The EMPOwer (Equitable Mental wellness Programming for Older Adults with multiple chronic conditions ) - An RCT to assess the impact of scalable, effective online solutions

Drastic social changes during COVID-19 have had a significant impact on the lives of older adults (aged 55+ years) with multiple chronic conditions. This group is at high risk of worsening mental health and social isolation. Online mental wellness programming is ideal for broad dissemination, but needs to be carefully designed to ensure it serves the unique technology, engagement and content needs of this group. Working together with patients, we have designed an evidence-based, 12-week online mental wellness program. Usable by older adults from tech novices to experts, the program includes physical movement at 4 levels, and a psychology informed chronic disease behavioural skills series. In our effectiveness work, the program has shown 90% completion rates and significant improvements in anxiety, depression and resilience. To date, it has been provided alongside costly 15-minute weekly 1-to-1 phone check-ins. With a vision of scaling the program broadly, alongside a team of patient Partner organizations, we propose to assess the effectiveness of two new features introduced to replace the weekly check-ins: gamification and live online group classes. 500 participants aged 55+ years with 2 or more chronic conditions will be randomized to a study group: (1) mental wellness program (control), (2) mental wellness program + gamification, or (3) mental wellness program + gamification + group classes. The primary study outcome measure is change in anxiety and depression scores after 12 weeks. Secondary study outcomes include changes in loneliness, social isolation, resilience, quality of life, sleep quality, adherence, and acceptability of the program. This adequately powered trial will provide data on a co-developed program that can be distributed by Partner organizations to their patients, guide relevant policy and service revisions to reflect mental health supports of older adults using digital technology, and enhance our understanding of the pandemic's impact.