	11.01^a,b	.28
Psychological health-related quality of life	1	11.67	.21
	2	12.54^a	.20
	3	12.34^a,b	.20
Loneliness	1	4.32	.23
	2	3.65^a	.23
	3	3.53^a,b	.22
Food insecurity	1	3.65	.26
	2	3.16	.24
	3	2.80^a,b	.24

^aStatistically, a significant difference from Time 1.

^bNon-statistically, a significant difference from Time 2

Discussion

The “double jeopardy” experienced by Black older adults results in intrapersonal, interpersonal, and systemic experiences that contribute to adverse indicators of health. These adverse indicators of health place Black older adults at risk for poor health outcomes and contribute to premature mortality. There have been national calls for behavioral health interventions to improve the health of Black older adults and prevent adverse health outcomes (Centers for Disease Control and Prevention, 2020). The HSHH Program for Seniors intervention responds to this call. The HSHH Program for Seniors is a novel, multi-level (e.g., intrapersonal, interpersonal, and systemic) intervention program designed to prevent adverse health outcomes among Black older adults by addressing physical and psychological health-related quality of life, BMI, loneliness, and food insecurity among this high-risk, understudied group.

The results of the intervention program partially supported the first hypothesis. All indicators showed significant improvement from baseline to the immediate post-intervention measurement, with the exception of food insecurity. Food insecurity did not show a statistically significant improvement from baseline to the immediate post-intervention follow-up; it is notable that food insecurity exhibited statistically significant improvements from baseline to the 3-month post-intervention follow-up. This change suggests that there were delayed effects of the prevention program on food insecurity. It should also be noted that the food insecurity measure assessed this variable by asking respondents to report their access to healthy food over the past 12 months, a period that exceeded the timeframe of the current study. Results also partially supported the second hypothesis. As with the first hypothesis, the second hypothesis was met in that the improvements in BMI, loneliness, physical health-related quality of life, and psychological health-related quality of life were maintained at 3 months post-intervention. Changes were maintained in food insecurity; no statistically significant difference was found from the post-intervention measurement to the 3-month post-intervention follow-up.

The results of this effort corroborate the results from the limited existing research demonstrating the success of CBPR interventions in improving the health of Black adults. Recent reviews by Speights et al. (2017) and McFarlane et al. (2021) have shown that CBPR can be a powerful mechanism for recruiting and improving the health of Black adults. In addition, existing research indicates health promotion efforts rooted in CBPR are effective in promoting weight management (Coughlin & Smith, 2017; Tucker et al., 2017a, 2017c) and overall engagement in health-promoting behaviors (Tucker et al., 2017a, 2017c) among Black adults. It should be noted that much of the cited existing research focuses on health promotion rooted in CBPR among Black adults and that there is a paucity of research describing the impact of health promotion efforts rooted in CBPR among Black older adults, a major gap in the literature that is filled by the present study.

The results of this intervention and implications derived from these results should be viewed in light of the intervention’s strengths and limitations. One strength of this intervention is the use of a holistic and multi-level approach to promote health. Interventions must target multiple levels of the individuals’ systems (e.g., food access) in order to sustainably improve individual and community health. Another strength of this study is the use of a community–academic partnership approach in the design and implementation of the intervention program. Mutually trusting, respectful, and beneficial academic–community partnerships offer the benefit of drawing from the expertise of academic institutions and community partners in pursuit of health equity (Tucker et al., 2017a, 2017b). A third strength is the inclusion of assessment-based goal setting that customized the intervention program for the participating Black adult seniors. A key aspect of CBPR is that it addresses salient needs and concerns of the target community, as identified by community members (Tucker et al., 2017a). Assessment-based goal setting is anchored in this notion. Our intervention was based on needs identified by community members. A final strength of this study is that it follows the core CBPR principle of training the community members (e.g., to be health empowerment coaches) to assume leadership by implementing the intervention program, thus facilitating cultural saliency (Tucker et al., 2017a, 2017b). Addressing this principle also ensures the sustainability of the program; the health promotion program can continue to be implemented once the project terminates.

The strengths of the intervention program are novel in that they are responsive to the recognition that many health promotion programs for Black adults are ineffective because they are too narrow in scope (Gilbert et al., 2016). Furthermore, qualitative health studies involving Black adults have indicated that these individuals have a holistic conceptualization of health that integrates psychological, physical, and social functioning (Griffith et al., 2018; Hankerson et al., 2015). Additionally, interventions that leverage community engagement, such as those based in CBPR, are recognized as having a unique potential to curb health disparities because they can be customized to align with the community’s values and preferences (Kumanyika, 2008; Kumanyika et al., 2002; Nápoles et al., 2013). This alignment was facilitated through the use of CBPR. Specifically, a needs assessment was conducted by the research partners to understand the community’s unique context and values. The needs assessment informed the partnership process, mediating mechanisms, and outputs of the program. Additionally, there was attention to the partnership process throughout the program development and implementation; the community was directly involved in the development and implementation of the intervention.

The primary limitation of the present study was the decision to not include a control group, a decision that was made with input from community stakeholders, including African American religious leaders in Health Zone 1. This limitation signals the researchers’ commitment to CBPR, though has implications when interpreting the results. One implication is that the results may be influenced by performance bias; that is, participants may have responded to questionnaires in a socially desirable way given their understanding of the purpose of the intervention program. Self-report instruments may encourage socially desirable responses, especially in the context of stigmatized issues such as loneliness, leading to under- or over-reporting. However, self-report measures are often used and valued in behavioral and physical health studies (DiMatteo, 2004; Hays et al., 1994), and many subjective measures of health are as reliable as objective measures of health (Oswald & Wu, 2010). Another limitation is that the improvements in the target health outcomes may be the result of time. However, BMI, health-related quality of life, loneliness, and food insecurity are health indicators strongly linked to premature mortality and typically increase with age (Banerjee et al., 2021; Berg-Weger & Morley, 2020; Brown et al., 2013; De Gonzalez, 2011; Hawkley et al., 2020; Holt-Lunstad et al., 2015; Jackson et al., 2019; Jura & Kozak, 2016; Pinquart, 2001). Given this point, it should be noted that the relationship between loneliness and age is not linear (i.e., loneliness decreases over time and then begins to increase around the age of 70), though much of the loneliness literature is derived from predominantly non-Hispanic White samples, and little is known about the age-related trajectory of loneliness among Black adults in the United States (Hawkley et al., 2020). Furthermore, the use of another Health Zone or other members living in Health Zone 1 as a control group were not viable options given the unique make-up (i.e., precluding other Health Zones as control groups) and the geographic limitation (i.e., a high likelihood of contamination effects if other members of this Health Zone were included as a control group) of Health Zone 1.

Conclusion

The results of the current study highlight the unique potential of the HSHH Program for Seniors for improving physical and psychological health of Black older adults. Such programs are particularly needed now given that the health of Black older adults has been disproportionately impacted by health disparities and that health promotion interventions among underserved communities, such as Black older adults, are less effective (Laurencin & McClinton, 2020; Millett et al., 2020). The present study lends support to development and use of health-promoting interventions programs that are implemented by academic–community partners who recognize and value each other’s expertise, have a holistic conceptualization of health, and target multiple levels of influence of health (e.g., the individual, the community, and systemic inequities). Such intervention programs have much potential for reducing health disparities and preventing adverse health outcomes among Black older adults living in economically disadvantaged communities. Future research should build on the promising results of our study by including a control group, testing the role of performance bias and time, employing strategies that lead to the recruitment of more men (over 80% of those enrolled in health promotion research are women; Anderson et al., 2016; Maher et al., 2014), and employing mixed methods to more fully understand the participants’ experiences of the intervention.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Humana Foundation (PI: Tucker; AWD05408; AWD07906; AWD09725). Dr. Tucker is also funded by the Moran Foundation and the Patient-Centered Outcomes Research Institute. Dr. Wippold is funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (K23MD016123).

Author Biographies

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