Optimising mobility for older adults with multiple chronic conditions: implementation of a co-design edevidence-based digital solution in the Unified Health System

• Grant number: 25/26331-0
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: December 01, 2025
• End date: November 30, 2029
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Monica Rodrigues Perracini
• Grantee: Mariane Chikazawa Jencius
• Host Institution: Pró-Reitoria de Pós-Graduação, Pesquisa e Extensão. Universidade Cidade de São Paulo (UNICID). São Paulo , SP, Brazil
• Associated research grant: 25/10483-6 - Optimising mobility for older adults with multiple chronic conditions in Brazil: implementation of a co-designed evidence-based digital solution, AP.PP

Abstract

This project is nested within an umbrella study in implementation science. Recent guidelines from the World Health Organization and the World Falls Guidelines recommend physical activity and individualized exercise to improve mobility and prevent falls in older adults, but prescribing this type of exercise is particularly challenging to implement in a sustained manner within the comprehensive primary health care model. The hypothesis of the umbrella project is that the offer of structured, evidence-based mobility exercises through a co-created and adapted digital solution integrated into the SUS care pathway will enable health professionals, including community health workers, to improve mobility and prevent falls in older adults with two or more chronic conditions, compared with usual care. The Dynamic Adaptation Process model will be used for collaborative adaptation and co-creation, and the study will be developed over four years in four phases-Exploration, Preparation, Implementation, and Sustainment. For this Direct Doctorate, subprojects will be developed in each of the four phases. Exploratory Phase: 1. Investigate the factors that hinder and facilitate screening (barriers and facilitators), assessment, prescription, referral, and implementation of physical exercise programs aimed at improving mobility and preventing falls in older adults with multimorbidity, including the use of digital technologies, from the perspective of SUS professionals and managers. Explore individual, interpersonal, organizational, and health system factors; 2. Identify the readiness of health professionals and managers for implementing an exercise program to improve mobility and prevent falls within SUS; 3. Consult and explore the perceptions of stakeholders (civil society organizations representing older adults, universities, health councils, churches, community leaders, etc.) regarding the implementation of an exercise program to improve mobility and prevent falls. Preparatory Phase: 4. Conduct the co-creation process of an exercise program to optimize mobility and prevent falls in older adults with multimorbidity for SUS and test its feasibility; 5. Prepare training materials for the team that will implement the program and support materials for older adults and family members. Implementation Phase: 6. Identify effectiveness and implementation elements through the conduct of a Type I hybrid randomized clinical trial. (AU)