COMMUNITY CASE STUDY article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1593490
This article is part of the Research TopicIntegrated Strategies for Lifelong Health: Multidimensional Approaches to Aging and Lifestyle InterventionsView all 31 articles
From the WHO ICOPE Framework to Integrated Senior Health and Wellness Hub Program: An Implementation Journey
Provisionally accepted
- Singapore General Hospital, Singapore, Singapore
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As global populations age, ensuring older adults maintain functional ability and well-being is a critical public health priority. The Integrated Senior Health and Wellness (ISHW) Hub program, developed by Singapore General Hospital (SGH), operationalizes the World Health Organization's (WHO) Integrated Care for Older People (ICOPE) framework within community-based models of care. Implemented in partnership with Active Ageing Centres (AACs), ISHW enhances preventive health through structured screening, customisable nutrition education, and targeted physical activity interventions. This study aimed to develop an implementation-informed, context-sensitive model for integrated care using the Consolidated Framework for Implementation Research (CFIR) and Theory of Change to guide the design and pilot of the ISHW program The ISHW program employs a multi-prong approach, integrating health interventions with social engagement to address both physical and psychosocial determinants of health. Key components include community-driven intrinsic capacity assessment including chronic disease screening for early detection, dietitian-curated nutrition education and exercise programme enhanced by physiotherapist. A critical innovation is the "train-the-trainer" model, which enhances capacity-building among AAC staff and volunteers which supports sustainable program delivery. Qualitative insights were gathered from 5 focus groups (n=20) and 1 feedback group (n=10), analysed thematically through consensus-driven coding.Early implementation findings highlight the feasibility of integrating ICOPE principles within community-based settings, but also underscore key challenges, including resource constraints and the need for stronger inter-sectoral coordination. Facilitators of success include structured capability-building, community participation, and alignment with national ageing policies such as Age Well SG and Healthier SG. Findings gleaned from CFIR and ToC was operationalised to a program's logic model that was iteratively refined to enhance adaptability and scalability across diverse community settings. This case study adds to current understanding of community-centred models for promoting healthy ageing and helps to serve as a guidance on how ICOPE-based program could be adapted to other community settings for integrating health and social care to support ageing in place. Future evaluations will assess longitudinal outcomes and inform the scalability of community-based ICOPE implementation strategies.
Keywords: ageing in place, seniors, Theory of change (ToC), Consolidated Framework for Implementation Research, ICOPE
Received: 14 Mar 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Huang, Tan, Er, Wong, Lim, Tan, Yee, Xin and Low. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaoting Huang, Singapore General Hospital, Singapore, Singapore
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