Enhancing engagement in hospital-affiliated adapted wellness

Importance: Engagement in hospital-affiliated adapted wellness programs for adults with chronic neurological conditions may be limited by barriers in awareness, referral, onboarding, and sustained participation; low-burden, workflow-fit supports may help improve access and engagement Objective: To identify barriers and facilitators affecting engagement in Shepherd Center’s Best Health Wellness (BHW) and Burnalong programs and to develop and evaluate tools to support referral and onboarding. Design: Mixed-methods needs assessment followed by applied tool development and pilot evaluation conducted over a 14-week capstone experience Setting: Shepherd Center, a private, nonprofit specialty rehabilitation hospital in Atlanta, Georgia Participants: Phase 1 needs assessment included clinicians/staff, adults with neurological conditions, and internal stakeholders. Phase 2 evaluation included 29 clinicians/staff who completed an anonymous post-survey with retrospective ratings after dissemination. Outcomes and Measures: Phase 1 identified barriers and facilitators to engagement. Phase 2 assessed perceived changes in clinician/staff familiarity, confidence explaining programs, and likelihood of recommending or referring. Internal expert review assessed clarity, usability, workflow fit, actionability, and sustainability. Results: Phase 2 produced a clinician quick-referral guide, patient quick-start flyer, intranet hub, staff training module, and community outreach portfolio. Readiness gains were strongest for BHW, with mean familiarity increasing from 1.71 to 2.89; confidence from 1.71 to 2.96; likelihood of referral from 2.61 to 4.46; “likely to refer” increased from 27.6% to 100%. Burnalong showed higher baseline readiness, with the likelihood of referral increasing from 64% to 93%. Internal expert review supported the readiness of the intranet hub and staff training module, with a recommendation for final internal review before external dissemination of outreach materials. Conclusions and Relevance: Low-burden, workflow-fit engagement tools may strengthen clinician readiness to refer and support more consistent referral and onboarding pathways in adapted wellness programs. Plain-Language Summary: This capstone project looked at why people fail to enroll in or continue adapted wellness programs after rehabilitation, even when staff and participants view those programs as helpful. At Shepherd Center, feedback from staff and participants was used to better understand barriers across the full engagement process, including learning about programs, being referred, signing up, getting started, and continuing over time. Based on that feedback, practical tools were created to make referrals and onboarding easier and more consistent. These tools included a quick guide for staff, a patient “start here” handout, a central online resource page, a short staff training resource, and outreach materials for community partners. After these tools were introduced through brief presentations, clinicians completed a survey about whether they felt more familiar with the programs, more confident explaining them, and more likely to refer patients. Results suggested improved clinician readiness, especially for Best Health Wellness, along with strong internal ratings for the online resource page and training materials. These findings suggest that long-term participation depends not only on offering strong programs but also on having clear, low-burden systems that help staff and participants take the next step.