The Problem

1
Developing a Wellness Program Tailored to the
Needs of Elders Using Qualitative Evaluation
Methods to Shape Program Design
Jennifer S. Pitts, PhD, Angela Camilleri, MPH,
MA, Dorothy George, PharmD, Zhania Cabral, Julia
Portale, MBA, MPH Pfizer Health Solutions, 235 E.
42nd St., Mailstop 235-14-03, New York, NY 10017
Correspondence to Jennifer.Pitts_at_Pfizer.com
Introduction
Results
The Problem With the aging of the baby boomer
generation, the Medicare population has increased
dramatically in recent years, as has the
proportion of this population with multiple
chronic illnesses. It is estimated that the
increasing cost of care for Medicare
beneficiaries will lead to the programs
insolvency for Medicare by the year 2018 unless
something dramatic is done to curb this trend.
Some believe that wellness programs for older
adults can prevent or delay chronic illness and
its associated disability, which could ultimately
save money for Medicare.1

• Stage 1 Focus Groups
• Program Concept
• In general, these older adults were interested in
  enrolling in the program.
• The program appealed to their desire to improve
  the quality of their own life and to avoid the
  problems associated with poor health late in
  life.
• In most cases they are trying to improve their
  health and welcome any help they can get that
  does not interfere with their existing Medicare
  benefits.
• Program Details
• Some of the appealing aspects of the program
  beyond the opportunity to improve their health
  and reduce health risks are
• That the program is free of charge
• The opportunity to get personalized information
  that they can share with their physician
• The monetary incentive for participation
• The most interesting online components of the
  program are
• Tools to track activities and health status over
  time such as exercise routines and blood pressure
• Tools to track medications use
• Tools to keep a record of medical conditions
• Participants would prefer to work with a health
  coach by telephone, although there is an interest
  in getting the instructions in written form too.

Shaping the Solution Program uptake and
participation is critical to ensure the success
of wellness programs, so it is crucial that the
program be compelling and attractive to the
intended audience. We drew upon years of program
design experience and a
growing knowledgebase in the literature when
designing the materials for a wellness program
for a Medicare-aged population. Even so, we felt
that pilot testing the program concept and
materials using qualitative methods could help
improve the quality of the final program and
ensure it would have maximum value and
effectiveness for the intended population.
The goal was to improve the quality of the final
program and ensure its maximum value and
effectiveness for the intended population.

• We used qualitative methods, including focus
  groups and individual interviews, with adults
  eligible for Medicare to obtain opinions about
  the components of the wellness program.
• Project Goals
• Determine how to present the program concept in a
  manner that will engage older adults
• Explore what types of incentives, program
  information, and other background material this
  group will need in order to be willing to
  participate
• Investigate which program components would be
  most valued
• Establish which participation methods would be
  most relevant for this population (i.e., mail,
  phone, or online)

Table 1.
Key Learnings About Medicare Beneficiaries
How We Can Address These Learnings?
When positioning the program, emphasize the
benefits of maintaining good health and quality
of life, and personalized assistance.
They want to stay healthy and live independently
Important to demonstrate the legitimacy of the
program
They are concerned about scams and identity theft
issues
Reassure about the security of online
participation
They dont trust the security of health
information on the web
They are concerned about how their health
information would be used
Emphasize that their Medicare benefits wont
change based on their health information
Be prepared for volume of mailed Health
Assessment Questionnaire and incoming phone calls
for questions
Most would complete the Health Assessment
Questinnaire by mail (1) or phone (2)
Materials and Methods

• Subjects
• Participants for both stages were
• 65 years of age or older
• Enrolled in Medicare
• Not enrolled in an HMO or PPO
• Never enrolled in a demonstration project
• In fair to excellent health, not recently
  hospitalized, and did not have a condition that
  would prevent them from participating in the
  focus group
• This 'purposive sampling' method was used because
  the aim of the sampling was to identify
  individuals with particular characteristics
  rather than to achieve a statistically
  representative sample of the population.
• We used a two stage process to find out directly
  from older adults what would appeal to them about
  this type of program.
• Stage 1 Focus Groups
• We conducted two focus groups in Pittsburgh,
  Pennsylvania on June 7, 2007 with a total of 19
  Medicare eligible participants. Each group
  included a mix of men and women as well as a
  range of races, education levels, marital status,
  health, and Internet usage.
• Each group lasted two hours (nine participants in
  the first group and ten in the second group).
• Participants were asked about the following
  during the focus groups
• General health issues
• Favorite sources of health information
• Reaction to the program concept
• Barriers to participation
• Elements of the program

• Stage 2 Individual Interviews
• The program appealed to this group of older
  adults because of their desire to improve their
  quality of life and avoid problems associated
  with poor health later in life. They especially
  liked
• The personalized approach
• The individualized assessment
• The opportunity to help other older adults

Unpopular Logo Images

• Participants had strong opinions about the
  program name and logo
• They disliked logos with clouds, flowers or
  sunsets evoked images of pushing up daisies,
  heaven, or end of life.
• They shied away from names with gold, golden
  or generation implied program was for old
  people.
• They liked designs that depict activity
• They preferred logos with multiple vibrant
  colors.
• What we learned allowed us to choose a logo and
  program name that resonates with this group.

PROGRAM NAME
PROGRAM NAME
PROGRAM NAME
Preferred Logo Image
Example Program Name
Conclusions
Combining a focus group methodology with
one-on-one interviews generated a wealth of
information about the preferences of
Medicare-eligible seniors and their opinions
regarding what they expect in a wellness
program. The
participants were engaged, outspoken, and
provided valuable and practical information that
was used to tailor the program concept and
materials. We believe these efforts have made
the program more attractive and useful to this
population and will significantly contribute to
our ability to effectively serve the people who
participate.
These qualitative methods generated rich
information about the preferences and opinions of
an engaged and insightful group of elders.
Key lessons for planning future programs

• These qualitative methods can be used to shape
  the development of any type of program, with any
  population, in any geographic region.
• Recruitment from local senior centers is an
  efficient and effective means of assessing the
  potential receptivity to a variety of materials
  and processes during a programs development.
• To gain diversity of participants, sites for
  recruitment can also include businesses
  frequently accessed by elders, such as gyms that
  offer senior classes and medical practices.

Ultimately, we hope the improved understanding
gained from these early program design efforts
will enrich the quality of life for older adults,
as well as improve health behaviors, improve
clinical outcomes, and reduce health care costs.
1. Ozminkowski RJ, Goetzel RZ, Wang S, Shechter
D, Musich S, Bender J, Edington D. The Savings
Gain from Participation in Health Promotion
Programs for Medicare Beneficiaries. J. of
Occupational and Environmental Medicine. J Occup
Environ Med. 2006 Nov48(11)1125-32.
Photos do not depict actual focus group
participants, but reflect the types of people who
participated. CONFIDENTIAL PROPRIETARY Do not
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Health Solutions Inc.