Keeping Older people healthy, deSigning and evaluating effective HEalth Services to maintain functional AbIlity (KOSHESAI); study protocol for a multimethod, prospective, hybrid implementation-effectiveness study

Background
Whilst life spans are increasing globally, health spans are not. There is
a critical need for “Healthy Ageing”, particularly in low- and middleincome countries (LMICs). This study aims to adapt the WHO
Integrated Care of Older People (ICOPE) framework and implement and evaluate a contextually-appropriate, “health check-up” for older
people, incorporating community interventions to promote healthy
ageing within the existing public healthcare system in Zimbabwe.

Methods
Keeping Older people healthy, deSigning and evaluating effective HE
alth Services to maintain functional AbIlity (KOSHESAI) is a prospective
hybrid type 2 implementation-effectiveness study. Its objective is to
create and implement a community-based, non-specialist assessment
and management of age-related impairments in intrinsic capacity and
functional ability in older Zimbabweans. The intervention will be
delivered in local primary healthcare clinics in urban Harare and rural
Murehwa district, targeting 732 adults age ≥65 years in each setting.
Participants will be screened and assessed for impairments across
seven intrinsic capacity domains. Interventions include immediate onthe-spot care, personalized health advice, patient-facing written
guidance, specialist referrals, and home visits if individuals are homebound. Two types of Community-based Healthy Ageing Peer-to-peer
Support (CHAPS) groups will be developed for those with identified
deficits, focusing on ‘healthy ageing’ and ‘healthy minds’ (if cognitively
impaired). Baseline and 4-month follow-up data, will assess the
proportion who access appropriate care. Secondary outcomes include
diagnostic accuracy, impairment prevalence, clinical improvements,
process evaluation (coverage, fidelity, acceptability), and cost metrics.
Quantitative data will use descriptive statistics and before-after
comparisons; qualitative data will use thematic analysis and elements
of the Framework Method, integrating identified theoretical
frameworks. A convergent parallel design will triangulate findings.

Conclusion
The adaptation, implementation and evaluation of the WHO ICOPE
framework will inform the development of a ‘Healthy Ageing
Intervention Toolkit’, providing a structured, comprehensive, personcentred assessment and management approach, ready for scale-up
across sub-Saharan Africa.