Wits Wellness Facilitates Engagement and Self-Efficacy for Practicing Healthy Behaviors

Abstract

Most adults 65 and older have one or more chronic health conditions and 11% are at risk for or have changing cognitive abilities. Also, more adults are socially isolated, increasing their risks for adverse health effects. Classes that build self-efficacy for increasing healthy behaviors and social engagement are important for older adults’ health and well-being. Wits Wellness, a 12-week evidence-informed workshop series, was designed to encourage social interaction, intellectual engagement, and healthy behaviors. Participant-level feasibility and acceptability were examined with a survey (N = 164) and six focus groups (N = 22). Content analysis was conducted on the survey and thematic analysis was utilized for the transcribed focus groups. Participants were satisfied with Wits Wellness and described how the course is intellectually engaging, facilitates social interaction, and encourages practicing healthy behaviors/skills. Focus group findings revealed that combining enjoyable intellectual activities with health information was acceptable and feasible. Participants appreciated the opportunity for social engagement, and Wits Wellness increased their confidence to engage in healthy behaviors. Participants also described continuing to participate in healthy and socially engaging activities after the workshop ended. Course improvement suggestions include having a skilled facilitator to manage online etiquette, offering activities that appeal to diverse skill sets, and offering shorter sessions for younger older adults.

Background and objectives

There are 56 million people 65 years and older in the United States, representing 16.9% of the population (United Health Foundation, 2023). Though today’s older adults are living longer and more active lives, 85.6% of people over 65 years have one or more chronic health conditions, and approximately 11% of the U.S. older adult population is at risk for or has changing cognitive abilities (Centers for Disease Control and Prevention, 2015). Additionally, more older adults are living alone. A report from the National Academies of Sciences, Engineering, and Medicine (2020) found that one in four Americans report feeling socially isolated or lonely and a recent report from the Office of the Surgeon General (2023) declared loneliness a public health emergency. Socially isolated older adults are at an increased risk for numerous adverse health effects, including chronic conditions, disability, and changes in cognitive abilities (Talmage et al., 2020). Social isolation has been associated with a 50% increased risk of dementia, and public health research has suggested the negative health impacts of social isolation are as severe as the effects of obesity and smoking (National Academies of Sciences, Engineering, and Medicine, 2020; Novotny, 2019).

Positive lifestyle changes such as eating a healthy diet, regular physical activity, managing stress, and getting enough sleep can positively impact health and potentially delay or reduce changes in cognition (Baranowski et al., 2020; Dhana et al., 2020; Global Council on Brain Health, 2022; Lee & Kim, 2016; Musiek & Holtzman, 2016; Shankar et al., 2013; Tyndall et al., 2018). Increased social engagement can also positively affect older adults’ physical and cognitive health (Lock et al., 2017). Participation in socially and intellectually engaging activities has been found to have a protective effect on several aspects of cognitive function (e.g, memory, processing speed, global cognition, executive function (Mitchell et al., 2012; Wang et al., 2013; Yates et al., 2016). Research also indicates that stronger beliefs of one’s ability to control their health outcomes (i.e, self-efficacy) is related to greater positive health behaviors, and practicing healthy behaviors is important to maintain health and quality of life (Kostaka & Jachimowicz, 2010). Yet older adults often lack the self-efficacy and social support to improve their health behaviors (McAuley et al., 2013). A component of social cognitive theory, self-efficacy stems from the premise that people can self-regulate their behaviors (Bandura, 1977). Self-efficacy emphasizes human agency in the process of health behavior change, and research indicates self-efficacy is essential to initiate and sustain health behavior changes such as physical activity and chronic disease self-management (Lorig et al., 2009; Olson & McAuley, 2015).

Thus, workshops that build self-efficacy for increasing healthy behaviors and facilitate social engagement and support are important for enhancing older adults’ health and well-being. Although some evidence-based behavioral and brain health workshop series exist, many target one or two contributors to health (e.g, physical activity or nutrition) rather than focusing on overall self-efficacy to engage in multiple healthy behaviors that positively affect brain health and more holistically improve psychological and social health (Strout et al., 2016).

Wits wellness

The goals of Wits Wellness are to provide purposeful opportunities for older adults to engage intellectually and to increase their socialization through ongoing participation while learning about health behaviors that contribute to brain health. Wits Wellness was developed by University of Illinois Extension Family Life Educators, and is an evidence-informed, interactive, group-based wellness workshop series. This 12-week series meets (in person or online) weekly for 60-minute sessions. Weekly themed health topics were derived from the six pillars of brain health adopted by the Global Council on Brain Health (2020), which include restorative sleep, eating a healthy diet, regular physical activity, managing stress, connecting socially, and engaging intellectually. Each week, participants learn about memory concepts, tips and techniques for everyday forgetfulness, and strategies that promote brain health through leader-facilitated dialogue and group activities. Each of the 12 themed Wits Wellness units includes leader guides, printable activity handouts, answer sheets, and a summative evaluation survey. Wits Wellness is a group-based workshop series where participants work on four paper and pencil activities (first individually and then with the group) per session that address the factors that contribute to brain health. Social and intellectual engagement is facilitated through activities (which have embedded health messages) and interactive dialogue. Participants are taught about and encouraged to adopt or expand behavior practices that contribute to their overall health. Wits Wellness was evaluated by experts at two land grant universities and pilot-tested by Extension staff trained as workshop leaders. The curriculum was modified based on anonymous participant program evaluation feedback. Final edits were made, and the curriculum was published in 2019 by the University as a curriculum guide.

Research indicates that group courses with an educational focus can combat social isolation in older people (Nicholson, 2012). Based on the research that intellectual challenge and social connectedness are two of several factors that contribute to brain health throughout life (Lee & Kim, 2016), Wits Wellness had the following goals: 1) to provide purposeful opportunities for older adults to engage intellectually and 2) to increase their socialization through ongoing group participation.

Purpose

Though Wits Wellness was informally evaluated by Extension professionals while the curriculum was being developed, the aim of this study was to conduct a formal evaluation to determine the participant-level acceptability and feasibility of the Wits Wellness workshop series. Because Wits Wellness was developed and delivered by Cooperative Extension staff, we knew that it was both feasible and acceptable for delivery by them. However, we had never evaluated Wits Wellness at the participant level; therefore, the goal of this study was to assess the acceptability and feasibility of the workshop series at the participant level.

Research design and methods

Participants

For the overall study (which was a two-armed randomized controlled trial to assess outcomes and a feasibility and acceptability study), a purposive sampling strategy was used to recruit people 50 and older in urban and rural locations in a Midwestern State (Gothe et al., 2022). Extension staff recruited participants, and people from low-income, rural, and minoritized communities were prioritized to achieve a diverse sample. Recruitment strategies included sending information about Wits Wellness and an invitation to participate in the study through Extension list serves, community contacts in areas where Wits Wellness was being offered, targeted paid social media ads on Facebook in minority and underserved areas, advertisements in community newsletters, and flyers/in various community locations such as libraries and senior centers. To be eligible for inclusion in the Wits Wellness study, participants had to be ages 50 and older, able to read and understand English, have a Telephone Interview Cognitive Status (TICS) score of 28 or higher (Knopman et al., 2010), and be able to attend at least 10 of the 12 class sessions. Exclusion criteria included 1) being younger than 50, scoring lower than 28 on TICS, being unable to read and understand English, or being unable to attend at least 10 of the 12 class sessions. Eight workshop series were offered in person, and three were delivered online due to COVID-19 restrictions. The workshops were offered across Illinois in both urban and rural locations.

Program evaluation and focus group recruitment

All participants who attended Wits Wellness were invited to complete an anonymous evaluation at the end of the 12-week workshop series. If participants were not present on the last day of the workshop or the workshop was offered online, participants were sent a link to fill out the survey anonymously online.

Participants were also invited to attend an online focus group corresponding to their workshop time. For example, if a workshop took place on a Tuesday morning, we offered a focus group on a Tuesday morning, or if it took place on a Monday evening, we offered a focus group on a Monday evening.

Data collection

Data to assess feasibility and acceptability were collected in two ways: 1) an anonymous evaluation survey was collected at the end of the 12-week workshop series to gather immediate post-workshop series feedback, and 2) focus groups were held three months after the series ended to learn their thoughts about the program including takeaways from the workshop series and the continued effects of Wits Wellness on their health and well-being. This study was approved by the university’s Office for the Protection of Research Subjects (OPRS).

Survey

From October 2021 to November 2022, we collected evaluation surveys (N = 164) at the end of each of the 12-week workshop series. For the in-person series, evaluations were collected on site after the final session and entered into a REDCap database. Participants who were not present for the last session or attended the workshop series online were sent a link to an electronic survey. The surveys were anonymous to ensure participants were comfortable providing honest feedback. The evaluation included 12 closed and open-ended questions that assessed the feasibility and acceptability of the workshop series. Participants were asked to rate the overall quality of the workshop series and the course content and materials on a scale from one to 10, where 1= poor and 10 = excellent. Using the same 10-point scale, participants rated workshop leaders’ content knowledge, approachability, leadership skills, and interactions with participants. Satisfaction with the length of each session was assessed with one item: “Do you think the sessions (one hour) were: a) too short, b) just right, and c) too long?” Satisfaction with the duration of the workshop series was measured with one item: “Was the Wits Wellness program duration of 12-weeks: a) too short, b) just right, and c) too long?” We also asked peoples’ preference for weekly versus monthly sessions. Open-ended questions included “What aspects of Wits Wellness did you find most beneficial?;” “What aspects of Wits Wellness did you find least beneficial?;” “What aspects of Wits Wellness kept you coming to class regularly?;” and “Please share three ways in which Wits Wellness has had an impact on your life.”

Focus groups

Focus groups enabled researchers to obtain more in-depth evaluative insights about the acceptability and feasibility of Wits Wellness. Twenty-two (of the 164) Wits Wellness participants volunteered for one of the six focus groups, which took place from March to August 2022 online via Zoom (see Table 1). Focus group size ranged from three to five participants and each one lasted approximately one hour. The focus group participants were mostly female (91%) and White (91%), and participants’ mean age was 69, with a range of 55 to 88 years (see Table 1). Fifty percent were married, 23% were divorced, and the rest were never married (18%) or widowed (9%). About one-third (32%) of respondents had an income of $75,000–100,000 and $25,000–50,000. Forty-five percent reported having a graduate/professional degree, followed by a bachelor’s degree (41%) and an associate’s degree (14%). The majority of participants (73%) attended an urban workshop, and 59% attended an in-person workshop.

Table 1.

Focus Group Participant (N = 22) Demographics.

Characteristics	Category	Frequency (N)	Percent (%)	Mean (SD)
Age				69 (7.7)
Class Location	Online	9	41
	In-person	13	59
Gender	Male	2	9
	Female	20	91
Ethnicity	Hispanic	0	0
Race	White	20	91
	African American	2	9
Location	Urban	16	73
	Rural	6	27
Education	Associates	3	14
	Bachelors	9	41
	Graduate/Professional	10	45
Marital Status	Married	11	50
	Divorced	5	23
	Never Married	4	18
	Widowed	2	9
Income	Prefer not to answer	4	18
	25–50k	7	32
	50–75k	1	4
	75–100k	7	32
	100k+	3	14

All participants consented to the focus groups when they were screened for the project. At the beginning of each focus group, researchers stressed the importance of maintaining confidentiality of the thoughts shared by participants during the conversation. Participants had the option to have their video cameras turned off, and facilitators did not use their names during the focus groups. Also, if a participant said something that could be identifying, it was removed from the transcript. The focus groups were led by one of the researchers and guided by ten questions about the participants’ experiences during and after Wits Wellness. Examples of focus group questions include “What influenced you to continue participating in the Wits Wellness classes over the 12-week session,” “What did you like most about Wits Wellness,” “In what ways did Wits Wellness impact your wellness,” “Since you participated in the workshop series, what workshop activities have you been doing on your own that impacts your wellness,” “What did you like least about Wits Wellness,” “What suggestions do you have to improve Wits Wellness,” “What other topics would you find useful,” and “What else would you like to share?” During the focus groups, the researcher repeated back, summarized, and clarified participant comments to ensure their meaning was captured correctly. Another researcher attended the focus groups to observe and take notes. Researchers debriefed after each focus group. Zoom’s transcription feature was used to transcribe the meetings. To ensure the transcription quality, a graduate assistant listened to the audio tapes and reviewed the Zoom transcription to make sure the transcription and audio files matched. Any identifying information was removed from the transcripts prior to analysis.

Analysis

Survey

Frequencies, mean scores, and standard deviations were calculated for the closed-ended questions using SPSS version 29. We conducted a summative content analysis on 164 responses for the evaluations (Hsieh & Shannon, 2005). Two researchers first reviewed the responses to the open-ended questions identifying words and phrases, then created codes and determined categories. For example, codes such as “cognition,” “thinking,” “memory,” and “brain function” were grouped under the category intellectual, and codes such as “social,” “socialization,” “new connections/friendships,” “reminiscing,” and “spending time with others” were grouped under category socialization. We grouped several codes about “learning” or building “skills” or “healthy behaviors/habits” (e.g., tips for remembering, attending a yoga class, eating better) under the category activation/motivation. Under the question about course improvement, we had a variety of codes about other participant behaviors that we categorized as participant etiquette. Though comments for this question were fewer in number, we included any comments about the individual activities in a category called program content. The remaining comments were about the workshop instruction, so we included the code facilitator. In total, we had six codes (see Figure 1).

Figure 1.

Process of content analysis.

Focus groups

We used reflective thematic analysis with an inductive approach to analyze the focus group data (Braun & Clarke, 2019). First, two researchers open-coded a random selection of two transcripts to develop an initial codebook. The codebook included (a) the code name, (b) description of the code, (c) when and when not to use the code, and (d) examples of interview text (see Table 2). Three researchers then used the initial codebook to code two additional focus groups to determine if coding was applied consistently. After the final codebook with 11 codes, was established, two researchers independently coded all the transcripts in NVivo QSR 12 (Jackson & Bazeley, 2019). Routine meetings between two researchers followed to discuss the coding and emerging themes and to reflect on biases and interpretations. Regular discussion and consultation with project team members increased the credibility and confirmability of the results.

Table 2.

Codebook for Focus Groups.

Code	Description	Example	When not to use
Program content	Use this code when any discussion has to do with the Wits Wellness content - positive or negative.	I think it was very personal; it was not intimidating. Maybe a little bit of a repeat on the different types of memory.	Don’t use for program length or discussion about the facilitator
Program Session	Use this code when discussing the individual sessions: length of time of 60 minutes and the number of people in Wits Wellness.	I thought the hour was good We had six people in our group, and I think that was an ideal number because it gave everybody sufficient time	Don’t use if discussing the intellectual stimulation of Wits Wellness. Anything about it being intellectually stimulating goes in the code "intellectual”
Program Series	Use this code when there is a discussion about the entire series - the number of sessions when it should be offered (i.e., day or evening).	The 12 weeks was just right	Don’t use it for talking about length of the single actual class (i.e. more or less than an hour).
Facilitator	Use this code when there is any discussion about the impact of the leader/facilitator (positive/negative).	Molly was terrific we really enjoyed having molly's the way she presented it, she was prepared, she was fun, it was just really enjoyable to have her guiding	N/A
Socialization	Use this for any conversation regarding discussion, socialization, coming together, reminiscing, feeling connection	It was interesting to just be around other people to hear their views and to feel comfortable and talk and laugh	N/A
Intellectual	Use this code for comments about Wits Wellness being intellectually stimulating	it invigorates you -makes you think and it kind of clears out some of the fog	Not about content of the actual program and not about motivation for attending.
Activation/takeaways	Use this code when there is any discussion regarding what they took away from Wits Wellness, and/or reasons to continue a behavior post workshop or engage in a behavior learned from Wits Wellness	I joined a scrabble group, where I play every day	Not about the length of Wits Wellness or content.
Motivation	Use this code when there is discussion about the reason for wanting to take Wits Wellness or continuing to come to Wits Wellness.	I have this hour once a week that I have to be there and we look forward to it.	N/A
Evaluation	Any discussion that has to do with the evaluation process.	I think the evaluations were very good and I think they were also a form of exercise . . .	N/A
Marketing	Any thoughts about marketing Wits Wellness.	I think I found out about it on Facebook	N/A

Results

Survey results

Overall, participants (N = 164) were highly satisfied with Wits Wellness. The mean satisfaction level with the overall workshop series was 8.8 out of 10. Respondents rated all of the workshop attributes very high, with “leader’s approachability” and leader skills each rated 9.5/10 and “knowledge of content” was rated as 9.4/10. “Quality of program materials” was rated 8.9/10, and “quality of Wits Wellness content” was rated 8.7/10. These high ratings indicate respondents evaluated Wits Wellness as acceptable.

Of the 164 participants who responded to the surveys, 151 chose to respond to the three open-ended questions. The content analysis of the open-ended survey questions resulted in 396 write-in comments that were sorted into codes, then grouped into categories, and resulted in the following themes: 1) facilitated intellectual challenges and engagement, 2) social interaction, 3) development of healthy behaviors/skills, and 4) areas for improvement. The themes for the open-ended evaluation questions are described in detail using written-in comments exactly as provided by the participants. See Figure 1.

Facilitated intellectual challenges and engagement

Seventy-five percent (N = 114) of participants mentioned that Wits Wellness facilitated intellectual challenge and engagement. Some participants (22%; N = 33) provided multiple comments about intellectual challenge and engagement (N = 160 total comments). Wits Wellness included several memory-related paper activities each week, so it is no surprise that people discussed this topic. Numerous participants wrote that they learned tips for remembering things, especially short-term memory and that they learned ways to stay intellectually engaged. For example, many participants stated that the workshop series “Challenged my thinking,” “Stretched my brain functions,” “Increase in mental alertness,” “It prompted me to think about my memory and cognitive health,” and “Importance of focus for memory retention.”

Further, many participants reported how the workshop series continued to influence their intellectual engagement outside of the workshop. For example, participants said, “It has given me motivation to do more word brain games,” “I had fun doing extensions of the activities during the week and with my husband,” “I will work on helping my memory with seek and finds,” and “I have a new goal to be active daily in keeping my mind sharp.”

Providing opportunities for social interaction

Overall, 36% (N = 54) mentioned social interaction as an important aspect of their experience with Wits Wellness. In total, there were 80 comments (some people provided multiple comments) about Wits Wellness increasing social interaction and improving opportunities for social engagement. One participant wrote, “Joy in sharing and getting to know others in the group.” Others shared, “Listening to other participants was fun, and I learned new things,” and “I looked forward to meeting with the group every week and meeting new people.” Though many of the comments centered on Wits Wellness being fun and interactive, some participants mentioned how the workshop series brought them out of their comfort zone. For example, one participant wrote, “Being an introvert, [but] feeling comfortable engaging with complete strangers,” and another “Showed the importance of social contacts.”

Developing healthy behaviors/skills

After accounting for intellectual and social-related comments, we found many comments related to participants transferring what they learned in class to initiating and/or practicing healthy lifestyle behaviors. Thirty participants (20%) commented on learning new skills and tips that would help them. For example, one participant said, “It has made me more aware of things I can do to improve health,” and another shared that the workshop series “Taught me ways to be confident.” Further, many commented on learning skills or tips for remembering or completing tasks, such as “Showed me examples of fun activities to improve memory,” “I’ve put tips for remembering things into place,” and “Great tips on improving my memory, which I’ve used.”

Areas for improvement

Our question about what participants least liked about Wits Wellness was intended to help us identify what could be improved about the workshop series. This was also the category with the fewest responses (N = 124), where participants either left the response blank (N = 41) or provided a “N/A,” “Nothing,” or wrote comments such as “I liked everything” or “all good” (N = 39). The remaining comments were examined and generally fit into two areas for improvement: 1) participant etiquette (N = 15) and 2) program content (N = 29). Most of the negative comments came from the online classes. For example, one participant shared that “Participants should be muted while working on the worksheets,” and another wrote, “Watching people eat/drink.” Also, “Keep your cat somewhere else.” While participant etiquette is not something that facilitators can always control or improve, it emphasizes the importance of setting ground rules and having a facilitator who can help regulate group dynamics. In terms of workshop content, the comments varied considerably, so there was not one particular issue that was consistently mentioned. Mainly, feedback was based on a particular personal interest. For example, some of the items written in included, “I enjoyed less the sports themed activities because I do not follow sports.” and “Some of the games were a challenge. . . which is good but sometimes it is discouraging.” One participant shared, “Most of the wellness tips I already practice, so that was just a review of what I am already doing.” Though there were few negative comments, it is important to investigate how this feedback can be used to improve Wits Wellness. They also confirm that having a variety of activities that do not focus on the same topic will appeal to a wider audience.

Overall, offering anonymous evaluations provided participants the opportunity to give feedback that they may not have otherwise felt comfortable sharing if they were identifiable. However, to provide more in-depth insights and learn more about the longer-term impact of Wits Wellness, we turn to our focus group data gathered from participants three months after the workshop series ended.

Focus group results

The thematic analysis resulted in the following themes: 1) workshop format, 2) workshop content, 3) social engagement, and 4) self-efficacy and practicing healthy behaviors.

Workshop format

Though our focus group questions did not ask specifically about the Wits Wellness format, the topics of 1) length of time each weekly session was offered, 2) whether it should be offered more or less often than weekly, and 3) how many weeks it was offered in total was discussed in all of our focus groups. While participants debated the merits of offering the workshop series in fewer or more than twelve, once-a-week sessions, overall, they agreed that the current format worked well, and they liked the hour-long sessions. In the excerpts below, two participants discussed why Wits Wellness worked best in a weekly format instead of offering it more than once a week or only monthly.

I think weekly was great because it gave you time in between to mull over whatever you picked up, and you’re ready to go again the next week. Group 3, Participant 1

For this type of memory thing and working on it, I don’t think once a month is enough, I think it needs to be at least once a week or once every two weeks to keep it fresh. Group 3, Participant 2

The length of the workshop series format was also discussed in terms of offering Wits Wellness online. In the excerpt below, a participant, who was younger and still employed, discussed how it would not have been feasible for her to attend Wits Wellness without it being offered online.

I appreciated having the opportunity to do it online because otherwise, I probably would not have been able to. You know, because some of us are still working . . . Group 1, Participant 2

Though offering Wits Wellness in an online format helped to reach more participants, it was not without challenges. Below, one participant explains that it worked better with fewer participants, and another discusses the challenge of not knowing who will talk first.

So that we’re limited to “x” amount of people that would all fit like right now, I think I can fit nine people comfortably on my screen, and I understand all devices are different. Group 3, Participant 1

The only hard part with Zoom is, you know, because we’re all starting to talk at the same time. But other than that, you know I really like that. Group 6, Participant 1

Workshop content

Each of the Wits Wellness sessions is based on a particular theme such as the importance of sleep or staying physically active. Following the introduction of the topic, the facilitator works through four paper-based activities. We were interested in understanding how participants felt about the workshop content and through our focus groups, we learned that participants felt the content was fun and intellectually engaging. Though not every participant loved every activity, there were enough different types of activities to be interesting to a broad audience. For example, one participant said,

I’m not real big into music so when we talked about music and different songs and comedians. . . I wasn’t real tip top on that, but when it came to my husband - he was a mechanic so I know a lot about cars- I could just zoom right through that. So, I understand what you’re saying . . . we have more knowledge in some areas than the other. Group 1, Participant 1

Participants also discussed how it was also important to see how others responded.

Really opened my eyes to the way other people think about the same question that I was just presented with. I really did like that. Group 3 Participant 1

Throughout the discussions about workshop content, an important factor seemed to be that the sessions were facilitated so that everyone could participate if they wanted but did not feel pressured to do so.

You know I want to say, I never felt judged. I mean I thought that the way we did it perfectly anonymous on that. I thought you did a really good job of that and keeping us all individuals and allowing us to do our thing. Group 3 Participant 2

Participants also liked the way Wits Wellness leaders facilitated interaction among participants. In the excerpts below, participants explain why they enjoyed the facilitators’ style. Several participants discussed that Wits Wellness was facilitated in a comfortable and interactive way for participants.

She was very good at keeping us all engaged and involved, and you know just dealing with us. It was just really, really nice. Group 4, Participant 3

Kept things moving. You know, nothing was static. If somebody went off base instead of talking about something else, she always brought it in. There was nothing negative ‘cause our facilitator was so good at presenting, sharing. Group 5, Participant 1

Alternatively, if the facilitator did not keep on top of the session, some participants discussed how another member of the group might take over.

I think the facilitator needs to keep in mind that there are some people that do a lot of talking and we tend to dominate the whole conversation and other people like me don’t talk as much. Group 3, Participant 3

This was particularly important during online sessions where it was difficult to make eye contact, and there were times when more than one participant started to talk simultaneously.

Social engagement

One of the appealing aspects of Wits Wellness that participants discussed was that Wits Wellness facilitated social engagement among participants during the online Zoom sessions. Included in this discussion was the topic of reminiscing. Many of the workshop activities include recall of past events, music, movies etc. and these spurred participants to reminisce about the past.

Oh, it was fun, you know, with regards to meeting people and enjoying each other’s company, and I just wanted that person to know I learned from them too. Group 1, Participant 2

I would agree with XX. I think it took a while also for the group [online] we were in just to kind of gel a little bit . . . But it was kind of fun getting to know a little bit more about each other. Group 6, Participant 2

The camaraderie in the room was fun. You met new people. It was fun to reminisce about things that we’ve remembered for a long time. Group 2, Participant 3

Participants also discussed how Wits Wellness continued to impact social interaction beyond the end of the 12-week series.

It got to the point where it was like a whole group of friends just sitting and chatting and going through the exercises in it, it was really good . . . our group here at XX was so excited about the whole concept that even after Wits Wellness ended, we decided to continue meeting monthly. Group 4, Participant 1

I am going to that balance class at XX . . . It is in person . . . but I wouldn’t have looked for other classes if I hadn’t enjoyed this one as much. Focus Group 6, Participant 2

Self-efficacy and practicing healthy behaviors

Wits Wellness increased self-efficacy of participants to make choices and practice health behaviors that would positively affect their health and continued social engagement. In some of the quotes below, participants explained how they or others in their group increased their self-efficacy to start and continue to practice what they learned in the workshop series.

One lady in our class was saying that she was doing cardio and now she was going to start strength training and other people were walking or biking so it’s just nice to see what other people were doing. Group 2, Participant 3

Not only do you now remember things, but you know different ways to do things that improve our life every day. Group 4, Participant 2

But what the class made me bring home is to get moving you know, instead of sitting around on the couch doing nothing, to be conscious of that to make sure I’m doing something whether it be physical or mental. Group 5, Participant 1

Well, I’ve started, and I’ve kept it up amazingly. I’ve kept it up writing one letter a week, not just email, not text, but literally sit down with a blue pen on white paper and writing a letter to somebody. The other thing I’ve just very recently started, because of that is Wordle. Group 6, Participant 4

In the quote below, another participant discussed how what she learned in Wits Wellness taught her to break down the steps into manageable pieces, and she confidently set up her new computer.

I recently bought a new computer and thought to myself oh my gosh, I’ve got to put all the stuff from the old computer into the new computer . . . I think it [Wits Wellness] kind of gave me like . . . I tell myself; I know how to do it, I just have to stop and think it through, and the answers will come, and you’re successfully looking at me on my new computer. Tada! Group 3, Participant 1

Discussion and implications

Feasibility and acceptability

Feasibility and acceptability of a workshop series at both the individual and organizational levels are indicators of implementation success and the reproducibility of the workshop (Brownson et al., 2017). In this study, we examined the feasibility and acceptability of Wits Wellness at the participant level to assess the participant’s experience and perceived value of this social and activity-based course. Further studies, however, can look at the organizational level when offering Wits Wellness through other organizations in other states or expansion beyond Extension offices. Additionally, future projects should examine the feasibility and acceptability of Wits Wellness when delivered by lay-leaders within community-based organizations, including evaluating the facilitator’s training and guidebook. Though the workshop series was initially designed for participants aged 65 and older, it was expanded to include people 50 and older for this study. We found that our study participants preferred meeting one hour per week for twelve weeks, although a few younger participants stated they preferred a shorter timeframe (fewer than 12 weeks). Therefore, future adaptation of Wits Wellness for younger older adults could be a consideration.

The COVID-19 pandemic occurred during a portion of the study and therefore, we developed an online version for some of our workshops. This allowed us to determine that Wits Wellness could be offered online successfully with some modifications. For all workshops, we learned about the importance of a good facilitator, which is consistent with other research on delivering health workshop series (Bell et al., 2023; Crozier et al., 2020). However, for our online workshops, having skilled facilitators with experience managing online education positively impacted the acceptability of the online delivery.

Intellectual engagement

Participants also found the content to be fun and intellectually engaging. Research shows that education and intellectual engagement across the lifespan can have protective factors for the brain by building cognitive reserve (McDonough et al., 2015; Richards & Deary, 2005; Stern, 2021). For those at younger ages, school-based education can build cognitive reserve (de Rooij, 2022). As people age, intellectual engagement can be facilitated by continuing education or taking on new challenges through occupations, learning new hobbies, volunteering, or doing novel leisure activities that can reduce or prevent changing cognitive abilities by building cognitive reserve (Baumgart et al., 2015; Blazer et al., 2015; McDonough et al., 2015; Wang et al., 2017). Early research supports the importance of brain exercises (Carstensen, 2007; Wilson et al., 2003), and a more recent study found that intellectual engagement combined with social interaction (e.g., discussions with others, playing brain games with a partner instead of alone) had an even more significant impact on brain health (Baumgart et al., 2015). Thus, research supports the combination of Wits Wellness activities with the opportunity for social engagement in terms of partnering, group interaction, activity discussion, and reminiscing in facilitating more impactful cognitive, social, and overall health benefits (Baumgart et al., 2015; Blazer et al., 2015; McDonough et al., 2015).

Socialization

Wits Wellness was designed to enhance social connectedness by facilitating interaction through fun and engaging activities and encouraging participants to continue pursuing activities during and after the workshop series ended. Our study confirmed that participants experienced social engagement during the sessions; they recognized the importance of social engagement and intended to stay more socially engaged beyond the end of the workshop series. Walker et al. (2023) found that social engagement was a key motivation and outcome of older adults’ participation in organized classes and workshops, thus serving as a way to combat social isolation. Social isolation is often defined as living alone with minimal to no social support and little or infrequent social contact with others (Holt-Lunstad et al., 2015; Valtorta & Hanratty, 2012).

Loneliness is an emotional state caused by social needs that often go unmet, and loneliness is often related to depression (Holt-Lunstad et al., 2015; Valtorta & Hanratty, 2012). Research has shown that social isolation and loneliness have many health effects, including cognitive decline, physical illnesses, and sleep issues (Christiansen et al., 2021; Malcolm et al., 2019; Vieira da Silva et al., 2024). Many multi-modal studies show that engaging in physical or intellectual activities that include socialization, like playing games (cards or chess), dancing, and volunteering, have shown improved cognitive abilities (Chen & Lu, 2020; Marco et al., 2014; Wang et al., 2013). These leisure activities offer a variety of benefits by engaging multiple cognitive domains, including recall, memory, processing speed, and higher levels of cognition (Yates et al., 2016). Socialization is key to many activities and may be associated with higher levels of cognitive functioning; therefore, providing opportunities for older adults to engage socially through community programming has many health benefits (Blazer et al., 2015).

Self-efficacy

General self-efficacy is a psychological construct that refers to an individual’s belief in their ability to perform a specific behavior or meet specific goals (Bandura, 1977; Bandura et al., 1999; Carey & Forsyth, 2009). Self-efficacy is particularly important for older adults who may encounter an increasing number of health and social barriers that can challenge their sense of independence and control (Easom, 2003). Research indicates that general self-efficacy is positively associated with better health outcomes among older adults, such as better physical and mental health, lower stress, and greater life satisfaction (Grembowski et al., 1993; Haugland et al., 2016). One possible explanation for this association is that individuals with high self-efficacy are better equipped to handle the challenges and stressors associated with aging, such as chronic health conditions and social isolation. Older adults with high self-efficacy are also more likely to engage in healthy behaviors, which can lead to better health outcomes (Grembowski et al., 1993; Robb et al., 2013). Thus, workshops such as Wits Wellness that increase general self-efficacy can have positive effects on an individual’s overall health and well-being.

Limitations

Although our efforts to recruit participants for the focus groups from a variety of backgrounds were successful in terms of matching our population of enrollees for the study, our sample lacks racial and ethnic diversity, was skewed toward women, a majority of participants were from urban areas, and the sample is not representative of all older adults across the state. It is important to have the perspectives of diverse participants to know that Wits Wellness is acceptable and feasible for a variety of individuals. Furthermore, participants in Illinois may not reflect participants from other states. The focus groups were facilitated via Zoom, which required participants to have internet and/or cell phone coverage to access Zoom. Thus, we may have missed some important insights due to the online focus group format. Additionally, Wits Wellness was facilitated by professionals with gerontology backgrounds and training in delivering courses to older adults, both in-person and online. It is unclear whether Wits Wellness will have the same impact on participants when delivered by community-based organizations with trained lay leaders as the facilitators. Future research efforts will include offering Wits Wellness through a variety of community-based organizations that serve older adults. We will also expand our research to train lay-leaders to be facilitators of Wits Wellness and evaluate workshop implementation at the organizational level.