Age-friendly initiatives as community interventions: An exploration of implementation components and processes

Age-friendly community (AFC) initiatives are multi-sectoral community interventions that seek to make place-based communities more prepared for and responsive to population aging in the 21st century (Levasseur et al., 2017). In the coming decades, the majority of countries in the world will, and are already, experiencing dramatic changes in the ratio of older to younger members of their societies, such that older adults are starting to outnumber younger individuals in most geographies (Ritchie & Roser, 2019). While population aging reflects great public health achievements (Davitt et al., 2016), the demographic transition necessitates a robust societal response to ensure people have the necessary services and infrastructure supports for them to age in their communities with health, safety, and dignity. In direct response, AFC initiatives are programmatic efforts spread across 60 countries that aim to spur local-level action and response toward increasing community readiness for population aging. While AFC initiatives have a shared programmatic identity across globally distributed AFC efforts, the ways these social change efforts work toward durable impact on aging are only beginning to emerge in both research and practice. In response to this gap, this dissertation uses a combination of qualitative and quantitative methods to advance insights into key components and processes that underpin AFC initiatives’ ability to enact desired social change. Grounded in the lens of social work community practice, this dissertation positions AFC initiatives as community interventions working to alter community-level contexts. This perspective invites the study of AFC initiative process as intervention implementation, a conceptual and empirical approach that has yet to be adopted in AFC-focused literature. This dissertation aims to advance the systematic study of AFC initiatives as community interventions by highlighting the applicability and promise of using implementation science theorizing and concepts to generate insights into critical facets of how AFC initiatives work toward social impact in their communities. The greater integration of implementation science into this area of study offers the promise of enhancing the field’s conceptual and methodological capacity to understand and detect how the components, processes, and mechanisms of AFC implementation generate multidimensional and multilevel outcomes and sustainable impact. Specifically, this three-paper dissertation uses implementation science theories and methods to: (a) explore how older adults advance AFC implementation, (b) develop insights into the structure of AFC partnership networks, and (c) elucidate practitioner conceptualizations of AFC sustainability as a practice outcome. Each of these three aims represents a distinct study, and a separate paper, in the dissertation. The data for the three papers were collected prior to the dissertation by Pope and Greenfield, with varying other team members. These three papers are part of a broader knowledge production endeavor situated within a multi-year developmental evaluation of a grant-funded cohort of AFC initiatives in northern New Jersey spanning 2015-2023. Reflecting the action research underpinnings of developmental evaluations that prioritize actionable knowledge, the three papers reflect practice-inspired analytic foci spanning various phases of the evaluation project, including questions about implementation processes and actors (Papers 1-2) and programmatic sustainability (Paper 3). The first paper is a qualitative study of how a multi-state sample of 23 older adults advance AFC implementation, specifically in terms of the functions—the underlying purposes and social processes—operating in and through their implementation actions. Using Reflective Thematic Analysis, this paper presents the core functions that older adults as AFC implementation actors engage in: (a) advancing program processes by guiding and carrying out the work, and (b) building network capacity through making connections and spreading mindsets/practices. The second paper is a quantitative social network analysis (SNA) of the partnership networks of eight AFC initiatives in the grant-funded AFC cohort in New Jersey. This analysis identifies novel insights into network composition, network involvement among partner types, and structural configurations of each initiative’s partnership network. This study demonstrated the feasibility and promise of using SNA to study and evaluate AFC processes and outcomes. The third paper used Dimensional Analysis to develop a conceptual framework for the dimensions of AFC programmatic sustainability as a practice outcome, based on the narratives of AFC leaders about their work. Specifically, the findings highlight AFC sustainability as occurring across the processes of embedding and expanding various facets of programmatic components, as well as capacity for age-friendly systems change. This dissertation offers notable contributions to the study of AFC implementation and macro social work, with each paper offering unique insights into AFC implementation. Collectively, this dissertation elevates the value of systematically integrating implementation science concepts into the study of AFC social change, while also positioning age-friendly efforts and implementation science as critical areas for social work research. In so doing, this dissertation highlights practice-relevant research opportunities to advance knowledge of the social change processes catalyzing community responses to population aging.