From the WHO framework to integrated senior health and wellness hub program: an implementation journey

IntroductionAs global populations age, ensuring older adults maintain functional ability and wellbeing is a critical public health priority. The Integrated Senior Health and Wellness (ISHW) Hub program, developed by Singapore General Hospital (SGH), operationalizes the World Health Organization’s (W...

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Main Authors: Xiaoting Huang, Hao Yi Tan, Pei Ling Er, Amber Wong, Si Qi Lim, Joshua Kuan Tan, Wan Qi Yee, Xiaohui Xin, Lian Leng Low
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1593490/full
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author Xiaoting Huang
Xiaoting Huang
Hao Yi Tan
Hao Yi Tan
Hao Yi Tan
Pei Ling Er
Amber Wong
Si Qi Lim
Joshua Kuan Tan
Wan Qi Yee
Xiaohui Xin
Lian Leng Low
author_facet Xiaoting Huang
Xiaoting Huang
Hao Yi Tan
Hao Yi Tan
Hao Yi Tan
Pei Ling Er
Amber Wong
Si Qi Lim
Joshua Kuan Tan
Wan Qi Yee
Xiaohui Xin
Lian Leng Low
author_sort Xiaoting Huang
collection DOAJ
description IntroductionAs global populations age, ensuring older adults maintain functional ability and wellbeing is a critical public health priority. The Integrated Senior Health and Wellness (ISHW) Hub program, developed by Singapore General Hospital (SGH), operationalizes the World Health Organization’s (WHO) Integrated Care for Older People (ICOPE) framework within community-based models of care. Implemented in partnership with Active Aging Centers (AACs), ISHW enhances preventive health through structured screening, customizable nutrition education, and targeted physical activity interventions.MethodsThis study aimed to develop an implementation-informed, context-sensitive model for integrated care using the Consolidated Framework for Implementation Research (CFIR) and Theory of Change to guide the design and pilot of the ISHW program. The ISHW program employs a multi-prong approach, integrating health interventions with social engagement to address both physical and psychosocial determinants of health. Key components include community-driven intrinsic capacity assessment including chronic disease screening for early detection, dietitian-curated nutrition education and exercise program enhanced by physiotherapist. A critical innovation is the “train-the-trainer” model, which enhances capacity-building among AAC staff and volunteers which supports sustainable program delivery.ResultsQualitative insights were gathered from 5 focus groups (n = 20) and 1 feedback group (n = 10), analyzed thematically through consensus-driven coding. Early implementation findings highlight the feasibility of integrating ICOPE principles within community-based settings, but also underscore key challenges, including resource constraints and the need for stronger inter-sectoral coordination. Facilitators of success include structured capability-building, community participation, and alignment with national aging policies such as Age Well SG and Healthier SG. Findings gleaned from CFIR and ToC was operationalized to a program’s logic model that was iteratively refined to enhance adaptability and scalability across diverse community settings.DiscussionThis case study adds to current understanding of community-centered models for promoting healthy aging and helps to serve as a guidance on how ICOPE-based program could be adapted to other community settings for integrating health and social care to support aging in place. Future evaluations will assess longitudinal outcomes and inform the scalability of community-based ICOPE implementation strategies.
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spelling doaj-art-05bc99679ebb4cbbbc54da5816acb2052025-08-20T03:58:45ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-07-011310.3389/fpubh.2025.15934901593490From the WHO framework to integrated senior health and wellness hub program: an implementation journeyXiaoting Huang0Xiaoting Huang1Hao Yi Tan2Hao Yi Tan3Hao Yi Tan4Pei Ling Er5Amber Wong6Si Qi Lim7Joshua Kuan Tan8Wan Qi Yee9Xiaohui Xin10Lian Leng Low11Population Health and Integrated Care Division, Singapore General Hospital, Singapore, SingaporeDepartment of Geriatric Medicine, Singapore General Hospital, Singapore, SingaporeHealth Services Research Unit, Singapore General Hospital, Singapore, SingaporeHealth Systems Group, Harvard T.H. Chan School of Public Health, Boston, MA, United StatesPractice Office, Saw Swee Hock School of Public Health, Singapore, SingaporeDepartment of Dietetics, Singapore General Hospital, Singapore, SingaporeDepartment of Physiotherapy, Singapore General Hospital, Singapore, SingaporeDepartment of Physiotherapy, Singapore General Hospital, Singapore, SingaporeHealth Services Research Unit, Singapore General Hospital, Singapore, SingaporePopulation Health and Integrated Care Division, Singapore General Hospital, Singapore, SingaporeHealth Services Research Unit, Singapore General Hospital, Singapore, SingaporePopulation Health and Integrated Care Division, Singapore General Hospital, Singapore, SingaporeIntroductionAs global populations age, ensuring older adults maintain functional ability and wellbeing is a critical public health priority. The Integrated Senior Health and Wellness (ISHW) Hub program, developed by Singapore General Hospital (SGH), operationalizes the World Health Organization’s (WHO) Integrated Care for Older People (ICOPE) framework within community-based models of care. Implemented in partnership with Active Aging Centers (AACs), ISHW enhances preventive health through structured screening, customizable nutrition education, and targeted physical activity interventions.MethodsThis study aimed to develop an implementation-informed, context-sensitive model for integrated care using the Consolidated Framework for Implementation Research (CFIR) and Theory of Change to guide the design and pilot of the ISHW program. The ISHW program employs a multi-prong approach, integrating health interventions with social engagement to address both physical and psychosocial determinants of health. Key components include community-driven intrinsic capacity assessment including chronic disease screening for early detection, dietitian-curated nutrition education and exercise program enhanced by physiotherapist. A critical innovation is the “train-the-trainer” model, which enhances capacity-building among AAC staff and volunteers which supports sustainable program delivery.ResultsQualitative insights were gathered from 5 focus groups (n = 20) and 1 feedback group (n = 10), analyzed thematically through consensus-driven coding. Early implementation findings highlight the feasibility of integrating ICOPE principles within community-based settings, but also underscore key challenges, including resource constraints and the need for stronger inter-sectoral coordination. Facilitators of success include structured capability-building, community participation, and alignment with national aging policies such as Age Well SG and Healthier SG. Findings gleaned from CFIR and ToC was operationalized to a program’s logic model that was iteratively refined to enhance adaptability and scalability across diverse community settings.DiscussionThis case study adds to current understanding of community-centered models for promoting healthy aging and helps to serve as a guidance on how ICOPE-based program could be adapted to other community settings for integrating health and social care to support aging in place. Future evaluations will assess longitudinal outcomes and inform the scalability of community-based ICOPE implementation strategies.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1593490/fullaging in placeseniorsTheory of Changeconsolidated framework for implementation researchICOPE
spellingShingle Xiaoting Huang
Xiaoting Huang
Hao Yi Tan
Hao Yi Tan
Hao Yi Tan
Pei Ling Er
Amber Wong
Si Qi Lim
Joshua Kuan Tan
Wan Qi Yee
Xiaohui Xin
Lian Leng Low
From the WHO framework to integrated senior health and wellness hub program: an implementation journey
Frontiers in Public Health
aging in place
seniors
Theory of Change
consolidated framework for implementation research
ICOPE
title From the WHO framework to integrated senior health and wellness hub program: an implementation journey
title_full From the WHO framework to integrated senior health and wellness hub program: an implementation journey
title_fullStr From the WHO framework to integrated senior health and wellness hub program: an implementation journey
title_full_unstemmed From the WHO framework to integrated senior health and wellness hub program: an implementation journey
title_short From the WHO framework to integrated senior health and wellness hub program: an implementation journey
title_sort from the who framework to integrated senior health and wellness hub program an implementation journey
topic aging in place
seniors
Theory of Change
consolidated framework for implementation research
ICOPE
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1593490/full
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