Haikel Asyraf Lim

Background: As rapidly aging populations become a worldwide phenomenon, early detection and prompt management of chronic disease become essential to support healthy aging. Community-based health screenings, a key component of this strategy, often struggle with poor follow-up rates, limiting their long-term impact. Given the untapped potential of youth volunteers and the urgent need for a scalable approach to improve continuity of care post health screenings, we developed HealthStart: a structured, theory-based program that empowers these older adults to take greater ownership of their health and their chronic conditions with the support of youth community health volunteers (CHVs). Objective: This study aimed to describe the development, implementation, and early outcomes of HealthStart—an intergenerational, layperson-led health coaching program—and summarize operational lessons to guide similar models in Asian communities. Methods: HealthStart adopted an intergenerational service-learning approach modeled on a self-determination theory–based layperson-led health coaching framework. Each HealthStart team consisted of 1 health care volunteer (HCV) and 4 youth CHVs. All volunteers underwent blended training and were assessed for layperson-led health coaching readiness. Between September 2022 and June 2023 in Singapore, youth CHVs empowered adult participants aged 40 years and older after their health screening to (1) learn about their chronic diseases, (2) learn at least one digital health app, (3) enroll with a primary care provider, and (4) set a lifestyle goal (based on the Specific, Measurable, Achievable, Realistic/Relevant, and Time-bound [SMART] framework for goal setting) and achieve it. We used an implementation-focused case study design using descriptive statistics and volunteer-participant feedback to evaluate feasibility and outcomes. Results: Of 236 eligible individuals, 192 enrolled. Participants had a mean age of 67 (SD 9.6) years; 52.1% (n=100) of participants were female, with a majority of Chinese ethnicity, having completed primary or secondary school education, residing in self-owned flats, and living in 3-room public housing. Follow-up rate with primary care increased from 42.7% (82/148) preprogram to 84.5% (125/148) postprogram (χ²₁=43; P<.001). In total, 58 HCVs were recruited, comprising 26 nurses and 6 doctors, with the remainder as allied health professionals. A total of 33 were trained and deployed. The mean age of HCVs was 37 years old, and 24 (72.7%) were female. Furthermore, 149 youth CHVs were recruited, 138 trained, and 102 deployed. The mean age of the youth CHVs who were deployed was 24 years, and 75 (73.5%) were female. Reflections included the importance of volunteer competency and selection criteria, tiering of participant intervention, tapping on community assets, adoption of a social prescription framework, importance of alignment with population health policies, and cultivating intergenerational relationships. Conclusions: HealthStart demonstrates the feasibility and acceptability of a structured, intergenerational, layperson-led health coaching model embedded in primary care. We identify key lessons learned in the conceptualization and implementation of the program that may inform the design of similar volunteer-enabled initiatives for harnessing laypersons, an often-underused asset, to promote health in the community.

Background: In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. Objective: We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. Methods: A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ≥55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. Results: There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. Conclusions: This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult–friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes.

This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives.

UNSTRUCTURED This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives.

Introduction: Standardized patients are widely used in psychiatry teaching and examinations, but their effectiveness in teaching psychopathology and the Mental State Examination in particular has not been established. A mixed‐methods study was undertaken amongst fourth year medical students during a psychiatry rotation to explore the usefulness of learning the Mental State Examination with standardized patients compared with real patients.Methods: Qualitative semistructured interviews (N = 10) were done to explore learning experiences with standardized patients. The Experience with Standardized Patients Scale was used (N = 200) for the quantitative assessment in relation to examination performance and learning experience.Results: In qualitative interviews, the common themes were that the experience with standardized patients was not natural and made it difficult to suspend disbelief, but students recognized the usefulness of standardized patients for practicing their skills. While there was no significant relationship between overall student experiences with standardized patients and their examination performance in the end‐of‐rotation Observed Standardized Clinical Examination (P = .40), the exception was with those who perceived they learnt more communication skills with standardized patients (P = .002). Students' experience with standardized patients role‐playing psychotic disorders was poorest compared with standardized patients role‐playing depressive and neurotic disorders. There were statistically significant differences in experiences between the three diagnostic groups.Discussion: Standardized patients are useful in psychiatry for students to practice and improve their skills in eliciting psychopathology. However, attention to the training and selection of these individuals for psychiatric roles are crucial.

Introduction: Family caregivers of cancer patients experience many negative effects due to the heavy responsibility involved. Although various psychosocial interventions have been found to improve caregivers' quality of life (QOL), the sustainability of the benefits of these interventions over time has been less consistently investigated and hence less clearly established. Extending previous research on the immediate post‐intervention effects, this study aims to examine the trajectories of change in caregivers QOL over an 8‐week follow‐up period.Methods: Caregivers of patients attending an outpatient clinic at a cancer center in Singapore were recruited. Participants had to fulfill the following criteria: (a) between 21 and 74 years; (b) willing to attend hour‐long weekly programs for 4 weeks; (c) able to understand, speak, and read English; (d) a family member living with and providing care and support for the patient; and (e) provide written informed consent. Participants completed the Caregiver QOL–Cancer scale at baseline, immediately post‐intervention, and at 4 and 8 weeks after the end of the intervention. Data from 56 participants were analyzed.Results: Majority of participants exhibited a stable trajectory of change in their QOL, while a small number of participants either improved or declined.Discussion: Understanding the sustainability of the effects of the intervention is important in determining the need to initiate periodic “booster” sessions to provide consistent support for caregivers. Further research could investigate the sustainability over an even longer period, as well as intra‐individual change trajectories using growth modeling among a larger sample.

The Fear of Cancer Recurrence Inventory has shown adequate psychometric properties to assess for fear of cancer recurrence among cancer survivors. However, the use of the Fear of Cancer Recurrence Inventory in Asia is limited due to the paucity of validation studies. Participants include 331 cancer survivors who completed the English and newly developed Mandarin versions of the Fear of Cancer Recurrence Inventory. The results revealed that both versions of the Fear of Cancer Recurrence Inventory demonstrated satisfactory internal reliability, test–retest reliability, convergent validity, and concurrent validity. A confirmatory factor analysis provided support for the original seven-factor structure. The validated Fear of Cancer Recurrence Inventory is applicable to cancer survivors in Singapore.

Family caregivers of cancer patients often experience an impaired quality of life (QOL) and emotional distress as a result of their caregiving duties, which may potentially influence the quality of care of their care recipients. The COPE (Caregivers of cancer Outpatients’ Psycho-Education support group therapy) intervention was developed as a response to the lack of work done among family caregivers of ambulatory cancer patients in Asia. This group intervention comprised four weekly sessions simultaneously targeting psychoeducation, skills training, and supportive therapy. The present study sought to evaluate the pilot COPE intervention using both quantitative and qualitative measures. The Hospital Anxiety and Depression Scale (HADS) was used to measure both depression and anxiety, while the Caregiver QOL – Cancer (CQOLC) measured caregiver QOL. These instruments were measured at baseline pre-intervention, and immediately post-intervention. A waitlist control group design was adopted. A subset of caregivers from the intervention group were invited for a semi-structured interview post-intervention. Quantitative analyses suggest that while QOL remained stable in control group participants, intervention group participants experienced QOL improvements – both in overall QOL and in the specific domain of burden. There were no significant differences in the trajectories of depression and anxiety in both groups. Qualitative analyses suggest that this might have been a result of the intervention not only equipping participants with the relevant coping skills, but also providing a platform for emotional expression and situational reappraisal. The COPE intervention has shown some efficacy in helping family caregivers of cancer patients, but more work is required before this can be implemented. Current Controlled Trials NCT02120183 . Registered 17 April 2014. Retrospectively registered.