A Culturally Tailored Digital Education Intervention to Improve Nutrition Among Older Adult Congregate Meal Participants During COVID-19: Protocol for a Stepped-Wedge Cluster Randomized Controlled Trial.

Background: Inadequate nutrition and a lack of physical activity contribute to functional decline and complications from chronic diseases in older adults. The pandemic halted or altered necessary Older Americans Act (OAA) nutrition services provided to vulnerable, community-dwelling older adults in San Antonio, Texas. The "digital divide" or gap in technological access and knowledge further heightened the detrimental effect of the COVID-19 pandemic on older adults who may be "digitally excluded" from social, economic, and health-related interactions. During the pandemic, San Antonio congregate meal sites funded by OAA remained partially open biweekly to distribute meals but no longer offered in-person nutrition education, physical activity classes, and social activities. This project expands the current congregate meal programming infrastructure and partnerships with Older Adults Technology Services (OATS) to create a sustainable approach focused on improving the health of older adults. Objective: The study aims (1) to test the impact of a digital nutrition education intervention on the primary outcomes of food security and diet quality; (2) to determine the effect of the intervention on secondary outcomes of technology knowledge and usage, physical activity, and social isolation and loneliness; and (3) to examine the long-term impact and sustainability of technology use on food security, diet quality, physical activity, social isolation, and loneliness. Methods: This proposed digital nutrition education intervention study targets technologically limited older adults enrolled in the congregate meal program (CMP) using a stepped-wedge clustered randomized controlled trial. Key community partners, City of San Antonio Department of Health Services Senior Services Division and OATS, contributed to the study's planning phase, research design, and implementation. The 20-week intervention included 5 weeks of in-person technology training, including internet access and technical support for 1 year and devices, followed by 15 weeks of a culturally tailored online nutrition education intervention. The study randomized 398 older adults from 12 congregate meal sites. Data collection took place at baseline, 3 months, 6 months, 9 months, 12 months, and 18 months. If successful, the impact of this program could be applied throughout the national OATS network and to similar CMPs to bridge the digital divide beyond the COVID-19 pandemic. Results: Recruitment and enrollment of 398 older adults at 12 CMPs was completed in December 2022. Study CMPs were randomly assigned to Cohort 1 and 2: 164 completed Cohort 1 in August 2023 and 111 completed Cohort 2 in April 2024. Eighteen-month data collection is ongoing. Conclusions: This study aims to determine the impact of a digital nutrition intervention on older adults' nutrition status, physical activity, loneliness and isolation, and technology access and usage. Results from this study can inform future interventions with vulnerable populations and may serve as a basis for other OAA nutrition services.