Spanish Language Older Adult eHealth Learning

C. Approach C.1 Overview. In aim 3, the PI will assess the feasibility and acceptability of the intervention with Spanish-preferred older adult Latinos. Combined with a rigorous training plan, working with top experts in the fields of aging, Latino health, implementation science, and technology-based intervention development, this proposal will generate novel data to justify a future R01 proposal to advance aging research with underrepresented populations and assess efficacy with a larger sample.

C.2 Changes in Design. Previous versions of the intervention have been guided by the literature on older adults' learning of computer technology, and feature key elements designed specifically to accommodate older computer learners' needs and preferences. These include (1) providing step-by-step, detailed instructions and avoiding technical jargon, (2) providing hands-on practice and encouraging questions, (3) making sure each lesson builds on previous lessons and increases complexity gradually, (4) ensuring the learners experience at least some level of success at the initial stage of the training6, (5) conducting the training in a familiar, relaxed, and supportive environment, and (6) offering the training in the early morning hours, which is generally the optimal time of day for older learners. These elements remain key components of the intervention.

These changes have been made for two reasons. First, due to changes in people's way of living post-COVID (i.e., less in-person contact), in-person intervention delivery may not be acceptable as a delivery method for older adults who continue to be a vulnerable group as COVID shifts from a pandemic to an endemic. Additionally, interaction with healthcare systems is increasingly moving online. Thus, virtual learning with a live facilitator synchronously over Zoom may be a more acceptable approach. Second, the literature assessing interventions with Latino populations suggests the use of peer advisors (i.e., promotoras or Lay-health Advisors) has emerged as a potentially effective approach for improving access to care, health outcomes, and health behaviors. Wisniewski et al. proposed the importance of a new role in healthcare, in which peers assist others in navigating technology to take advantage of new tools that augment existing pathways to good health and healthcare. The emergence of the use of peer advisors (promotoras) is a natural progression for healthcare as the role of technology expands, so will the need to support its implementation. The next section describes the cultural adaptation process and further justifies the need of a peer advisor (promotora) in intervention work with Latino populations.

C.3 Cultural Adaptation. In addition to including promotoras and having the intervention materials translated into Spanish, cultural adaptation goes beyond language to focus on factors relevant to the Latino community. The literature provides practical steps for culturally adapting interventions for adult Latinos. Much of the literature in this area comes from one of the mentors on this proposal, as a pioneer in cultural adaption with Latino populations and internet-based interventions

Religion. Muñoz and Mendelson suggest incorporating religion, particularly Catholicism, often resonates with Latino participants who use religion as an important lens when making decisions. The use of relevant phrases or "dichos" to motivate and engage participants is another important part of cultural adaptation and this can be paired with incorporation of religion. For example, Latinos often use the phrase "si Dios quiere" ("what God wants"), which can guide their perception about control over aspects of their health. Subjects' beliefs can be used as a counter to what subjects perceive as barriers. For example, suggesting God brought this intervention into their lives and addressing the concept that God helps those who help themselves.