Health and social service requirements of disabled elders represent an increasing challenge for the U.S. Effective strategies to prevent elder disability include community-based disability prevention programs. Program completion, however, remains an important barrier to their effectiveness. This study examined the association of organizational, provider, and client variables with program completion and health outcomes for a one-year evidence-based disability prevention program in 22 U.S. senior center sites. It was hypothesized that program completion and health outcomes would be positively associated with sites having more focus on relational coordination and client relationships, and with higher baseline client self-efficacy. The two primary theories included Relational Coordination theory, which was extended by the provider client relationship concept, and Social Cognitive theory.

Using mixed methods, the study combined: a quantitative analysis of secondary longitudinal data for 719 elder clients; primary data on organizational and provider variables; and qualitative data on provider perspectives on participation, through telephone interviews with 16 nurses, 18 social workers, and 15 site managers.

Quantitative findings showed that, as expected, higher baseline self-efficacy positively influenced program completion and functional outcomes at 12 months. Minority status negatively influenced program completion. Unexpectedly, relational coordination did not independently influence program completion or health outcomes, but its effects varied depending on client variables, showing an important variation of the theory. Urban sites and smaller size sites positively influenced 12 month functional outcomes. Qualitative patterns showed that sites with high completion rates had providers who perceived the importance of relationship building for program completion, versus sites with low completion rates where providers felt that client self-efficacy helped program completion. High completion sites had a higher percentage of health mentor programs (matching clients to trained elder peers) than low completion sites.

Study findings have implications for the design and implementation of community-based chronic disease programs that reduce elder disability, including: a need for increased practitioner awareness of client baseline self-efficacy and relationship building, and a need for policy makers and community-based site administrators to fund and train more minority providers, and fund more lay health mentor programs to enhance program completion and health outcomes.