How to implement sustainable community-based programs for older adults in rural Australia

Introduction:
The design and delivery of health and wellbeing programs in rural areas is often complicated by well-known challenges that impact the implementation and ongoing sustainability of community-based interventions. Given that one third of older Australians live outside metropolitan areas and experience higher prevalence of chronic disease, ensuring that evidenced-informed community-based programs are adaptable for the rural context is critical. This will improve the effectiveness and sustainability of programs and support the health and wellbeing of older rural adults. However, consideration of appropriate implementation approaches that specifically suit the rural context is often lacking. This is primarily due to limited guidance and awareness on what implementation strategies are likely to succeed.
Methods:
The research used a scoping review method to identify what strategies can support sustainable implementation of community-based interventions with older adults in rural Australia. The review was undertaken following the Joanna Briggs Institute methodology for scoping reviews Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). An electronic search of seven databases was undertaken and a thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest.
Results:
Of 1277 records screened, 15 studies were identified and included in the review. Five themes were identified as key enablers for rural implementation: 1) Co-designing for the local context; 2) Embedding local champions; 3) Leveraging existing local resources; 4) Maintaining impact beyond the end of the funded period; 5) Flexibility in funding modes.
Discussion:
This study brings together the existing knowledge on strategies that can be used to overcome well-known barriers to program implementation in rural areas. It highlights that rural program design and implementation must recognise the pivotal role of collaborative processes that integrate local expertise through methods such as local partnership and co-design. As well as building a case for the development of rural implementation guidelines to inform future practice.
Conclusion:
Further work needs to be undertaken to better support health professionals, researchers, policymakers, health services and funders to develop practical and evidenced-based approaches that focus on implementing effective and sustainable community-based programs for older people that appropriately reflect the unique contextual needs and strengths of rural Australian communities.