C International Psychogeriatric Association 2014 International Psychogeriatrics (2015), 27:1, 79–94  doi:10.1017/S1041610214001306

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations ...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Nathalie Bier,1,2 Agathe Lorthios-Guilledroit,2 Kareen Nour,3 Manon Parisien,4 Dave Ellemberg5 and Sophie Laforest4,5 1

School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3C 3J7, Canada Research Centre of the Institut universitaire de gériatrie de Montréal, Montreal, Quebec H3W 1W5, Canada 3 Direction de santé publique de la Montérégie, Longueuil, Quebec J4K 2M3, Canada 4 Centre for Research and Expertise in Social Gerontology (CREGÉS), CSSS Cavendish-Centre affilié universitaire, Côte St-Luc, Quebec H4W 2T5, Canada 5 Department of Kinesiology, Université de Montréal, Quebec H3C 3J7, Canada 2

ABSTRACT

Background: Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind. Methods: Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process. Results: Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained. Conclusions: Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions. Key words: cognitive training, health aging, memory, neuropsychological testing, research design and methodology

Introduction Growing attention has been devoted to promoting cognitive health or cognitive vitality among healthy older adults (Martin et al., 2011). It is now well-known that healthy behaviors and stimulating physical, cognitive, and social activities can delay the appearance of symptoms related to cognitive disorders (Karp et al., 2006). Several studies Correspondence should be addressed to: Sophie Laforest, PhD, Associate Professor, Department of Kinesiology, Université de Montréal, 2100 ÉdouardMontpetit, Suite 8202, P.O. Box 6128, Station Centre-ville, Montreal, Quebec H3C 3J7, Canada. Phone: +514-343-5632; Fax: +514-343-2181. Email: [email protected]. Received 30 Oct 2013; revision requested 30 Dec 2013; revised version received 10 Mar 2014; accepted 3 Jun 2014. First published online 17 July 2014.

have revealed that group-based interventions were effective in preserving cognitive function of normal aging older adults. Such interventions are usually oriented towards training of specific cognitive functions (e.g. memory, attention, problemsolving; Craik et al., 2007), whereas some use strategies to improve self-efficacy towards one’s cognitive capacities (Winocur et al., 2007). Other interventions focus on physical activity (Colcombe and Kramer, 2003), stress management (Hayslip et al., 1995), or promotion of healthy diet (Small et al., 2006). Social and intellectual engagement of participants was also included in certain documented interventions (Parisi et al., 2007).

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Despite this evidence, few interventions integrated all of these components in a single multifactorial intervention, within a perspective of promoting cognitive vitality among elderly people. Furthermore, most cognitive interventions are typically evaluated in a clinical context (Tardif and Simard, 2011). Yet, very little is known about the effectiveness of multifactorial programs in improving cognitive abilities among elderly people when implemented in natural settings, such as the community (Rebok et al., 2007). While conducting research in the community is increasingly needed, it is not without its challenges. Validity, reliability, and objectivity are continually challenged, and the success of a particular intervention in a community-based research may be difficult to prove, given the presence of environmental factors (Israel et al., 1998). Some methodological challenges often raised include: no possible randomization (Bonell et al., 2011), unstandardized implementation of interventions across all sites (Straw and Herrell, 2002), and high attrition rate (Davis et al., 2002). While these challenges are inherent to community-based research, many authors believe that evaluative research should be conducted under natural conditions more often for knowledge to be effectively translated into practice (Glasgow et al., 2003). Community-based studies provide examples showing that achieving scientific rigor while involving community members’ in the research is challenging but possible (Allison and Rootman, 1996). Given these considerations, a team of researchers and practitioners from the Cavendish Health and Social Services Centre (CSSS Cavendish) and Université de Montréal, along with community partners, developed and evaluated the Jog Your Mind program (Musclez vos Méninges in the original French version; Parisien et al., 2013a; 2013b). Jog Your Mind is a multifactorial community-based program for promoting cognitive vitality among elderly individuals without known or diagnosed cognitive impairment. Following a literature review and consultations with stakeholders, this cognitive vitality promotion program followed established criteria of quality, namely: (1) specific (addressing frequent complaints of elderly people who have normal cognitive aging); (2) integrative (using a multifactorial approach that combines stimulation of cognitive function, teaching of mnemonic strategies, psychosocial modalities, and strategies to promote lifestyle habits favorable to healthy cognition); (3) educative (based on an andragogy approach in order to pursue objectives related to knowledge, attitudes, and behaviors); (4) community-based (implemented by non-expert

group leaders in community organizations); (5) accessible (low cost, adaptable to different settings); and (6) validated (evaluated on its impacts as well as on its implementation process). This program was conceived within a perspective of creating a largely diffusible tool in Quebec (Canada) community settings. It was developed according to the co-construction framework used by the CSSS Cavendish team for the creation of health promotion tools (Nour et al., 2010). This framework promotes the engagement of stakeholders, such as volunteers, potential participants, and community partners, from the beginning of the program’s development. Steps undertaken to develop the program included: (1) a literature review of existing best practices; (2) building of the program’s logic model and creation of the facilitating tools; (3) validation by experts on its scientific content, implementation feasibility, and pragmatic aspects of delivery; and (4) pilot testing with groups of elderly people in order to adjust the program’s format and content (Popov et al., 2010). The logic model of the program is presented in Figure 1. It shows how the different components of the program are linked to its intended objectives and goals. The model suggests that positive changes in attitude and knowledge, as well as behavior, will lead to optimization of cognitive vitality. Cognitive vitality refers to the “development and preservation of the multidimensional cognitive structure that allows the older adult to maintain social connectedness, an ongoing sense of purpose, and the abilities to function independently, to permit functional recovery from illness or injury, and to cope with residual functional deficits” (Hendrie et al., 2006, p. 13). It is presented here as a determinant of active aging given its considerable benefits to elderly people’s quality of life (Fillit et al., 2002). The logic model allowed deriving research objectives and hypotheses for the evaluation of the program. Indeed, after the pilot testing of the Jog Your Mind program, it was essential to evaluate its effectiveness through a larger quasi-experimental study, and to document the implementation settings and process to improve the program. The main research objectives were: (1) to verify the effects of the Jog Your Mind program immediately and 12 months after the baseline; (2) to explore individual, organizational, and environmental factors associated with short-term and medium-term effects (e.g. baseline cognitive level); (3) to document the implementation settings and process of the program (e.g. population reached, adherence to the program), and to identify barriers and facilitating factors to implementation. The pursuit of these three objectives will allow for verification of the following hypotheses: (1) immediately after the program, the program’s

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Figure 1. Logic model for the Jog Your Mind program.

participants will use more mnemonic strategies and will have improved subjective memory functioning in daily life compared to those who did not participate in the program. Other variables (practice of physical activity, participation in stimulating occupations, cognitive abilities, attitudes, and knowledge) will also be improved among the program’s participants; (2) at medium term, i.e. 12 months after the baseline, these changes will be maintained; and (3) the short-term and mediumterm effects of the program on the different variables will be weaker for people who are older, have a lower cognitive level, a lower socioeconomic status, a lower education level, are less active and who adhere less to the program (e.g. attendance of sessions, home practice). There will be fewer effects in community organizations located in high poverty index neighborhoods. A quasi-experimental design was chosen for testing the hypotheses mentioned above. The trial was designed to mimic natural conditions as much as possible by giving community organizations the responsibility of recruiting participants and group leaders, as well as implementing the program.

This paper describes the evaluation protocol of the Jog Your Mind program and the particularities of conducting research in partnership with multiple community organizations within natural settings.

Methods Study design and rationale The design was developed with the goal of achieving scientific rigor while maximizing broad generalizations of the results. As mentioned by some authors (Des Jarlais et al., 2004), results from controlled trials are not sufficient. Research must also produce knowledge on factors that can influence the effects of interventions when they are implemented in natural conditions. A quasiexperimental design with a one-year waiting list control group was chosen to evaluate the Jog Your Mind program and to document its implementation process. Because it promotes external validity, such design produces results that are particularly relevant to practitioners and decision-makers (Glasgow et al., 2003). This research design corresponds to

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Figure 2. Study design.

an effects analysis of “use or practical efficacy” (Contandriopoulos et al., 2000), meaning that it aims to verify whether the program works under natural conditions. Randomization of individuals or groups was therefore excluded, in order to maximize acceptability of the research among community partners. Figure 2 shows the overall design of the study. It involved two kinds of groups studied in parallel: the experimental and control groups. The experimental group participants took part in the program during the study. To limit differences between recruited participants as much as possible, the control group participants could take part in the program one year after their entry in the study. All participants were evaluated at three times during the study: (T1) at baseline (pre-program for the experimental group); (T2) 14 weeks later (post-program for the experimental group); and (T3) a 12-month follow-up from baseline. These three evaluation times allowed for the assessment of short-term and medium-term effects of the program. A 12month follow-up from baseline was chosen to have measurements at the same period of the year for both the baseline and the last follow-up, as well as to see a one-year evolution among the control group. The study was planned over a fouryear period (2009–2013) and recruitment and data collection were done in four phases (fall 2009, spring 2010, fall 2010, and winter 2011; Figure 3).

Experimental and control groups were matched for the time of year that they entered the study to control for potential effects of the season on elderly people’s participation and lifestyle habits (e.g. level of physical activity). This protocol was approved by the research ethics committee of Université de Montréal. All community organizations received a copy of the ethics certificate. In addition, all coordinators of community organizations, group leaders, interviewers, and anyone involved in participant recruitment, program implementation, and data collection, signed a confidentiality form.

INTERVENTION DESCRIPTION AND CONTENT

As mentioned previously, Jog Your Mind is a community-based program aiming to promote cognitive vitality in older adults without known or diagnosed cognitive impairment. It is offered to groups of seven to 15 elderly individuals over ten weekly sessions of 2 h with non-expert human resources, such as community practitioners or volunteers acting as group leaders. A group format was chosen as it allows for the use of strategies such as modeling, sharing of tips and resources, normalization, and networking. Hence, in addition to the acquired knowledge and the

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Figure 3. Planning of the study.

progress targeted, the program also promotes the development of social relationships. The program’s content has been described elsewhere (Popov et al., 2010). Briefly, the program is comprised of cognitively stimulating activities, teaching of mnemonic tips, strategies promoting self-efficacy, initiation to an autonomous walking program, exploration of neighborhood resources, and promotion of healthy behaviors for maintaining cognitive functions. The logic model (Figure 1) shows the modalities associated with the program’s strategies. Mnemonic strategies (e.g. attention focusing, categorization, use of memory aids) are practiced in a context that simulates daily tasks (e.g. remembering names, learning phone numbers). Intellectually stimulating activities (e.g. riddles, logic games, memorization tasks) are performed in each session. Some activities are also suggested as homework. The goal is to expose participants to a wide variety of leisure activities that are easily accessible to the public, in order to promote selfmanagement of their cognitive stimulation. For each theme discussed, participants and the group leader explore the available community resources so that benefits of the program can be maintained and the pursuit of a personal goal may continue after the program. Participants are also invited to start an autonomous walking program. In that regard, the group leader uses cognitive-behavioral strategies

to motivate the participants (e.g. pedometers, a walking log, personal objectives). IMPLEMENTATION

Partner community organizations were in charge of implementing the program. For the study, group leaders were referred by the community organizations to participate in the one-day training offered by the program managers at CSSS Cavendish. After the training, leaders and community organizations benefited from support and advice offered by the CSSS Cavendish to assist with implementation. A detailed facilitation manual (Parisien et al., 2013a; 2013b) was offered to partner organizations. They also received compensation to cover costs inherent to their participation in the study. Recruitment SITE RECRUITMENT

Twenty-three community organizations for elderly people were recruited in the metropolitan Montreal (Canada) area to be part of the study. The research coordinator used several strategies to recruit them: presentation of the project within community organizations, announcements in newsletters and invitations to organizations in the region. Thirteen of these community organizations were assigned

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to the experimental group, meaning that they would implement the Jog Your Mind program in their organization during the study. The other ten organizations were assigned to the control group, meaning that they agreed to wait at least 12 months (or after the study) before implementing the program within their organization. Assignment to the experimental or control group was mainly based on an organization’s readiness to implement the program and on the needs of the study. No randomization was done so as not to manipulate the implementation process to the extent possible, and to respect the reality of the partner community organizations. All organizations signed an agreement with the research team and committed to offering the program at least once in order to be included in the study. PARTICIPANT RECRUITMENT

The responsibility of recruiting elderly participants was given to the coordinators of the partner community organizations. They were invited to use their usual strategies (e.g. newspapers ads, activity calendar, demonstrations of the program) and to use Jog Your Mind’s promotional tools (e.g. pamphlets, posters) in order to recruit about 15 elderly individuals (to end up with 12 per group after screening). Study criteria were specified for the organizations in order to standardize the selection of participants. Both experimental and control groups were given the same instructions. In order to further ensure the comparability of the groups, control group participants were recruited on the condition that they participate in assessments for the study during the first year and that they would be invited to participate in the program the year after. The participants were eligible to participate in the study if they met the following criteria: (1) aged 60 years old and over; (2) able to speak French; (3) accept to participate in a study over a one-year period; (4) interested in participating in a program promoting cognitive vitality over ten weekly 2-h sessions; (5) not having followed a similar program over the last year and; (6) not having received a cognition-related diagnosis by a healthcare professional (self-reported). GROUP LEADER RECRUITMENT

Community organizations also had the responsibility of recruiting group leaders who would offer the program. For that purpose, they were invited to refer two members of their team. The only criterion specified for choosing group leaders was that these people had to demonstrate an interest and have previous experience in teaching. Group leaders could be elderly volunteers

or community practitioners (e.g. special care counselors, psychosocial practitioners, recreation technicians). In addition to the one-day training offered by the research team, group leaders were given the opportunity to observe a program session before they began leading the program. It was suggested that they be paired together, especially when a group leader had limited previous experience in teaching. Sample size and power calculation The goal was to recruit 144 participants in total for the experimental group and 144 participants in total for the control group, for a total of 288 participants. The 25% attrition rate between the first and second evaluation as initially projected, would allow for 108 people per group, for a power of 80% for detecting medium-size effects following the program (α = 0.05) for one of the primary outcomes, namely the use of everyday memory strategies and aids. The power was expected to be somewhat weaker for medium-term effects (at the 12-month follow-up from baseline), given an additional projected attrition of 25% between the second and third evaluation. Other researchers have detected comparable effects with a similar variable evaluating the use of everyday memory strategies (Troyer, 2001). Data collection Once the recruitment period was over, the coordinator of each organization sent the list of names and contact information of potential participants to the research coordinator. A first phone contact allowed to re-verify participants’ eligibility and interest in participating in the study and program. People who did not meet the selection criteria were not included in the evaluation study. However, they were allowed to follow the program within their community organization. Participants were told in which group (experimental or control) they belonged and gave their verbal consent to participate in the study and to share sociodemographic data over the phone. A depressionscreening test, the short version of the French Geriatric Depression Scale (Clement et al., 1997), was also administered on the phone. If distress was detected on the phone or during the interviews, the participant was referred to a listening and referral center. Appointments for all three evaluations were booked during this first phone contact. Each participant was evaluated at three times during the study (T1, T2, T3) by the same interviewer, most of the time. Because elderly adults’ performance in cognitive testing can be influenced by fatigue,

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participants were tested at the same time of day for the three interviews. At the beginning of the first interview, participants were asked to sign a consent form. They received a token amount of $10 per evaluation. Interviewers attended a two-day training offered by the research team (more details about the interviewers’ training are available in File S1, available as supplementary material attached to the electronic version of this paper at www. journals.cambridge.org/jid_IPG). They were not told in which group (experimental or control) the participant belonged in order to minimize the experimenter’s bias, nor were they aware of the program details and objectives. Each interview lasted around an hour and a half. The outcome variables evaluated and the procedures at T1, T2, and T3 were the same. Data on the settings and the implementation process were collected during the study. Community organization coordinators and group leaders were interviewed on the phone for a process follow-up at T2. Participants from the experimental group were interviewed both before and after the program to learn about their expectations and appreciation of the program.

Assessment tools OUTCOME MEASURES

Outcome measures and descriptions of related assessment tools are presented in Table 1. Keeping in mind the objectives and the communitybased context of the study, the assessment tools were chosen based on the following criteria: (1) psychometric qualities (e.g. validity among the target population, sensitivity to change); (2) could be administered by trained interviewers who were non-experts in cognition; (3) length of time for administration allowing for an interview of less than 2 h; and (4) ability to measure the different dimensions of the logic model. In order to ensure the validity and reliability of these tools for the target population, a pre-test of the measurement tools was conducted among a representative sample of the target population before the study (n = 15). As presented in Table 1 (last column), some measurement tools were modified following this pre-test, to adapt them to the needs of the study. The pre-test also allowed for confirmation of the validity, reliability, and absence of ceiling effects of the chosen tools for our population. The main independent variable was the type of group (experimental or control) as an indicator of exposure to the program Jog Your Mind. Dependent variables were chosen according to their ability to

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measure the specific effects of the program or to measure cognitive vitality. Primary outcomes were the use of everyday memory strategies and aids, assessed by the Multifactorial Memory Questionnaire Strategy (MMQ-Strategy; Troyer and Rich, 2002; Fort et al., 2004), and subjective memory functioning in daily life, assessed by the Multifactorial Memory Questionnaire Ability (MMQ-Ability; Troyer and Rich, 2002; Fort et al., 2004). As secondary outcomes, the following dependent variables were evaluated: (1) attitudes related to cognitive functions, such as confidence (Metamemory in Adulthood Capacity (MIA-Capacity); Hultsch et al., 1987; Dixon et al., 1988) and feelings of control (Metamemory in Adulthood Locus (MIA-Locus); Dixon et al., 1988; Dellefield and McDougall, 1996); (2) knowledge about normal aging, resources, mnemonic strategies (homemade questionnaire plus an adapted version of the Memory Situation Questionnaire; Troyer, 2001); (3) adoption of behavior related to cognitive vitality, such as physical activity (12item questionnaire inspired from the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire; Stewart et al., 2001) and participation in stimulating activities (18-item questionnaire adapted from the Florida Cognitive Activities Scale; Schinka et al., 2005); (4) cognitive performances in daily life situations (Rivermead Behavioural Memory Test; Vannier and Lemyse, 1994; Wilson et al., 1994; Lezak, 1995); Attention in daily life (Coyette et al., 1999); (5) cognitive abilities, more specifically memory and executive functions (Stroop test; Stroop, 1935; Golden, 1978); California Verbal Learning Test II; Delis et al., 1987; 2000) and; (6) perception of memory on a scale from 1 to 10 (1 = very bad; 10 = excellent). VARIABLES RELATED TO THE INTERVENTION PROCESS

Program delivery (e.g. number and length of sessions, group size, fidelity with manual content) was documented. Group leaders recorded attendance for every session so that adherence and attrition rates could be calculated. Implementation fidelity was evaluated during a phone interview with each group leader at the end of the program. Their satisfaction with the program and the oneday training session, as well as their level of facilitating experience, were also evaluated through this interview. A phone interview conducted after the program with the coordinator of each partner community organization (experimental and control groups), allowed us to collect organizational

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PSYCHOMETRIC PROPERTIES MEASURE AND INSTRUMENTS

DESCRIPTION

FROM OTHER STUDIES

FROM OUR PRE-TEST

(n = 15)

............................................................................................................................................................................................................................................................................................................................................................................................................................................................

ATTITUDE AND KNOWLEDGE OUTCOMES CONFIDENCE IN COGNITIVE ABILITIES Capacity subscale of the Seventeen items (13 in our study). Metamemory in Answer scale: 1 (strongly agree)–5 (strongly Adulthood disagree) (MIA-Capacity; Score calculation: Sum of all items. A higher score Hultsch et al., 1987; indicates a better confidence in one’s memory Dixon et al., 1988) capacity. A reverse-translation was done by the research team.

Internal consistency: (respectively, n = 120; 108; 150) Cronbach’s α: 0.86, 0.82, and 0.86 Internal consistency: (in other studies; respectively, n = 388 and 342) Cronbach’s α: 0.85 and 0.81

Internal consistency: Cronbach’s α: 0.73 Test–retest reliability: Pearson correlation: r = 0.48 (p = 0.07) Total scores from: 34–67 Mean: 58 (SD: 7.6) After the pre-test, four items were removed (items 2, 9, 19, and 100) from the original scale.

Internal consistency: Cronbach’s α: 0.79 Internal consistency: (in other studies) Cronbach’s α: 0.84–0.93

Internal consistency: Cronbach’s α: 0.45 Test–retest reliability: Pearson correlation: r = 0.70 (p < 0.004) Total scores from: 23 to 37 Mean: 30.2 (SD = 3.78) After the pre-test, the wording was slightly modified.

Sensitivity to change from the original version: Good

No pre-test was done as this instrument was added after the pre-test.

N/A

Following the pre-test, the answer scale was changed from True/False to 1 (strongly agree)–5 (strongly disagree) to increase sensitivity of this scale.

FEELING OF CONTROL OVER COGNITIVE FUNCTION

Locus subscale of the Metamemory in Adulthood (MIA-Locus; Dixon et al., 1988; Dellefield and McDougall, 1996)

Nine items in the original scale. Answer scale: 1 (strongly agree)–5 (strongly disagree). Score calculation: sum of all items. A higher score indicates a better sense of control over one’s memory capacity. A reverse-translation was done by the research team.

KNOWLEDGE (NORMAL AGING, RESOURCES, MNEMONIC STRATEGIES) Questions inspired from Five open questions where the participants are the Memory Situation asked to mention mnemonic tips. Questionnaire Score calculation: Global score is calculated (Troyer, 2001) depending on the number of tips mentioned. A higher score indicates a better knowledge. Homemade Six items developed according to the program. questionnaire Answer scale: 1 (strongly agree)–5 (strongly disagree) Score calculation: Sum of items. The highest score indicates a better knowledge.

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Table 1. Outcome measures and measurement tools

Table 1. Continued. PSYCHOMETRIC PROPERTIES MEASURE AND INSTRUMENTS

DESCRIPTION

FROM OTHER STUDIES

FROM OUR PRE-TEST

(n = 15)

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BEHAVIOR OUTCOMES USE OF EVERYDAY MEMORY STRATEGIES AND AIDS

Memory strategy subscale of the Multifactorial Memory Questionnaire (MMQ-Strategy; primary outcome measure; Troyer and Rich, 2002; Fort et al., 2004)

Nineteen items Answer scale: 0 (never) to 4 (always) Score calculation: Sum of all items. A higher score indicates a better use of everyday memory strategies and aids.

Internal consistency: Cronbach’s α: 0.83 Test–retest reliability: (After four weeks; n = 24) CCI: 0.84–0.93

Internal consistency: Cronbach’s α: 0.57 Internal consistency (without item 15 or 16): Cronbach’s α: 0.62 Test–retest reliability: CCI: 0.47 Total scores: 10–42 Mean: 30.6 (SD: 7.42) Normal distribution

Ten items Participants are asked about the frequency and the duration of their participation in physical activities in the last month. The number of different practiced activities, the frequency of activity per week and the total duration were calculated.

Internal consistency: Cronbach’s α: 0.45 Test–retest reliability: CCI: 0.67

Mean number of different practiced activities: 2.5 (SD: 1.12) Total scores from: 1 to 5 Test–retest reliability: Spearman correlation: s = 0.27 (p = 0.33) Mean frequency of activities per week: 8.1 activities per week (SD: 4.7) Total scores from: 0.25 to 18 Test–retest reliability: Pearson correlation: r = 0.64 (p = 0.011) Mean total duration (in minutes) of activities: 160 (SD: 124.1) Total scores from: 25 to 420 Test–retest reliability: Correlation: 0.65 (p = 0.017)

Internal consistency: Cronbach’s α: 0.65 Good concomitant validity.

With 15 items: Total scores from: 46 to 179 Mean score: 102.3 (SD: 31.5) Normal distribution Test–retest reliability: r = 0.59 (p = 0.021) After the pre-test, 16 out of the 25 original items were kept.

LEVEL OF PHYSICAL ACTIVITY

Questionnaire inspired from the CHAMPS (Stewart et al., 2001)

Questionnaire adapted from the Florida Cognitive Activities Scale (Schinka et al., 2005)

Sixteen items taken or adapted from the original scale on the frequency of practice of stimulating activities Score calculation: Sum of the frequency of all items. A higher score indicates a higher participation in stimulating activities.

Evaluation design for a cognitive vitality program

PARTICIPATION IN STIMULATING ACTIVITIES

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Table 1. Continued. 88

PSYCHOMETRIC PROPERTIES

DESCRIPTION

FROM OTHER STUDIES

FROM OUR PRE-TEST

(n = 15)

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COGNITIVE VITALITY OUTCOMES COGNITIVE ABILITIES

Stroop test (Stroop, 1935; Golden, 1978) California Verbal Learning Test II (CVLT-II; Delis et al., 1987; 2000) Perception of memory

Test comprised of three boards with ten lines where colors are written. The participant must read them as quickly as possible. The lower score indicates better cognitive abilities. Sixteen words and verbal memory measures. Words are read out loud at a rate of 5 seconds/word. Score calculation: number of correct answers. A higher score indicates a better verbal memory. Single question: On a scale of 1 (very bad) to 10 (excellent), indicate how you evaluate your memory.

This test has been subject to many studies that demonstrated its validity and reliability.

N/A

This test has been subject to many studies that demonstrated its validity and reliability.

N/A

N/A

Test–retest reliability: Spearman correlation: s = 0.44 (p = 0.10)

Twenty items for assessing self-reported frequency of memory mistakes made within the last two weeks. Answer scale: 0 (never) to 4 (always) Score calculation: Sum of all items. A lower score indicates poorer subjective memory ability.

Internal consistency: Cronbach’s α: 0.93 Test–retest reliability (n = 24): CCI: 0.84 to 0.93

Internal consistency: Cronbach’s α: 0.84 Total scores from: 0 to 50 Mean score: 27.7 (SD: 10.9) Normal distribution Test–retest reliability: CCI: 0.68

Ecological test with names, faces, places, appointment dates, pictures, story, and trajectory memory tasks

Test–retest reliability (n = 118): Screening test: 0.78 Profile score: 0.85 Inter-examiner reliability: 100% Concomitant validity: Correlation from 0.39 to 0.70 with other memory tests. A face-to-face communication with the author indicates that the tool has good metric properties.

N/A

COGNITIVE PERFORMANCE IN DAILY LIFE

Memory ability subscale of the Multifactorial Memory Questionnaire (MMQ-Ability; primary outcome measure; Troyer and Rich, 2002; Fort et al., 2004) Rivermead Behavioural Memory Test (RBMT; Vannier and Lemyse, 1994; Wilson et al., 1994; Lezak, 1995)

Attention in daily life (Questionnaire d’auto-évaluation de l’attention – QAA; Coyette et al., 1999)

Fifteen items (seven in our study) Answer scale: 1 (never) to 6 (always) Score calculation: Sum of all items. A higher score indicates poorer attention.

Internal consistency: Cronbach’s α: 0.90 Mean score: 35.3 (SD: 10.7) Total score from: 19 to 66 Normal distribution Test–retest reliability: CCI: 0.89 Following the pre-test, only seven out of the 15 items were included.

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MEASURE AND INSTRUMENTS

Evaluation design for a cognitive vitality program

variables, such as the type and size of the organization. The perceived level of difficulty to implement the program and the willingness to offer it in the future, were also assessed in both the experimental and control groups. Barriers, facilitators and required resources for the program’s implementation were also assessed during this interview for experimental groups. Participants’ expectations were gathered during phone interviews before the Jog Your Mind program, and their satisfaction and the perceived benefits were assessed after the program. Lastly, environmental variables (e.g. poverty index and level of urbanization) were collected from census data. CONTROL VARIABLES

Socio-demographic variables such as age, gender, marital status, living alone, years of education, perception of socio-economic status, and retired status were collected as control variables. Perceived physical health (Daveluy et al., 2000; Daveluy et al., 2001), perceived mental health (Statistique Canada, 2005), health problems (Daveluy et al., 2000), medication consumption (Daveluy et al., 2000; Daveluy et al., 2001), perceived level of stress (Statistique Canada, 2005), life satisfaction (Statistique Canada, 2005), and sense of belonging to local community (Statistique Canada, 2005) were also collected. Participants were also asked to report vision and hearing levels (Santé Québec, 1998), alcohol and tobacco consumption (Statistique Canada, 2005), changes in diet (Daveluy et al., 2000; Daveluy et al., 2001), and participation in other health promotion programs during the study. Control variables related to memory and cognitive level included: memory concerns reported on a scale from 1 (not concerned at all) to 10 (very concerned), general cognitive level assessed by the Montreal Cognitive Assessment – MoCA (Nasreddine et al., 2004) and whether the participant had discussed memory concerns with a health professional. Lastly, depression symptoms were evaluated using the short French version of the Geriatric Depression Scale (Clement et al., 1997). All of this information allowed us to create a portrait of the participants. It was also used to compare characteristics of the participants in both the experimental and control groups and to identify confounding variables that were possible to control during the statistical analyses. Analysis plan Data entry and cleaning, and variable transformation were performed using the SPSS and Stata. The same research assistant cleaned all questionnaires before data entry. The scoring of some cognitive

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tests (e.g. the visuoconstructional skills task of the MoCA) was done by an occupational therapist, and borderline scores were verified by a neuropsychologist. Descriptive analyses were conducted to document characteristics of the population reached and certain variables related to the implementation context and process. Group differences at baseline were assessed through ttests and χ2 analyses. Any potentially confounding variables were taken into account in multivariate analyses. The main analyses were comprised of simple comparisons. First, to compare groups at both T2 and T3, crude data were examined. The standardized effect was calculated in order to assess the sensitivity of the instrument for detecting a clinically significant difference (Kazis et al., 1989). Afterwards, a regression analysis controlled for potentially confounding variables at the individual level (e.g. age, socioeconomic status). Analyses were conducted according to the intent-to-treat principle and participants were maintained in the group to which they were initially assigned. Like in other studies, it was decided not to adjust for multiple comparisons (Rothman, 1990). Lastly, exploratory analyses allowed us to observe how some individual variables (e.g. cognition level) and variables related to the implementation context (e.g. group leader’s characteristics) are associated with effects of the program. Regression analyses, including interacting effects, were useful in documenting the differential effects of the program and identifying characteristics of participants who were most likely to benefit from this kind of intervention.

Proceedings of the study As shown in Figure 2, 13 community organizations referred 171 potential participants for the experimental group and ten community organizations referred 202 potential participants for the control group. Screening for the study began in August 2009 and the last participant entered the study in January 2011. After the first phone contact with potential study participants, 28 and 51 participants were excluded from the experimental group and control group respectively, leaving 143 participants in the experimental group and 151 participants in the control group at T1 (baseline). Between T1 and T3, an attrition rate of 15.2% was obtained, which was lower than expected. Of the 294 participants recruited, 251 remained at T3, thus leaving the power of the study intact. Participants were lost due to health problems, traveling, their decision not to continue, the difficulty of the study, their belief that

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the program would not meet their needs or if it was impossible to contact them. In total, the program was offered to 17 groups of older adults (three community organizations gave the program to two or three groups). Twenty-two group leaders were involved to deliver the program during the study. Group leaders were paired to co-facilitate the program for five experimental groups. All group leaders, except one, shared their appreciation of the program and their experience at the end of their mandate. Follow-up with each community organization was carried out after the end of the program. Each community organization coordinator who was responsible for a group provided his or her feedback on the implementation process and the program itself. With respect to data collection, the majority of interviews were conducted in a room at a partner community organization as was intended. However, some of the interviews (23%) were conducted in the participants’ homes to accommodate them. In addition, for practical reasons (e.g. conflicting schedules or loss of an interviewer), some participants did not have the same interviewer for all three evaluations. In general, the evaluation procedures were well tolerated by participants.

Discussion This paper described the protocol of a quasiexperimental study designed to evaluate a multifactorial health promotion program. This protocol will allow verifying whether participants to the Jog Your Mind program have better improvement in cognitive and health outcomes than participants of the control groups on short and medium term after the program. As the goal of the paper was to describe the protocol only, this section will discuss data related to the sample, the attrition rate, and the recruitment before addressing the methodological challenges associated with community-based research. Data related to the hypotheses and to the outcomes will be the object of future publications. Participant recruitment and retention Overall, recruitment and retention of participants were successful. The sampling goal was achieved with 294 participants being admitted in the study at baseline. This success may be explained by the fact that the Jog Your Mind program and study respond to an unmet need and that memory is a significant concern among elderly people. They thus sparked interest in a great number of people. In addition, community organizations were responsible for participant recruitment. As many

participants had a certain sense of belonging to their neighborhood, this may have motivated them to participate in the study. Given the recruitment challenges usually faced during controlled trials such as refusals due to personal-, contextual-, or research-related factors (Gul and Ali, 2010), taking advantage of community organizations’ relationships with the participants may be one way to overcome them. As for retention, we observed a low attrition rate of 15.2%, which was lower than expected. This was also an achievement, given that high attrition rate can reduce statistical power and limit internal and external validity. Our low attrition rate may be attributed to the fact that the same interviewer was assigned to a participant for all three evaluation times (T1, T2, and T3). This allowed for some continuity for the participants and enabled them to develop a relationship of trust with the interviewer. Furthermore, some interviews were conducted in the participant’s home to avoid losing participants due to, for example, mobility issues. Hence, attention to the interviewer–participants relationship and flexibility in the procedures may have helped to keep participants in the study. A low attrition rate has also been obtained in other studies using comparable field procedures (Robitaille et al., 2005). In our case, such good retention is also indicative that the Jog Your Mind study and the program sparked interest in a great number of people given that memory is a significant concern among elderly people and that the program responds to an unmet need in this regards. Originality of the Jog Your Mind program Compared to traditional cognitive training interventions (Tardif and Simard, 2011), the Jog Your Mind program distinguishes itself by its multifactorial approach. It combines cognitively stimulating activities, use of everyday memory strategies, self-efficacy promoting strategies, promotion of physical activity, awareness of neighborhood resources, and promotion of healthy behaviors for maintaining cognitive functions. According to Rebok and colleagues (2007), this type of multifactorial approach is promising but has rarely been implemented. Jog Your Mind empowers elderly people to take charge of their health through its strategies, content, and activities. Its development and implementation, carried out in close partnership with community organizations and lay people acting as leaders, allow for enhanced program sustainability and community empowerment (Fienieg et al., 2012). The program is simple enough to be administered by people with no specific clinical background, thus enhancing its potential for dissemination. However, the program

Evaluation design for a cognitive vitality program

does not include a booster session like other cognitive training programs (e.g. Willis et al. (2006)), which is a possible limitation. A booster session could help to maintain training-related benefits over time and facilitate the transfer of training to the activities of daily life required to maintain independent living (Rebok et al., 2007). It is thus possible that the results of this study show a weaker effect than other cognitive training interventions. In the same way, while its multifactorial approach is innovative, the Jog Your Mind program may not be as intensive and specific as other interventions, thus making it harder to detect large effect size. The co-construction process used to develop Jog Your Mind (Nour et al., 2010; Popov et al., 2010) was a key preparatory step for conducting the evaluation study. This development process promotes the engagement of stakeholders from the beginning of the program’s development. This allows for the creation of multiple partnerships with community organizations, which are also needed during the evaluation study. In addition, building a logic model during the development of the program allows for the identification of research objectives that are both relevant for the researchers and the community partners (Kaplan and Garrett, 2005). Lastly, testing of the program provides the opportunity for pre-testing and modifying the measurement instruments that are to be used during the evaluation study. Methodological challenges In line with the recommendation of many authors to conduct more pragmatic effectiveness trials (Glasgow et al., 2003), efforts were made to mimic natural conditions as much as possible when designing the Jog Your Mind evaluative protocol. One major aspect of the protocol reflecting this decision was the fact that community organizations were made responsible for the recruitment of participants and group leaders and for the program delivery. This had various implications on the design as described below. First, using this strategy did not allow for randomization, since many of the community organizations may not have been ready to implement the program. The research team had to opt for alternative designs. While some may see these alternative designs as less effective in eliminating potential confounding variables, a good understanding, rigorous measuring and control of these variables can make evidence from these trials more convincing (Bonell et al., 2011). In addition, it is worth noting that randomization does not, in and of itself, promote external validity, which

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is usually the main concern in these types of quasi-experimental pragmatic trials (Glasgow et al., 2003; Bonell et al., 2011). Given that little is known about cognitive intervention effectiveness in natural conditions, applicability of the study’s results to community settings was emphasized. Second, there may be less control available on the research process and program delivery, which may increase the possibility that differences between settings or between group leaders influence the study’s outcomes. As mentioned by Allison and Rootman (1996), while sharing control among multiple community partners is “consistent with the philosophical goals of health promotion research, it does have implications for scientific rigor in the traditional sense of the term” (p. 338). To minimize selection bias, a clear description of the participant selection criteria was provided to all community organizations. The same guidelines were given to both the experimental and control groups. Furthermore, to ensure a standardized implementation of the Jog Your Mind program across all sites, specific measures were taken. For instance, all group leaders received a 7-h training about the program and its application. They were asked to follow the guidelines of the Leader’s Manual that was provided to them. The research team also provided counseling and advice to group leaders and to the person in charge of implementing the program in each organization when needed. Lastly, a visit was made to the organization before the program to ensure that the setting was adequate. Unfortunately, program sessions were not observed for practical reasons (e.g. lack of time). Like in other studies (Filiatrault et al., 2007), observation of one or two sessions during the program could have allowed for an objective assessment of the community organizations and compliance of the group leaders to the program guidelines. While the primary concern in designing this study protocol was the applicability of results to community settings, internal validity of the protocol was also given consideration through careful selection of measurement tools with sound psychometric properties and rigorous processes to limit attrition, interviewer bias, and contamination. Measurement tools were carefully selected for their psychometric properties. In this regard, the pre-test of processes and data collection tools conducted before the study, was very useful. In fact, given that the older population without known or diagnosed health conditions is not often studied, the pre-test allowed for confirmation of the choice of measurement tools as a function of their variability and the absence of a ceiling effect. In addition, it allowed for verification of the feasibility of data collection processes and adjustment of its

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practical aspects (e.g. readability of documents, administration time). Interviewer bias was also given some consideration. In fact, the research team did not inform interviewers as to the group (experimental or control) in which participants were being evaluated. Participants were also reminded not to offer this information to the interviewers. Training and coaching of interviewers provided during the study, as well as a detailed interviewer’s manual prepared by the research team, certainly helped to maintain rigor and standardization of the data collection. Conducting research within the community has the primary advantage of reducing the gap between research and practice (Glasgow et al., 2003). In fact, research findings from pragmatic trials are particularly relevant to practitioners and decisionmakers given that they have been tested under natural conditions and they promote external validity (Glasgow et al., 2003). For the Jog Your Mind study, a wide variety of community settings (e.g. community organizations, elderly people’s residences) and non-expert group leaders were encouraged in order to maximize the applicability of the results for community practitioners. Many authors advocated for researchers to conduct more research under natural conditions so that knowledge could effectively be translated into practice (Glasgow et al., 2003; Bonell et al., 2011). Many researchers have yet to realize that the additional time, patience, and negotiation with community partners required for community-based research, do not necessarily lead to a loss of rigor (Allison and Rootman, 1996).

Conclusion This paper described the evaluation protocol of the Jog Your Mind program and the particularities of conducting research in partnership with multiple community organizations within natural settings. As few multifactorial community-based programs promoting cognitive vitality among elderly people have been documented, the results of this study will fill an important gap in the literature and will provide new knowledge on important questions concerning the effectiveness of such a program. This knowledge will help guide decision-makers in planning activities for elderly people that promote cognitive vitality and will also have implications for community organization practitioners who are looking for a creative cognitive vitality program. From a methodological perspective, the Jog Your Mind protocol can serve as an example to guide future research aiming to evaluate health interventions under natural conditions. Indeed, it describes a number of methodological considerations allowing

researchers conducting community-based studies to achieve scientific rigor while being sensitive to the reality of community settings. Those considerations include pre-testing and selecting measurement tools with sound psychometric properties, giving the community organizations responsibility for participant recruitment and program implementation, providing specific training to interviewers in order to ensure the standardization of the study protocol and intervention implementation. It is hoped that this protocol will inspire other researchers, not only to conduct more research in natural conditions, but to do so with rigor.

Conflict of interest This research was funded by the Canadian Institutes of Health Research (grant #102 545). This sponsor played no role in the research other than funding the research.

Description of authors’ roles Nathalie Bier, PhD, is a co-researcher for this study. She contributed in formulating the research questions and designing the study. She was also responsible for managing the preparation of the paper. Agathe Lorthios-Guilledroit, MSc, assisted with the literature review and the writing of the paper. Kareen Nour, PhD, Manon Parisien, MSc, and Dave Ellemberg, PhD, are also co-researchers for this study. They contributed in formulating the research questions, designing the study, and writing the paper. Sophie Laforest, PhD, is the principal investigator for this study. She too contributed in formulating the research questions, designing the study, and writing the paper.

Acknowledgments The authors wish to thank the community organizations and the elderly individuals who participated in this project. They are also grateful to Danielle Guay who was the research assistant for this study.

Supplementary materials To view supplementary material for this article, please visit http://dx.doi.org/10.1017/ S1041610214001306

References Allison, K. R. and Rootman, I. (1996). Scientific rigor and community participation in health promotion research: are

Evaluation design for a cognitive vitality program they compatible? Health Promotion International, 11, 333–340. Bonell, C. P. et al. (2011). Alternatives to randomisation in the evaluation of public health interventions: design challenges and solutions. Journal of Epidemiology and Community Health, 65, 582–587. Clement, J. P., Nassif, R. F., Leger, J. M. and Marchand, F. (1997). Mise au point et contribution à la validation d’une version française brève de la Geriatric Depression Scale de Yesavage. Encéphale, 23, 91–99. Colcombe, S. and Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science, 14, 125–130. Contandriopoulos, A. P., Champagne, F., Denis, J. F. and Avargues, M. C. (2000). L’évaluation dans le domaine de la santé: concepts et méthodes. Revue d’Épidemiologie et de Santé Publique, 48, 517–530. Coyette, F., Arno, P., Leclercq, M., Seron, X., Van der Linden, M. and Grégoire, J. (1999). Questionnaire d’auto-évaluation de l’attention (Q.A.A.): Élaboration de normes a partir d’une population de 220 sujets adultes. Geneva, Switzerland: Université de Genève. Available at: http://www.unige.ch/fapse/psychoclinique/UPNC/ publications/outils.html; last accessed 7 August 2013. Craik, F. I. M. et al. (2007). Cognitive rehabilitation in the elderly: effects on memory. Journal of the International Neuropsychological Society, 13, 132–142. Daveluy, C., Audet, N., Courtemanche, R., Lapointe, F., Côté, L. and Baulne, J. (2000). Méthodes. Québec, Canada: Institut de la statistique du Québec. Daveluy, C., Pica, L., Audet, N., Courtemanche, R., Lapointe, F. and Côté, L. (2001). Enquête sociale et de santé 1998 – Cahier technique et méthodologique: documentation générale (volume 1). Québec, Canada: Institut de la statistique du Québec. Davis, L. L., Broome, M. E. and Cox, R. P. (2002). Maximizing retention in community-based clinical trials. Journal of Nursing Scholarship, 34, 47–53. Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. (1987). California Verbal Learning Test. San Antonio, TX: The Psychological Corporation. Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. (2000). California Verbal Learning Test, 2nd edn. San Antonio, TX: Harcourt Assessment. Dellefield, K. S. and McDougall, G. J. (1996). Increasing metamemory in older adults. Nursing Research, 45, 284–290. Des Jarlais, D. C., Lyles, C., Crepaz, N. and the TREND Group (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. American Journal of Public Health, 94, 361–366. Dixon, R. A., Hultsch, D. F. and Hertzog, C. (1988). The Metamemory in Adulthood (MIA) Questionnaire. Psychopharmacology Bulletin, 24, 671–688. Fienieg, B., Nierkens, V., Tonkens, E., Plochg, T. and Stronks, K. (2012). Why play an active role? A qualitative examination of lay citizens’ main motives for participation in health promotion. Health Promotion International, 27, 416–426. Filiatrault, J. et al. (2007). Implementing a community-based falls-prevention program: from drawing

93

board to reality. Canadian Journal on Aging, 26, 213– 225. Fillit, H. M. et al. (2002). Achieving and maintaining cognitive vitality with aging. Mayo Clinic Proceedings, 77, 681–696. Fort, I., Adoul, L., Holl, D., Kaddour, J. and Gana, K. (2004). Psychometric properties of the French version of the Multifactorial Memory Questionnaire for adults and the elderly. Canadian Journal on Aging, 23, 347–357. Glasgow, R. E., Lichtenstein, E. and Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93, 1261–1267. Golden, C. J. (1978). Stroop Color and Word Test: A Manual for Clinical and Experimental Uses. Chicago, IL: Skoelting Co. Gul, R. B. and Ali, P. A. (2010). Clinical trials: the challenge of recruitment and retention of participants. Journal of Clinical Nursing, 19, 227–233. Hayslip, B., Maloy, R. M. and Kohl, R. (1995). Long-term efficacy of fluid ability interventions with older adults. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 50, 141–149. Hendrie, H. C., et al. (2006). The NIH Cognitive and Emotional Health Project. Report of the Critical Evaluation Study Committee. Alzheimer’s and Dementia, 2, 12–32. Hultsch, D. F., Hertzog, C. and Dixon, R. A. (1987). Age differences in metamemory: resolving the inconsistencies. Canandian Journal of Psychology, 41, 193–208. Israel, B. A., Schulz, A. J., Parker, E. A. and Becker, A. B. (1998). Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202. Kaplan, S. A. and Garrett, K. E. (2005). The use of logic models by community-based initiatives. Evaluation and Program Planning, 28, 167–172. Karp, A., Paillard-Borg, S., Wang, H. X., Silverstein, M., Winblad, B. and Fratiglioni, L. (2006). Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dementia and Geriatric Cognitive Disorders, 21, 65–73. Kazis, L. E., Anderson, J. J. and Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27, S178–S189. Lezak, M. D. (1995). Neuropsychological Assessment. New York: Oxford University Press. Martin, M., Clare, L., Altgassen, A. M., Cameron, M. H. and Zehnder, F. (2011). Cognition-based interventions for healthy older people and people with mild cognitive impairment. Cochrane Database of Systematic Reviews, 19, CD006220. Nasreddine, Z. S., Chertkow, H., Phillips, N., Whitehead, V., Collin, I. and Cummings, J. L. (2004). The Montreal Cognitive Assessment (MoCA): a brief cognitive screening tool for detection of mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699. Nour, K. et al. (2010). Développer un programme communautaire de promotion de la vitalité cognitive chez les aînés. Avantages et défis d’une synergie recherche-pratique. Presented at the 39th Annual Scientific and Educative

94

N. Bier et al.

Meeting of the Canadian Association of Gerontology, Montreal, Canada. Parisi, J. M., Greene, J. C., Morrow, D. G. and Stine-Morrow, E. A. L. (2007). Senior odyssey: participant experiences of a program of social and intellectual engagement. Activities, Adaptation and Aging, 31, 31–49. Parisien, M., Gilbert, N., Amzallag, M., Guay, D., Nour, K. and Laforest, S. (2013a). Jog Your Mind! A Program of Cognitive Vitality for Seniors. Côte-St-Luc, QC: CSSS Cavendish. Parisien, M., Gilbert, N., Amzallag, M., Guay, D., Nour, K. and Laforest, S. (2013b). Musclez vos méninges. Atelier de vitalité intellectuelle pour aînés. Côte-St-Luc, QC: CSSS Cavendish. Popov, P. et al. (2010). Jog Your Mind: a community program for intellecutal vitality. Pluriâges, 1, 10–11. Rebok, G. W., Carlson, M. C. and Langbaurn, J. B. S. (2007). Training and maintaining memory abilities in healthy older adults: traditional and novel approaches. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 62, 53–61. Robitaille, Y. et al. (2005). Moving forward in fall prevention: an intervention to improve balance among older adults in real-world settings. American Journal of Public Health, 95, 2049–2056. Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology, 1, 43–46. Santé Québec (1998). Questionnaire sur les habitudes de vie et de la santé 1998 (ESS98/QAA.1 Janvier 1998). Montreal, Canada: Santé Québec and Groupe Léger & Léger Inc. Available at: http://www.bdso.gouv.qc.ca/ docs-ken/multimedia/Enq98_QAA.pdf, last accessed 7 August 2013. Schinka, J. A., McBride, A., Vanderploeg, R. D., Tennyson, K., Borenstein, A. R. and Mortimer, J. A. (2005). Florida cognitive activities scale: initial development and validation. Journal of the International Neuropsychological Society, 11, 108–116. Small, G. W. et al. (2006). Effects of a 14-day healthy longevity lifestyle program on cognition and brain function. American Journal of Geriatric Psychiatry, 14, 538–545.

Statistique Canada (2005). Enquête sur la santé dans les collectivités canadiennes 2005. Ottawa, Canada: Statistique Canada. Available at: http://www23.statcan.gc.ca/imdbbmdi/instrument/3226_Q1_V3-fra.pdf, last accessed 7 August 2013. Stewart, A. L., Mills, K. M., King, A. C., Haskell, W. L., Gillis, D. and Ritter, P. L. (2001). CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Medicine and Science in Sports and Exercise, 33, 1126–1141. Straw, R. B. and Herrell, J. M. (2002). A framework for understanding and improving multisite evaluations. New directions for evaluation, 94, 5–15. Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662. Tardif, S. and Simard, M. (2011). Cognitive stimulation programs in healthy elderly: a review. International Journal of Alzheimer’s Disease, 2011, 378934. Troyer, A. K. (2001). Improving memory knowledge, satisfaction, and functioning via an education and intervention program for older adults. Aging Neuropsychology and Cognition, 8, 256–268. Troyer, A. K. and Rich, J. B. (2002). Psychometric properties of a new metamemory questionnaire for older adults. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 57, 19–27. Vannier, M. and Lemyse, C. (1994). Le Rivermead Behavioral Memory Test (version française). Montreal, QC: Centre de recherche Institut de réadaptation de Montréal. Willis, S. L. et al. (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. Journal of the American Medical Association, 296, 2805–2814. Wilson, B., Cockburn, J. and A., B. (1994). Rivermead Behavioural Memory Test. Bury St Edminds, England: Thames Valley Test Company. Winocur, G. et al. (2007). Cognitive rehabilitation in the elderly: an evaluation of psychosocial factors. Journal of the International Neuropsychological Society, 13, 153–165.