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An Innovative Approach for Building Health Promotion Program Capacity: A Generic Volunteer Training Curriculum

Correspondence: Address correspondence to Ellen C. Schneider, Institute on Aging, University of North Carolina at Chapel Hill, CB #1030, 720 Martin Luther King, Jr., Boulevard, Chapel Hill, NC 27599-1030. E-mail: eschneider{at}schsr.unc.edu

	Abstract

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Purpose: We examined the feasibility of creating a generic training curriculum for volunteers in health promotion programs for older adults by identifying common core content topics across 10 national programs. We also considered additional material that could augment common core content topics. Design and Methods: We reviewed in detail program manuals and associated materials from 10 national evidence-based or best practice health promotion programs for older adults that use volunteers. In Phase I, we created a spreadsheet matrix to track and tabulate the frequency of inclusion of elements across all 10 programs. We arrayed elements under appropriate topics, and program administrators reviewed and verified the information. In Phase II, we reviewed the matrix for comprehensiveness and added elements to augment the identified core topics. Program administrators again reviewed the matrix to ensure accuracy. Results: We found 67 elements of core content across 50% or more of the reviewed health promotion programs. We added 17 elements to enhance curriculum comprehensiveness; these included elements that were (a) in less than 50% of the reviewed programs but recommended by research staff, (b) introduced by research staff, or (c) recommended by program administrators. Implications: Although there are many steps, questions, and issues yet to consider, our findings identify a significant body of general core content that supports the feasibility of creating a generic training curriculum for volunteers as an approach to enhance capacity in evidence-based or best practice health promotion programs.

Key Words: Volunteer training • Health promotion programs • Civic engagement • Senior volunteers • Evidence-based health promotion

	Introduction

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The time is ripe for maximizing volunteerism. Interest in civic engagement among the current cohort of older adults is well documented. The U.S. Department of Labor's Bureau of Labor Statistics reported that during 2004–2005, Americans contributed a median of 50 hr per year to volunteer activities; however, the median hours of volunteer time of adults aged 65 and older was near double that at 96 hr per year (U.S. Bureau of Labor Statistics, 2005). As the baby boomers near retirement, they could prove to be a tremendous resource for responding to community needs, health and otherwise, through paid and unpaid work (The Gerontological Society of America, 2004).

Research has demonstrated that volunteering can improve the physical, social, and cognitive well-being of older adults (Fried et al., 2004; Greenfield & Marks, 2004; Van Willigen, 2000). Studies have also demonstrated that benefits are greater in older age groups than in younger ones. The Americans' Changing Lives survey reported that the positive effect of volunteerism on perceived health was more than 2.5 times greater for older adults than for younger adults (Van Willigen, 2000). Volunteering in health promotion programs has the potential to provide an array of benefits. A Matter of Balance/Volunteer Lay Leader Model is an evidence-based program, implemented by volunteer coaches, that was designed to reduce the fear of falling and diminish the risk of falling among community-dwelling older adults (MaineHealth, 2005). Results from a self-administered survey revealed that the coaches gained a sense of accomplishment, increased their purpose in life, felt they were making a positive difference in another person's life, and increased their own confidence about managing falls (Healy & Haynes, 2006).

Although these studies indicate that adult volunteers of any age can be instrumental in the successful implementation of health programs, recruiting and training them can be both time consuming and labor intensive, adding more responsibilities to agencies already burdened with limited staffing and resources. According to a 2003 Urban Institute survey of 1,354 U.S. nonprofit organizations that use volunteers, two out of every three believed that "recruiting a sufficient number of volunteers" was a problem. More than 50% of these groups stated that "lack of paid staff time to train and supervise volunteers" was an issue, and 60% cited "lack of funds to support volunteer administration" as a problem (Hager & Brudney, 2004). To address these issues, what can be done to cost-effectively recruit and train a wider and deeper pool of volunteers? One option would be to create a community-based, rather than agency-based, generic training course that covers core concepts across evidence-based or best practice health promotion programs.

	Purpose

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In March 2005, the National Council on Aging commissioned this conceptual study to examine the feasibility of creating a generic volunteer training course for widespread training of senior volunteers to serve as lay leaders or peer mentors in health promotion programs. Volunteer lay leaders conduct or facilitate program participant classes or meetings; peer mentors often serve as participant coaches or perform other tasks that assist with program administration. In our review of the literature, we could not find evidence that such a course has been designed or even that suggested course content has been outlined.

The project was conducted from April 1 to June 30, 2005. Three basic research questions were posed: (a) Can required knowledge and skill sets be identified in training curricula of health promotion programs that use volunteer lay leaders or peer mentors? (b) If so, are there core concepts common to these training curricula? and (c) Is there other training content not covered in the health promotion programs that should augment the identified core concepts to produce a comprehensive curriculum?

	Methods

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We reviewed 10 evidence-based or best practice health promotion programs for older adults that use volunteers as lay leaders or peer mentors and that have program materials that include volunteer training content. Seven of the programs were either National Council on Aging model program projects funded by the John A. Hartford Foundation or evidence-based health promotion grantee programs of the Administration on Aging: Healthy Changes, Healthy Moves for Aging Well, Healthy Eating for Successful Living, Matter of Balance, Chronic Disease Self-Management Program, Women Take Pride, and Active Start. We also identified three other national health promotion programs: Active Choices; Healthy Aging: Eating Better and Moving More; and the Health Enhancement Program, now named EnhanceWellness. We identified personnel from each of the selected programs who were most involved in producing the training curricula as program administrators and asked them to participate in an iterative process of data collection and analysis.

The analysis consisted of two phases. The initial phase addressed the first two research questions. We analyzed each volunteer curriculum to identify training content topics (general headings) and elements (subtopics). We created an Excel spreadsheet matrix to track and tabulate the frequency of inclusion of elements across all 10 programs. A total of 191 elements were identified. We derived preliminary core topics from themes within these elements, and we arrayed individual program elements under the appropriate topic. Program administrators reviewed and verified (a) the training topics and elements that we had identified as specific to their respective health promotion program, and then (b) those topics that were generic to the aggregate group.

The second phase of the analyses addressed Research Question 3. We reviewed the content matrix for comprehensiveness, basing this assessment on other volunteer training programs and our own practice experience with volunteers. We also responded to strong recommendations made by two program administrators about content not found in the majority of programs but nevertheless considered to be essential to comprehensive training. The program administrators again reviewed the expanded curriculum. We report the results of the analysis below.

	Generic Training Components: Nine Key Concepts

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As shown in Table 1 and noted by the superscript d, we found a total of 67 generic elements in 5 or more of the 10 evidence-based or best practice health promotion programs reviewed. Additional elements in Table 1, noted by the superscripts a, b, and c, provide the results of the second phase of the analysis, in which we made additions to the matrix content. Based, in part, on our experience in volunteer training and management in a five-county health promotion program and a countywide volunteer caregiving program, as well as knowledge of other volunteer training curricula, we concluded that 10 elements that appeared in less than 50% of the programs should be retained. These elements are identified by the superscript a. We introduced five new elements that did not appear in any of the reviewed programs but were considered important components of volunteer training. These elements are designated by the superscript b. Two program administrators urged us to include two content elements not found in a majority of the programs. These content elements are designated by the superscript c.

1. Becoming a Volunteer
This topic area sets the stage for the individual's management of his or her volunteer role. Even though less than half of the program curricula contained information about the benefits of the volunteer role, research findings have underscored the importance of highlighting the personal gains of becoming a volunteer. This topic also covers the difference in the purpose and function of the lay leader and peer mentor roles in health promotion programs. "Taking care of yourself as a volunteer" rounds out this content area, because volunteers can sometimes become passionately engaged in their roles and relationships with program participants, or they may experience worry or emotional distress about their assigned tasks. There are also personal safety concerns when volunteers participate in physical activity programming or provide services in home or public environments.

2. Overview of Evidence-Based Health Promotion With Older Adults
This topic is important as a context for understanding the bigger picture of health promotion and disease prevention programs. Specifically, this section focuses on aging and health demographics as well as basic information on how the body ages, and it provides a brief overview of how evidence-based health promotion and disease prevention programs are designed, tested, and then implemented in community settings. This content area also covers the importance of maintaining fidelity to the intervention's core components, measuring both individual- and program-level outcomes, and keeping records of the program's implementation and adaptation to community populations. We recommend emphasizing the significant contribution of volunteers' input and suggestions as a vital part of health promotion and disease prevention and "learning about community resources."

Two program administrators each requested the addition of an element, which we incorporated into the generic content recommendations. One suggested offering a component that educates volunteers about what to expect when they work with a client in the home (e.g., frailty of the older adult, unpleasant living conditions). Because few health promotion programs require volunteers to work with clients in the home, we expanded this idea to include working with older adults in various settings such as the home, community centers, and places of worship. The second program administrator recommended that volunteers receive training concerning a self-administered home safety evaluation checklist that would be included as core course material. The comprehensive checklist is a good health promotion tool regardless of whether a program focuses specifically on falls prevention. The checklist helps program participants to identify potential environmental hazards in various areas of their homes.

3. Behavior Change/Motivational Theories
Understanding how to motivate people to change and adopt healthy habits is critical to the success of any behavioral change and healthy lifestyle program. All 10 health promotion programs included various components of behavioral change and motivational theory (e.g., overcoming barriers to achieving healthy living goals, understanding factors that influence change, setting goals, learning problem-solving techniques, and understanding the stages of change model).

4. Communication Skills
A majority of programs covered basic communication skills, including the ability to convey knowledge, communicate effectively with participants, and foster communication between participants. Common skill elements included effective listening, learning how to ask open-ended questions, and recognizing and dealing with an older adult's emotional state. We grouped recognizing and dealing with depression, addressing fears, and reducing or defusing stress under the rubric of dealing with emotional needs.

5. Group Dynamics/Training Methods
A majority of programs discussed methods to cultivate, manage, and enhance the interactions and interrelationships that develop within groups. Furthermore, they described adult learning methods such as role playing and brainstorming, the importance of confidentiality and safety, how to deal with difficult participants, and how to establish rules and responsibilities for group meetings.

6. Planning/Recordkeeping
Most programs addressed the importance of evaluating and assessing participants. Five programs also required volunteers to complete self-assessments or self-evaluations on health or other matters. A majority addressed the role of the volunteer in recordkeeping for evaluating the success of the program and the participants.

7. Session Logistics
Eight programs addressed the importance of managing program logistics, including room location, set up, privacy, and media requirements. These "housekeeping" management skills are necessary for creating a comfortable environment for older adult participants, which can be a major factor in determining program satisfaction and, ultimately, successful program outcomes.

8. General Health Education: Physical Activity and Nutrition
Regardless of whether a program focused on health topics, all of the reviewed programs included general content on (a) the impact of physical activity and fitness on general wellness and (b) the benefits of proper nutrition.

Physical Activity
The focus on physical activity and fitness is not aimed at teaching volunteers how to lead exercises, but rather at teaching them the benefits of physical activity and the fundamental elements of safe and effective exercise. Elements include the benefits of an active lifestyle or physical activity, healthy weight and weight management, flexibility and stretching, strengthening exercises, endurance or aerobic exercise, balance, and injury prevention.

Nutrition
Nutrition content focuses on benefits such as increased energy and stamina, weight management, and diabetes control. In addition to discussing the benefits of healthy eating, we recommend that this topic area also provide an overview of the prevailing national guidelines or principles for healthy eating. This includes eating whole grains, a variety of fruits and vegetables, lean sources of protein, and low-fat or fat-free milk products while limiting intake of saturated and trans fats, cholesterol, salt, alcohol, and added sugars (U.S. Department of Agriculture, 2005).

9. Administrative Topics Volunteers Should Address With Agencies
All programs covered a range of topics for agency staff to address when managing, evaluating, and recruiting volunteers. However, to address volunteers, we reversed the focus and recommend that when participating in an agency's program activities, volunteers seek specific administrative information related to the policies and procedures for volunteer management, evaluation, and recruitment, as well as for participant screening.

Volunteer Management/Evaluation
The majority of programs included information on how to communicate with the organization, volunteer recognition and/or compensation, and emergency procedures. We recommend that additional elements include the agency's policies and procedures regarding absenteeism and resignation, use of the agency's resources, expenses incurred by the volunteer, liability, and conflict.

Recruitment
Each of the programs included a job description for the volunteer role, and most educated volunteers about local community resources that addressed various health and social concerns. We also recommend that volunteers learn about their agency's criteria for screening of program participants (e.g., if the volunteer will be working in the participant's home, will someone from the agency visit the home first? Are the participant's capacities and needs fully assessed?). To deal with privacy issues and to counter any potential misunderstandings, we suggest that volunteers be encouraged to ask about their agency's criteria and processes for screening volunteers (e.g., will they need to undergo background checks? How does the agency address the challenge of training candidates who come with dramatically different skills and experiences?).

	Next Steps

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Our study identified a significant body of general core content that supports the feasibility of creating a generic training curriculum for volunteers to enhance the capacity of evidence-based or best practice health promotion programs. Although we focused on health promotion programs, we realize that the generic elements uncovered may have implications for a range of volunteer training programs in the broader field of civic engagement.

We made an attempt to organize the core topics into a logical flow and to make them comprehensive. We recognize that the topics and related elements could be integrated or simplified into a different sequence, giving more or less emphasis to specific elements. Specific learning objectives must also be created. Another level of review is warranted to encompass the inclusion of updated material, and an experienced group of administrators, volunteers, and evaluators in health promotion programs should finalize the core content.

We also offer some suggestions for next steps and raise additional issues and questions for consideration. With respect to curriculum development, decisions need to be made about course length, instructional format, and accessibility. Issues to resolve include (a) the number of hours needed to cover the generic content and whether this time commitment would be feasible for potential trainees; (b) whether the training content must be taught in sequence and whether the format should be offered in modules taught in segments across weeks, or as one continuous whole that can be completed in a day or two; (c) whether training can be offered online or in person, self-instructed or with an instructor, and with or without field visits to health promotion programs. Curriculum development decisions will also need to address needed resources (e.g., budget, space, materials, personnel) and how often the curriculum will need to be updated. The curriculum will also need to be matched with the skills and needs of potential trainers.

Questions about the institutional home(s) of the curriculum will need to be answered. Should the generic volunteer training course be offered through one national entity or through the same types of institutions (e.g., community colleges, Area Health Education Centers, adult learning institutes) across states and communities, or will each state or community need to establish its own educational infrastructure? If there are multiple venues for offering the course, how will consistency in course management, implementation, quality assurance, and updates be ensured?

To encourage enrollment, curriculum marketers will need to make the training program recruitment materials appealing to both potential volunteers and agencies, with the value and benefits of training clearly stated. We recommend that a marketing plan be developed in concert with the curriculum. As a marketing strategy for the effective use and management of volunteers, orientation materials about the volunteer training course and possibly a companion administrator's manual should also be developed.

Related to marketing as well as to quality improvement is the consideration of whether the training should ultimately lead to a health promotion volunteer certification. Certification could serve as a fundamental component of quality control within agency health promotion programs, and it could empower individuals with confidence in a defined sense of competencies and skills. However, requiring certification may negatively impact agency efforts in volunteer recruitment and retention or may create barriers in course accessibility, cost, and additional time commitment for volunteers.

Although offering a generic health promotion training course for volunteers appears to be a worthwhile endeavor, we do not believe that this training should supplant already successful volunteer training programs conducted by existing health promotion programs, such as the Chronic Disease Self-Management Program. We believe a generic volunteer training course should be a kind of first-stage generalist training, with health promotion programs adding second-stage, tailored training for their specific program requirements.

Although there are many steps, questions, issues, and challenges yet to consider in the process of creating and implementing a generic volunteer training curriculum, we believe that this study provides a viable starting point. By creating a new pool of highly qualified volunteers, program administrators may be able to reduce the time and resources they typically spend on recruitment and training. The overall fidelity to evidence-based intervention protocols can be strengthened by virtue of the skill set of the trained volunteers. With additional trained volunteers in place, evidence-based programs can be disseminated to a wider audience within communities, thus creating the potential for greater impact on the health status and behaviors of older citizens. Even if their tenure as agency peer mentors or lay leaders is short or, in fact, never materializes, trainees themselves could well benefit from learning to make successful modifications of their own health behavior, to communicate more effectively, to eat healthier, and to incorporate regular physical activity into their lives. Thus, the creation and implementation of a generic volunteer training course for evidence-based health promotion programs has the potential to contribute significantly and in multiple ways to the overall goal of promoting healthy aging.

	Footnotes

 
This study was funded by Contract 5-49757 from the National Council on the Aging. We would like to acknowledge the contributions of the participants in this study and the health promotion programs that they represent: Diane Dowdy, Active Choices; Jocelyn Tobnick, Active Start; Bonnie Hafner, Partners on the P.A.T.H. (Chronic Disease Self-Management); Susan Snyder, EnhanceWellness; Cindy Klug, Healthy Changes; Margherita Doyle, Anne-Reet Ilves Annunziata Ruth Palombo, Healthy Eating; Jennifer Wieckowski, Healthy Moves; Peggy Haynes and Elaine McMahon, A Matter of Balance/Volunteer Lay Leader Model; Barbara Kamp, Steps to Healthy Aging: Eating Better and Moving More; and Cassandra Coyle, Women Take Pride.

¹ Institute on Aging, University of North Carolina at Chapel Hill.

² Center for Healthy Aging, National Council on Aging, Washington, DC.

Decision Editor: Nancy Morrow-Howell, PhD

Received for publication June 20, 2006. Accepted for publication November 27, 2006.

	References

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