Accessible by Design: Advancing Integrative Health for Real-World Reach to Promote Healthy Aging

Tony V Pham, MD; Chih-Hsiang ‘Jason’ Yang, PhD - Integrated Health and Spirituality SIG

Improving access to effective complementary and integrative health interventions is increasingly important for promoting healthy aging, supporting cognitive health, and addressing chronic conditions that affect independence and quality of life. Many older adults live in communities with limited access to specialty care, preventive programs, transportation, or practical support. Addressing these challenges requires evidence-informed interventions designed for real-world use. Drs. Tony Pham and Chih-Hsiang “Jason” Yang, recipients of the Integrative Health and Spirituality SIG Equity Award in consecutive years, illustrate overlapping and complementary approaches to expanding the reach and relevance of integrative health for older adults. Both scholars have been following the NIH Stage Model for Behavioral Intervention Development framework to systematically develop, refine, and evaluate interventions that are accessible, scalable, and responsive to the needs of aging populations experiencing health disparities.^1-2

Dr. Pham’s approach begins with the premise that adapting a behavioral intervention requires more than revising language or examples after a protocol has been developed. It involves working with people who have lived experience of the targeted health concerns to clarify the clinical priorities, identify outcomes that matter in daily life, and refine how an intervention is delivered and sustained. His research examines whether complementary and mind-body interventions can address the overlapping challenges of chronic pain, mood symptoms, early cognitive changes, daily functioning, social connection, and access to care among older Black adults. Drawing on prior work, Dr. Pham uses qualitative inquiry and the NIH Stage Model to refine content, communication, delivery, and feasibility before larger trials.

This approach is illustrated by Feeling of Being, Dr. Pham’s project adapting mindfulness-based cognitive therapy for older Black adults with co-occurring chronic pain and early cognitive decline, a combination that increases the risk for worsening pain and progression to dementia. In collaboration with Greater Boston residents and community partners, the project used Community Engagement Studios to identify practical refinements before pilot testing. Community experts highlighted the value of peer involvement, clear language, repetition, multisensory learning, familiar everyday examples, flexible in-person and virtual options, and supportive group settings. The Feeling of Being open pilot met all feasibility and acceptability benchmarks, resulting in a National Institute of Aging R21 submission to conduct a pilot RCT of Feeling of Being.

Dr. Yang is developing a mindful-walking intervention for underserved older adults, with its ongoing refinement guided by the NIH Stage Model. Mindful walking integrates mindfulness practice with walking, two strategies that have each been associated with physical, psychological, and cognitive health benefits in older adults. This strategy is particularly well suited for individuals with limited resources because walking is the most common and widely accessible form of physical activity that requires little specialized equipment, infrastructure, or financial investment. These features make mindful walking especially adaptable for individuals with chronic health conditions, mild mobility limitations, transportation barriers, or limited access to structured prevention programs.

Through a two-year CDC-funded project, Dr. Yang’s team has partnered with local aging organizations and community partners to implement and evaluate an outdoor mindful walking program in downtown Columbia, South Carolina. Designed with flexibility and scalability in mind, the program was developed with a vision for future adaptation across community, home-based, and remote settings. The program enrolled more than 100 community-dwelling Black older adults at elevated risk for dementia, and his team observed promising signals for cognitive and emotional well-being among intervention participants. These preliminary findings suggest that mindful walking may offer a low-threshold and accessible approach to expanding preventive cognitive-health opportunities for populations that have been traditionally underrepresented in clinical research.

Together, these examples illustrate how integrative-health interventions can be designed from the outset for implementation beyond specialized research settings and to promote healthy aging among older adults experiencing health disparities. By combining community-engaged research with a staged model for intervention development, Drs. Pham and Yang demonstrate how behavioral interventions can be made understandable, accessible, and sustainable in everyday settings for populations experiencing health disparities.

References:

1. Onken, L., Carroll, K., Shoham, V., Cuthbert, B., & Riddle, M. (2014). Reenvisioning clinical science: Unifying the discipline to improve the public health. Clinical Psychological Science, 2, 22–34.
2. Onken, L. (2022). Implementation science at the National Institute on Aging: The principles of it, Public Policy & Aging Report, 32(1), 39-4.