We propose here our overall plan for the Health Promotion Research Center (HPRC) at the University of Washington for the next five years. One of the original three Prevention Research Centers funded by CDC in 1986, HPRC focuses on promoting healthy aging and reducing health disparities among adults aged 50 and older. Building on our 15 years of experience conducting dissemination and implementation research aimed at scale-up of effective interventions, we plan to focus our work in three areas: cancer prevention and control, mental and physical health of older adults, and workplace health promotion. Specifically, we will expand the national reach of three flagship healthy-aging programs that were developed and tested by HPRC and disseminated by community organizations partnering with HPRC. First is EnhanceFitness, a group-exercise program for older adults. Since 1999, Senior Services, a Seattle-based non- profit organization serving older adults, has disseminated EnhanceFitness to more than 500 community sites in more than 30 states. It has reached more than 25,000 older adults, most of whom are low-income or members of racial and ethnic minorities. Second is PEARLS, a depression-management program delivered in community settings. Since 2003, Area Agencies on Aging have delivered PEARLS to more than 2,000 low-income, largely fragile and home-bound older adults with depression, through 45 sites in 14 states. Third is Workplace Solutions, a package of evidence-based cancer prevention practices for the workplace. Since 2003, the American Cancer Society has disseminated Workplace Solutions to more than 1,600 workplaces with 6.9 million employees in 42 states. Scale-up of the EnhanceFitness program, with a focus on reducing race/ethnicity-related disparities in arthritis suffering, will be the objective of our Core Researh Project. In 2011, Senior Services licensed EnhanceFitness to YMCA of the USA (Y-USA), the national-network office for more than 2,700 YMCAs. Because EnhanceFitness decreases pain and increases mobility for persons with arthritis, Y-USA will focus its EnhanceFitness implementation on the half of older adults who suffer from arthritis. Older adults are much more likely to participate in a community-based program like EnhanceFitness if it is recommended by a health care provider, so Y-USA has asked for HPRC's help in enhancing its current, limited approach to increasing provider recommendations for EnhanceFitness participation. To do so, we will first conduct formative research with pharmacists and physical therapists to learn the most effective means of increasing recommendations to a community-based program like EnhanceFitness. Second, we will develop an enhanced approach tailored to obtaining recommendations by pharmacists, physical therapists, and primary-care providers for participation of older-adult arthritis patients in EnhanceFitness at YMCAs. Third, we will conduct a cluster-randomized trial to compare the effectiveness and the cost of the current and enhanced approaches.
HPRC's three healthy-aging focus areas - cancer prevention and control, mental and physical health of older adults, and workplace health promotion - address many of the biggest health problems among middle- aged and older adults. Our research is aimed at national expansion of HPRC's three evidence-based healthy- aging programs: EnhanceFitness, which increases physical activity and preserves functioning;PEARLS, which reduces depression;and Workplace Solutions/HealthLinks, which increases employers'use of evidence-based practices to prevent chronic illnesses. These programs all have a record of success in reaching underserved, diverse populations at disparate risk for chronic diseases and related disability and mortality.