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The Healthy Aging Research Network: Modeling Collaboration for Community Impact

      As the first Centers for Disease Control and Prevention (CDC) Prevention Research Centers Program thematic network, the Healthy Aging Research Network was established to better understand the determinants of healthy aging within older adult populations, identify interventions that promote healthy aging, and assist in translating research into sustainable community-based programs throughout the nation. To achieve these goals requires concerted efforts of a collaborative network of academic, community, and public health organizational partnerships. For the 2001–2014 Prevention Research Center funding cycles, the Healthy Aging Research Network conducted prevention research and promoted the wide use of practices known to foster optimal health. Organized around components necessary for successful collaborations (i.e., governance and infrastructure, shaping focus, community involvement, and evaluation and improvement), this commentary highlights exemplars that demonstrate the Healthy Aging Research Network’s unique contributions to the field. The Healthy Aging Research Network’s collaboration provided a means to collectively build capacity for practice and policy, reduce fragmentation and duplication in health promotion and aging research efforts, maximize the efficient use of existing resources and generate additional resources, and ultimately, create synergies for advancing the healthy aging agenda. This collaborative model was built upon a backbone organization (coordinating center); setting of common agendas and mutually reinforcing activities; and continuous communications. Given its successes, the Healthy Aging Research Network model could be used to create new and evaluate existing thematic networks to guide the translation of research into policy and practice.

      Introduction

      In 2001, the Prevention Research Centers (PRC) Program at the Centers for Disease Control and Prevention (CDC) established the Healthy Aging Research Network (HAN) to better understand the determinants of healthy aging across diverse populations and settings, identify and evaluate health promotion interventions, and assist in the translation of such research into sustainable community-based programs and policies throughout the nation. HAN was funded for three funding cycles during 2001–2014 as a public health network of academic and community partners.
      The HAN model of collaboration provided a means to collectively build capacity for practice and policy, reduce fragmentation and duplication in health promotion and aging research efforts, maximize the efficient use of and generate additional resources, and create synergies for advancing HAN goals. This collaborative model was built upon a framework of support organizations to set common agendas and mutually reinforce activities through continuous communications. It underscores the belief that “there is no other way society will achieve large scale progress against urgent and complex problems, unless a collective impact approach becomes the accepted way of doing business.”
      • Hanleybrown F.
      • Kania J.
      • Kramer M.
      Channeling change: making collective impact work.
      Using exemplars, this commentary describes aspects of the HAN collaborative model (Table 1) and demonstrates strategies used and outcomes achieved by HAN, which have an ongoing impact on public health research, training, and practice.
      Table 1Components of Collective Impact With Exemplars From the Healthy Aging Research Network (HAN)
      Components of collective impact
      Hanleybrown et al. (2012).1 CDC, Centers for Disease Control and Prevention.
      Healthy Aging Research Network (HAN) exemplars
      Governance and infrastructure
      • Developed and funded a coordinating center for the network with staff and skills to serve as the backbone for the HAN and coordinated efforts across stakeholders
      • Held monthly conference calls and annual in-person grantee meetings with the coordinating center, member centers, community partners, and federal and non-federal agencies
      • Member centers regularly evaluated the functioning of the coordinating center
      • Applied an evaluation framework (Reach, Effectiveness, Adoption, Implementation, Maintenance [RE-AIM]) to HAN initiatives
      Shaping the focus
      • Created and secured consensus within and external to HAN on the first ever definition of healthy aging
      • Established, secured consensus, and published a research and translation agenda for healthy aging for specific topics
      • Engaged and partnered with community partners and federal and non-federal agencies
      Community involvement
      • Conducted projects based on unmet community needs
      • Invited community partners who represented varied settings and ethnic diversity to participate in the development, execution, and dissemination of HAN projects
      • Disseminated, evaluated, and enhanced sustainability of evidence-based health promotion programs for older adults
      • Created linkages between community and clinical partners
      • Built capacity of communities to offer and evaluate evidence-based health promotion programs
      Evaluation and improvement
      • Planned and conducted a HAN social network analysis
      • Used RE-AIM as an evaluation framework for community-based projects
      • Published action briefs and scholarly publications and conducted webinars
      • Developed and distributed the Health Saving Cost Calculator (see www.ebp-savings.info for more information)
      • Demonstrated reach and effectiveness of evidence-based health promotion programs
      • Collaborated with CDC resources such as the Task Force on Community Preventive Services to implement findings
      • Improved our understanding of factors associated with brain health
      • Increased understanding of essential elements necessary for successful healthy aging network structure and processes
      • Developed a pipeline of healthy aging researchers
      • Received national awards for HAN products
      a Hanleybrown et al. (2012).
      • Hanleybrown F.
      • Kania J.
      • Kramer M.
      Channeling change: making collective impact work.
      CDC, Centers for Disease Control and Prevention.

      Governance and Infrastructure

      Over the three funding cycles, HAN included more than 100 active investigators and scholars, nine HAN member centers, selected for their experience linking public health and aging, ability to work in multisite collaborations, and geographic distribution. HAN also included partners from multiple community sectors and federal and non-federal agencies (Figure 1). The HAN Coordinating Center served as the backbone organization
      • Kania J.
      • Kramer M.
      Collective impact.
      and provided the core infrastructure by facilitating the collaboration, communications, and mutual agenda setting. To document its collective efforts, HAN members published the first social network analysis of a PRC thematic network, illustrating the structure, connectivity, and products of a multisite collaborative.
      • Petrescu-Prahova M.
      • Belza B.
      • Leith K.
      • Allen P.
      • Coe N.B.
      • Anderson L.A.
      Using social network analysis to assess mentorship and collaboration in a public health network.
      This network analysis confirmed high connectivity among HAN members and partners across the organizational boundaries of a diverse group of stakeholders.
      Figure 1
      Figure 1Healthy Aging Research Network (HAN) member centers and partner organizations.
      Note: Selected partner organizations: Centers for Disease Control and Prevention (Healthy Aging Program; Division of Nutrition, Physical Activity and Obesity; Division of Emergency and Environmental Health Services; National Community Committee; Prevention Research Centers Program); American Association of Retired Persons; Agency for Health Care Research and Quality; Alzheimer’s Association; American Medical Association; Easter Seals; Environmental Protection Agency; HAN Member Centers Community Advisory Boards; Health Foundation of South Florida; National Association of Chronic Disease Directors (National Council on Aging; National Institute on Aging; Pan American Health Organization; Retirement Research Foundation); U.S. Administration on Community Living (formerly Administration on Aging).

      Shaping the Focus

      Research, policy, and practice gaps in the fields of public health and aging were systematically identified by HAN.
      • Lang J.E.
      • Anderson L.
      • et al.
      The Healthy Aging Research Network Writing Group
      The Prevention Research Centers Healthy Aging Research Network.
      As an initial activity, HAN formulated a comprehensive definition of healthy aging:
      • Healthy Aging is the development and maintenance of optimal physical, mental, and social well-being and function in older adults. Healthy aging is most likely to be achieved by individuals who live in physical environments and communities that are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being, and the effective use of health services to prevent or minimize the impact of acute and chronic disease on function.
        • Lang J.E.
        • Anderson L.
        • et al.
        The Healthy Aging Research Network Writing Group
        The Prevention Research Centers Healthy Aging Research Network.
      This definition was adopted by CDC among others and guided subsequent HAN projects. For example,

      CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, Atlanta GA. Healthy Aging Research Network: putting collective wisdom to work for older Americans. www.cdc.gov/prc/pdf/han-booklet.pdf. Published 2011.

      HAN contributed to developing research agendas about critical topics such as physical activity,
      • Prohaska T.
      • Belansky E.
      • Belza B.
      • et al.
      Physical activity, public health, and aging: critical issues and research priorities.
      hosted national conferences, and published resources about topics such as environmental and policy control for healthy aging.
      • Hunter R.H.
      • Anderson L.A.
      • Belza B.
      • et al.
      Environments for healthy aging: linking prevention research and public health practice.

      Community Involvement

      The priorities of HAN included enhancing provider capacity and moving community provider practice beyond traditional methods and sectarian silos. In the early years of HAN, many aging services organizations were not systematically planning for, or implementing, evidence-based health promotion programs, building partnerships across service sectors, or seeking sustainable funding outside of the aging services funding streams. HAN partnered with the National Council on Aging to develop ten online training modules about evidence-based health promotion for older adults for use by providers in aging services and their public health and community partners. Grounded in components of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, the modules offer systematic strategies and step-by-step approaches for delivering health promotion programs. HAN also developed two monographs to assist providers modify programs to local needs, monitor local adaptations, and assess their programs’ impact, reach, and effectiveness (Appendix, available online).
      Additionally, HAN mentored, engaged, and provided leadership opportunities for graduate students, early-career investigators, and Health and Aging Policy Fellows sponsored by the Healthy Aging Program. HAN built professional capacity by developing and delivering accessible, state-of-the-science trainings and resources.
      • Wilcox S.
      • Altpeter M.
      • Anderson L.
      • et al.
      The Healthy Aging Research Network: building capacity for public health and aging practice.
      Conferences, special theme journal issues, and policy briefs geared toward community stakeholders focused on evidence-based health promotion and gave attention to program processes (e.g., recruitment, delivery, and quality assurance) as well as substantive topics (e.g., physical activity, mental health, environment, and policy).
      • Wilcox S.
      • Altpeter M.
      • Anderson L.
      • et al.
      The Healthy Aging Research Network: building capacity for public health and aging practice.
      • Belza B.
      • Altpeter M.
      • Hooker S.P.
      • Moni G.
      The CDC Healthy Aging Research Network: advancing science toward action and policy for the evidence-based health promotion movement.

      Evaluation and Improvement

      Evaluation efforts should be meaningful to all players to ensure results inform/guide quality improvement. HAN deployed RE-AIM to evaluate efforts related to evidence-based programming.
      • Belza B.
      • Glasgow R.
      • Toobert D.
      RE-AIM for Program Planning: Overview and Applications.
      With federal partners, HAN worked with grantees to address research questions such as “What works?” “How do we implement what works?” and “How do we make such efforts last?” throughout the aging services provider network.
      • Altpeter M.
      • Bryant L.
      • Schneider E.
      • Whitelaw N.
      Evidence-based health practice: knowing and using what works for older adults.
      • Bryant L.L.
      • Altpeter M.
      • Whitelaw N.A.
      Evaluation of health promotion programs for older adults: an introduction.
      HAN recognized the evaluation challenges experienced by many community providers and clinical partners whose major priority was program delivery. Toward this end, HAN worked with the National Council on Aging and Administration on Community Living community grantees (N=131 projects) to define “measures of success” that would be meaningful to them, emphasizing the importance of brief pragmatic measurement questions and strategies for initial adoption and long-term maintenance of evaluative efforts.
      • Belza B.
      • Glasgow R.
      • Toobert D.
      RE-AIM for Program Planning: Overview and Applications.
      HAN advocated for the importance of program fidelity, designed brief checklists and tools for assessing program fidelity, and promoted adherence to essential programmatic elements for achieving maximal programmatic gain.
      • Ory M.G.
      • Ahn S.
      • Jiang L.
      • et al.
      Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform.
      In addition, HAN participated in the national evaluation of Stanford’s Chronic Disease Self-Management Program. This study demonstrated the ability of evidence-based programs to be widely disseminated to diverse populations with results similar to those found in the initial RCTs.
      • Lorig K.R.
      • Sobel D.S.
      • Stewart A.L.
      • et al.
      Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.
      HAN went beyond traditional programmatic studies to introduce the aging services network to themes from health outcomes research including the triple healthcare reform goals of better health, better health care, and better value.
      • Ory M.G.
      • Ahn S.
      • Jiang L.
      • et al.
      Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform.
      Knowing the importance of showing value, HAN created a health savings cost estimator so that community partners could assess the cost–benefit of delivering such programs in their local setting.
      • Ahn S.
      • Smith M.L.
      • Altpeter M.
      • Post L.
      • Ory M.G.
      Healthcare cost savings estimator tool for chronic disease self-management program: a new tool for program administrators and decision makers.
      Through member center collaboration, HAN conducted formative research to better understand older adult perceptions of cognitive health and impairment. Findings informed the Alzheimer disease state plans and national recommendations.
      • Friedman D.B.
      • Becofsky K.
      • Anderson L.A.
      • et al.
      Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature.
      HAN members participated in the development of the inaugural CDC “Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships.” Additionally, HAN partnered to develop CDC’s Behavioral Risk Factor Surveillance System cognitive decline and caregiving modules and conducted systematic reviews about depression that informed the Guide to Community Preventive Services.

      The Community Guide website. Community Preventive Services Task Force. www.thecommunityguide.org/index.html.

      Other collaborative efforts led to the publication of books on the built environment
      and public health and aging.
      CDC funding for HAN occurred from 2001 to 2014; however, many of the products and dissemination efforts continue through PRC network activities and ongoing collaborations with HAN members.

      Conclusions

      The HAN model of collaboration impacted practice and policy by reducing fragmentation of healthy aging efforts across multiple campuses and community sectors, maximizing the efficient use of resources, building an extensive pool of healthy aging program implementation and training materials, and creating synergies for advancing the healthy aging research agenda. This collective impact approach can be applied to the growing number of PRC thematic networks and other organizational networks to help guide the translation of research into policy and practice.

      Acknowledgments

      This publication is a product of the Prevention Research Centers Program at the Centers for Disease Control and Prevention. The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
      The Healthy Aging Research Network (HAN) was a Prevention Research Centers program funded by the Centers for Disease Control and Prevention (CDC) Healthy Aging Program from 2001 to 2014. The subsequent network is newly funded as the Healthy Brain Research Network (HBRN; 2014–2019). Efforts were supported in part by cooperative agreements from CDC’s Prevention Research Centers program: U48-DP-001911, 001908, 001921, 001924, 001936, 001938, and 001944. We appreciate the reviews of this commentary by Lynda Anderson, PhD (retired), former Director of CDC Healthy Aging Program and CDC lead of HAN, and Lisa McGuire, PhD, current lead, CDC’s Alzheimer’s Disease and Healthy Aging Program, and CDC lead of HBRN.
      No financial disclosures were reported by the authors of this paper.

      SUPPLEMENTAL MATERIAL

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