Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

H. Virginia McCoy

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Richard C. Palmer

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Elena Bastida

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Leslie Frazier

Fourth Advisor's Committee Title

Committee Member


Adherence, older adults, health promotion, men's health, evidence-based programs, exercise

Date of Defense



The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants were male, and only 25% of EF participants met attendance criteria for adherence. This mixed-methods dissertation explored program instructor and coordinator perspectives on barriers and strategies related to male participation in EBPs, examined predictors of short-term and long-term adherence to EF, and applied a theoretical framework to explore participant and instructor perspectives on factors influencing adherence to EF. Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate findings. Themes among barriers to male participation included women outnumbering men in programs, incompatibility of programs with male gender roles, and preference for other activities. Themes among strategies included endorsement by male community leaders, advertisements featuring males, and content adaptation. Among 5,619 EF participants, logistic regression confirmed age, race/ethnicity, gender, and health status as significant predictors of adherence. The likelihood of short-term and long-term adherence increased with age and health. Black participants were less likely than whites to adhere short-term (OR=0.82, p=.05) but more likely to adhere long-term (OR=1.77, p=.000). Hispanics were more likely than whites to adhere short-term (OR=1.25, p=.008) and long-term (OR=1.30, p=.001). Men were more likely to meet the criteria for short-term (OR=1.47, p=.001) and long-term adherence (OR=1.19, p=.04). Interviews with 12 adherent EF participants and 10 instructors revealed cues to action, goals, beliefs, intentions, program factors, social factors, and benefits that supported adherence. Findings inform efforts to improve participation and adherence in EBPs and maximize their impact on health among older adults.





Rights Statement

Rights Statement

In Copyright. URI:
This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).