Impact of Youth Community Health Volunteers on Community Health Screening Program Outcomes for Older Adults: Mixed Methods Evaluation Study

Background: Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. HealthStart is a Self-Determination Theory (SDT)-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health and digital coaching, and post-health screening follow-up. Youth Community Health Volunteers (YCHVs) were taught principles of motivational interviewing, health coaching, and the social determinants of health through a program model anchored in principles of intergenerational and service learning. YCHVs, guided by healthcare volunteers, served as health and digital advocates for participants over a three-month post-screening period. Objective: This study evaluated the effectiveness and acceptability of the HealthStart program, a structured, layperson-led intergenerational health coaching intervention. Methods: This study employed a convergent parallel mixed-methods design. A total of 192 older adult participants’ (mean age 66.9 years) quantitative data were collected through pre- and post-program surveys between September 2022 and January 2024. Follow-up with primary care provider (PCP) was the primary outcome; secondary outcomes include health goal attainment, self-efficacy, and digital and health literacy among older adults, and acceptability amongst all stakeholders. PCP follow-up and health goal attainment were self-reported, while self-efficacy was measured using the Patient Activation Measure-13 (PAM-13). Health and digital literacy were assessed with an adapted questionnaire and the eHealth Literacy Scale (eHEALS), respectively. 36 semi-structured interviews were conducted with 13 older adults included in the qualitative study, 17 YCHVs, and 6 healthcare volunteers between November 2023 and January 2024, which were qualitatively analyzed using thematic analysis. A joint analysis was conducted to generate meta-inferences. Results: The follow-up rate among PCPs increased significantly from 42.7% to 84.5% (p<0.001). A total of 66.2% (92/139) of the participants achieved their health goals, and 81.3% (113/139) reported satisfaction with the program. There were no significant pre-post differences in PAM-13, knowledge, and eHEALs scores. However, a statistically significant correlation was found between post-cycle eHEALS scores and the number of follow-up visits (p = 0.003). The qualitative findings substantiate HealthStart’s Theory of Change and its SDT underpinnings. Participants’ narratives highlighted the three SDT psychological needs—increased autonomy, competence, and relatedness—which are associated with sustained behavior change and health engagement. An increase in PCP follow-up rate was influenced by individually tailored goal setting and relationship-building that leveraged motivational interviewing to support intrinsic motivation. The program’s primary outcome was, to some extent, influenced by digital health onboarding and possibly improvements in health literacy. Participants’ self-efficacy could have been enhanced with a structured social prescription framework. Conclusions: HealthStart demonstrated the feasibility of utilizing YCHVs and SDT principles to improve PCP follow-up rates and promote healthier lifestyles through digital enablement among older adults participating in community health screening.