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Volume
3:
No. 1, January 2006
COMMUNITY CASE STUDY
The Prevention Research Centers Healthy Aging Research Network
The Healthy Aging Research Network Writing Group
Suggested citation for this article: The Healthy Aging Research Network
Writing Group. The Prevention Research Centers Healthy
Aging Research Network. Prev Chronic Dis [serial online] 2006 Jan [date
cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2006/
jan/05_0054.htm.
PEER REVIEWED
Abstract
Background
The Prevention Research Centers Healthy Aging Research Network (PRC–HAN), funded by
the Centers for Disease Control and Prevention’s (CDC’s) Healthy Aging
program, was created in 2001 to help develop partnerships and create a
research agenda that promotes healthy aging. The nine universities that
participate in the network use their expertise in aging research to collaborate with their communities and other partners to develop
and implement health promotion interventions for older adults at the
individual, organizational, environmental, and policy levels.
Context
The population of older adults in the United States is growing rapidly;
approximately 20% of Americans will be aged 65 years or older by 2030. The
health and economic impact of an aging society compel the CDC and the public
health community to place increased emphasis on preventing unnecessary
disease, disability, and injury among older Americans.
Methods
The PRC–HAN has a broad research agenda that addresses health-promoting skills and behaviors, disease and syndrome topics, and
knowledge domains. The network chose physical activity for older adults as its
initial focus for research and has initiated two networkwide projects: a
comprehensive, multisite survey that collected information on the capacity,
content, and accessibility of physical activity programs for older adults and
a peer-reviewed publication that describes the role of public health in
promoting physical activity among older adults. In addition to participating
in the core research area, each network member works independently with its
community committee on PRC–HAN activities.
Consequences
As a result, the network is 1) expanding prevention research for older adults
and their communities; 2) promoting the translation and dissemination of
findings to key stakeholders; 3) strengthening PRC–HAN capacity through
partnerships and expanded funding; and 4) stimulating the adoption of policies
and programs by engaging policymakers, planners, and practitioners. In 2003, the PRC–HAN initiated an internal evaluation to better define
the network’s contributions to healthy aging, formalize internal processes,
and better equip itself to serve as a model for other PRC thematic networks.
The PRC–HAN is conducting a pilot evaluation for eventual inclusion in the PRC national evaluation.
Interpretation
The PRC–HAN has established itself as an effective research network to
promote healthy aging. It has developed trust and mutual respect among
participants, forged strong ties to local communities, and shown the ability
to combine its expertise in healthy aging with that of partners in national,
state, and local organizations.
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Background
In 2001, the Centers for Disease Control and Prevention’s (CDC’s)
Healthy Aging program issued a request for proposals to create a Prevention
Research Centers Healthy Aging Research Network (PRC–HAN). The plan for this
network was guided by the principles underlying academic–community
partnerships and coalitions (1,2) and had several goals. First, the
network would foster a strong sense of local program ownership by drawing on
the Prevention Research Centers' (PRCs') established community relationships to collaboratively develop a
healthy aging research agenda. Second, facilitating partnerships among PRCs
would strengthen the focus, cohesiveness, and collaboration of research on aging.
Third, by combining the diverse perspectives of network members and
establishing new national linkages, the network would have the potential to
develop and promote interventions at individual, organizational,
environmental, and policy levels. Fourth and finally, the network would link
the CDC’s Healthy Aging program to additional prevention researchers outside
of the CDC. Here we describe the evolution of the PRC–HAN's
structure, mission, and research agenda. We then provide several examples of
network activities that are helping the CDC and its partners to meet the
challenges of an aging U.S. population. We conclude with planned evaluation
activities and next steps.
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Context
Changing demographics in the United States
Both the number and the percentage of older adults (aged 65 or older) in this country are
increasing at a much faster rate than ever before. This population will
continue to grow, doubling from 35 million in 2005 to 70 million by 2030, when
one in every five Americans will be aged 65 years or older (3). The looming
health and economic impact of an aging society compels the CDC and the public
health community to increase emphasis on preventing unnecessary
disease, disability, and injury among older Americans. An enhanced focus on
prevention is critical to preserving older individuals’ independence and
reducing long-term care needs. This enhanced focus on prevention is also
critical for helping to stem escalating health care costs. Fortunately, our
increased understanding of the role of risk factors such as physical
inactivity in the onset and progression of chronic illness and disability has
made this goal achievable.
The CDC's Prevention Research Centers (PRC) Program
The PRC Program, which includes 33 academic centers in 26 states, was
established in 1984. (More information on the program is available from www.cdc.gov/prc).
The centers are selected through a competitive peer-review process. All funded PRCs share a set of common principles, including 1) a focus on community-based
participatory research that contributes to the knowledge base and informs
public health programs and policies; 2) the creation of partnerships among
communities, health departments, and other groups; 3) the timely collection,
synthesis, and dissemination of the results of research and programs; 4)
education and training in prevention research for the community, policymakers,
health advocacy groups, and others; and 5) strong collaborative ties to the
CDC PRC Program office for ongoing network enhancement and evaluation (4). The
research focus of each PRC reflects the scientific expertise of its faculty
and the goals of its community partners. Each PRC establishes a committee of
community leaders and organizations to build a long-term relationship for
engaging communities as partners in research and dissemination efforts. In
addition to conducting a core research project within the area of research
focus, the centers work with partners and are eligible to apply for Special
Interest Projects (SIPs) Competitive Supplements, which are defined by the CDC
and other federal agencies.
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Methods
Creation of the PRC–HAN
Through the PRC SIPs competitive process in 2001, the University of
Washington; the University of California, Berkeley; the University of
Colorado; the University of Illinois at Chicago; the University of North
Carolina at Chapel Hill; and the University of South Carolina became the first
members of the PRC–HAN. The University of Pittsburgh was added to the
network in 2002, and Texas A&M University and West Virginia University
joined in 2004. All of the centers funded in 2001 competed and were refunded
in 2004. For more information on the PRC–HAN, see http://depts.washington.edu/harn/*.
Structure and communications
The participants from each university bring their unique perspectives and
those of their communities to the network. Two of the network’s PRCs have
healthy aging as a focus of their core programs. The other network members
represent various aging centers and programs from the broader universities
that house their core PRC programs. Each member of the PRC–HAN has an equal
voice in a consensus-based decision-making process that includes the agreement
of all funded centers and key partners, such as the CDC, when selecting
research topics and identifying the number of network centers that will
participate in a given activity. The network structure allows additional
research expertise and community capacity to be brought in from outside the
network membership to help investigate new topics. The University of
Washington Health Promotion Research Center (UWHPRC) is designated as the
coordinating center. UWHPRC receives additional funds to support coordinating
activities, which include initiating regular network communications, acting as
a clearinghouse for information among network members, and serving as the PRC–HAN’s primary representative to outside organizations and groups.
The CDC’s Healthy Aging program funds the infrastructure of the PRC–HAN.
During the PRC–HAN’s first year, its members collaborated with the CDC to
formulate a common mission, establish a definition of healthy aging, and
develop a framework and agenda for research in public health and aging. The CDC SIPs and external partners
continue to support the work of the network.
Mission
The mission of the PRC–HAN is to better understand the determinants of
healthy aging in older adult populations, to identify interventions that
promote healthy aging, and to help translate this knowledge into sustainable
community-based programs throughout the nation. The PRC–HAN defines healthy
aging as the development and maintenance of optimal physical, mental, and
social well-being and function in older adults. It is most easily achieved
when physical environments and communities are safe and support the adoption
and maintenance of attitudes and behaviors known to promote health and
well-being and when health services and community programs are used
effectively to prevent or minimize the impact of acute and chronic disease on
function. This definition reinforces a social–ecological view of the
determinants of health (5). The PRC–HAN adapted and applied a social–ecological
framework first developed by McLeroy et al and later refined by Sallis et al
(5,6). This model emphasizes the interactions among individual, group, and
community levels while also considering the environmental and
policy arenas. The model is available from http://depts.washington.edu/harn/research%20agenda/ research%20agenda.shtml*.
The research agenda developed by the PRC–HAN is intentionally broad. The
agenda is built upon the intersections of three areas: disease topics,
health-promoting skills, and knowledge domains (Table). The diseases and
conditions that the agenda addresses are leading causes of illness and death
among older adults. The second intersecting area of the agenda consists of six
key health-promoting skills and behaviors. Although many of the skills and
individual behaviors are analogous to the concept of underlying causes of
illness and death, the agenda has expanded the usual list to include skill
building for self-management and involvement in social activity (7). Finally,
the agenda points to five primary areas of knowledge required to translate
topics from research to policy arenas. These five domains allow the PRC–HAN
to determine priority areas for the network by identifying risk factors, their
impact on health and well-being, and behavioral, social, and environmental
strategies to reduce them.
Objectives
Grounded in the philosophy of participatory research and collaboration, the
network strives to 1) expand prevention research for older adults and their
communities; 2) promote the use of research findings by translating and
disseminating them to stakeholders; 3) strengthen PRC–HAN capacity
through partnerships and expanded funding; and 4) stimulate the adoption of
policies and programs by engaging policymakers, planners, and practitioners in
the development process. Consistent with the national PRC Program, each
network member works with its own community committee on PRC–HAN activities.
Research activities
Through a consensus process, the network chose physical activity for older
adults as its initial focus for research. As an example of the ecological
framework within which the PRC–HAN works, one research question of
particular interest was how barriers within the built environment limit the
amount of physical activity that older adults engage in.
Two PRC–HAN projects have involved all network members. The first of
these, led by the University of Illinois at Chicago and modeled after the Get
in Shape Chicago guide (available from http://shapechicago.com*),
was a comprehensive, multisite survey that collected information on the
capacity, content, and accessibility of physical activity programs for older
adults. The workgroup developed a common survey instrument, refined the survey
and analysis methods, tracked field activities, and coordinated data
collection and analysis in the PRC–HAN community sites. The PRC–HAN members
used the results of this survey to develop local resource guides for their
communities. The project will track community distribution and use of the
guides, which will soon be available online. The survey results are also being
used to develop a publicly available interactive Web guide that can be
applied in any community. An example of a draft guide is available from www.shapeupkingcounty.org*.
The second networkwide project was the development of a peer-reviewed
publication, which is currently under review. This publication describes the role of
public health in promoting physical activity among older adults. The in-depth,
evidence-based review has become a template for how the PRC–HAN will prepare
for new topic areas. Further, the messages emerging from this effort will form
the basis for training and educational materials that will be shared with constituents in the public health and aging services network.
The PRC–HAN conducts many of its activities through workgroups. The
environmental factors workgroup is addressing issues associated with the
physical environment and its relationship to physical activity among older
adults. The University of California, Berkeley serves as lead center for this
workgroup. Reaching beyond the expertise of the current PRC–HAN members, the
workgroup collaborated with researchers at St Louis University PRC to develop and refine an instrument for assessing
environmental factors that affect the walkability of neighborhoods for older
adults. Using a revised instrument based on their previous work, St Louis
University researchers trained PRC–HAN members on how to conduct audits.
These PRC–HAN members then conducted pilot environmental audits in each of
their communities. These data are currently being analyzed and will be used to
refine the final instrument, along with qualitative data from interviews
conducted with older adults to determine their reasons for walking or not
walking.
This workgroup has developed a directory of Web sites related to environmental
assessment and a manuscript assessing the current knowledge base and next
steps for research. Finally, members of the network have received funding from
The Robert Wood Johnson Foundation Active Living by Design program to assess
the environmental correlates of physical activity among older adults. The
project will include environmental assessments and interviews with older
adults in five areas covered by PRC–HAN member sites.
Additional workgroups have been formed. A CDC-supported depression
workgroup, led by the UWHPRC, is conducting an evidence-based review of
community interventions to prevent or alleviate depression. The nutrition
interest group, under the leadership of Texas A&M University, is looking
at the neighborhood food environment by examining the accessibility,
affordability, and availability of healthy foods in communities where older
adults live.
Translation and dissemination
Led by the University of Colorado and the University of North Carolina at
Chapel Hill, the research dissemination and practice workgroup has been the
PRC–HAN’s direct link to providing training to build state-based programs
for healthy aging. The workgroup’s goal is to help create local, state, and
national community partnerships to build capacity and infrastructure in the
public health and aging services networks and to provide more evidence-based
health promotion opportunities for older adults. Key partners in this effort
include the CDC, the Chronic Disease Directors, the Administration on Aging (AoA),
the National Council on the Aging (NCOA), the National Association of State
Units on Aging (NASUA), and the Agency for Healthcare Research and Quality (AHRQ).
The workgroup plays a central role in developing materials to increase
understanding of evidence-based interventions and disseminating these
interventions and best practices.
Capacity
To strengthen the network’s capacity, the PRC–HAN is working to
maximize relationships with partners and obtain new sources of funds for PRC–HAN
priorities. Developing new partnerships has made it possible to enhance rather
than duplicate efforts. For example, PRC–HAN members are supporting NCOA’s
development of a National Resource Center (www.healthyagingprograms.org*)
for AoA’s evidence-based grants by developing and disseminating technical
assistance topic papers and manuals for the AoA grantees. The PRC–HAN also
collaborated with Medstat, the Centers for Medicare & Medicaid Services,
NASUA, and NCOA to plan a demonstration of the Senior Risk Reduction Program,
which will evaluate health risk appraisal systems in target
communities nationwide. The PRC–HAN’s contribution to planning the study
was to develop a sampling frame that allows researchers to assess the
usefulness of community support systems for behavior change. For example,
ensuring that a known number of communities with adequate capacity (e.g., physical
activity programs or information and assistance capability) are included in
the sample would facilitate assessment. The network is also strengthening
capacity by pooling its resources with those of its partners to generate new
funding for PRC–HAN priorities. For example, the PRC–HAN successfully
obtained funding from The Robert Wood Johnson Foundation for a best
practices project in partnership with NCOA. Finally, fostering the
development of workgroups enhances PRC–HAN functioning, strengthens the
capacity of the individual members, and promotes synergy among network
members. The depression workgroup, for example, has benefited from the
contributions of researchers from both within and outside the PRC–HAN.
Conference planning and communications
The PRC–HAN will stimulate the adoption of policies and programs by
engaging policymakers, planners, and practitioners. The conference support
workgroup, lead by UWHPRC, is designing a series of conferences to disseminate
the lessons learned from our current work in physical activity and future work
on depression and nutrition. The planning committee worked with two
HAN-affiliated groups, the PRC–HAN community committees and representatives
from the PRC–HAN research dissemination and practice workgroup, to ascertain
their interests and needs for the design and content of the conferences.
Presenters for the conferences include nationally known scholars in the field
of public health, aging, and evidence-based programs in the areas of physical
activity, depression, and nutrition. Such efforts are aimed at developing
teams of public health and aging services practitioners, community members,
and policymakers from states.
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Consequences
An evaluation of the PRC-HAN is important from several perspectives,
including those of the CDC’s Healthy Aging and PRC programs, PRC–HAN
members, PRC–HAN community committees, other partners, and funders. In 2003,
the PRC–HAN initiated an internal evaluation to better define the network’s
contributions to healthy aging, formalize internal processes, and better equip
itself to serve as a model for other PRC thematic networks. The process began
with internal interviews that led to a retreat to start developing a PRC–HAN
logic model. The PRC–HAN is refining its logic model, developing
performance indicators, and conducting a pilot evaluation to ensure that the PRC–HAN evaluation can be integrated into the PRC national evaluation.
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Interpretation
By making partnership, shared responsibility, and broad expertise key
components of its capacity, the PRC–HAN has earned the recognition of other
organizations as an important partner in advancing science-based health
promotion activities for older adults. Its work in the area of physical
activity for older adults brought additional partners to the network, which in
turn has increased the diversity of the group’s expertise and provided new
outlets for its products. Such expansion also enables the network to increase
its resources and engage in new project areas. Established trust and mutual
respect among participants, strong ties to local communities, and the ability
to combine its expertise in healthy aging with that of partners in national,
state, and local organizations have positioned the PRC–HAN to
continue as a productive and effective research network for years to come.
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Acknowledgments
We thank Gwen Moni, who manages the PRC–HAN activities for the network. We
also acknowledge the university members of the PRC–HAN and the
community committee members who are instrumental in guiding and shaping the
work of the network. The PRC–HAN is funded by the CDC Healthy Aging program in
the National Center for Chronic Disease Prevention and Health Promotion. The
publication was supported by Cooperative Agreement Numbers 1-U48-DP-000033,
1-U48-DP-000045, 1-U48-DP-000048, 1-U48-DP-000050, 1-U48-DP-000051,
1-U48-DP-000052, 1-U48-DP-000054, and 1-U48-DP-000059 from the CDC. Its contents
are solely the responsibility of the authors and do not necessarily represent
the official views of the CDC.
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Author Information
Corresponding Author: Jason E. Lang, MS, MPH, Health Care and Aging Studies
Branch, Division of Adult and Community Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, 4770 Buford Hwy NE, Mail Stop K-51, Atlanta, GA 30341.
Telephone: 770-488-5597. E-mail: jlang@cdc.gov.
Mr Lang is a member of the Healthy Aging Research Network Writing Group.
Author Affiliations for the Healthy Aging
Research Network Writing Group: Lynda Anderson, PhD, Division of Adult and Community
Health, Centers for Disease Control and Prevention, Atlanta, Ga; James LoGerfo,
MD, MPH, Health Promotion Research Center, University of Washington, Seattle,
Wash; Joseph Sharkey, PhD, MPH, RD, Texas Healthy Aging Research Network
Center, Texas A&M University, College Station, Tex; Elaine Belansky, PhD,
Lucinda Bryant, PhD, MSHA, Rocky Mountain Prevention Research Center,
University of Colorado, Denver, Colo; Tom Prohaska, PhD, Center for Research
on Health and Aging, University of Illinois at Chicago, Chicago, Ill; Mary
Altpeter, PhD, Victor Marshall, PhD, Institute on Aging, University of North
Carolina at Chapel Hill, Chapel Hill, NC; William Satariano, PhD, MPH, Susan
Ivey, MD, MHSA, University of California, Berkeley, Berkeley, Calif; Constance
Bayles, PhD, Center for Healthy Aging, University of Pittsburgh, Pittsburgh,
Pa; Delores Pluto, PhD, Sara Wilcox, PhD, Prevention Research Center,
University of South Carolina, Columbia, SC; R. Turner Goins, PhD, Robert C.
Byrd Health Sciences Center School of Medicine and Center on Aging, West
Virginia University, Morgantown, WVa.
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