# Adapting a Green Activity Program With Older Black People Living With Memory Challenges

## TL;DR

This study adapts a nature-based activity program for Black older adults with memory challenges, addressing cultural and practical barriers to participation.

## Contribution

The paper introduces a culturally adapted green activity program co-designed with Black older adults and their study partners.

## Key findings

- Participants identified noise, weather, and physical discomfort as key challenges for engaging in outdoor activities.
- Solutions included using headphones, wearing weather-appropriate clothing, and offering free or low-cost activities.
- Cultural adaptations included preferred terminology, family involvement, and nature activities like water Zumba and camping.

## Abstract

Few physical activity programs are designed with Black older adults living with mild cognitive impairment and dementia (memory challenges) to address their needs. Applying the Cultural Adaptation Process model and the Framework for Modification and Adaptations, we sought to adapt a nature or ‘Green’ Activity Program for Black people living with memory challenges (PLMC) and study partners. Participants were recruited from Eskenazi Health in Indianapolis, Indiana. A modified 5-step co-design process occurred with six 90-minute sessions with four teams separately (n = 21 total, n = 5-6 each). Participants were Black PLMC (n = 5), Black study partners (n = 6), outdoor professionals (n = 5), and healthcare providers (n = 5). Recorded design sessions were analyzed. Challenges for PLMC included: 1) noise (construction, traffic), 2) weather 3) aches and pain; Study partners: 1) health challenges/behaviors, 2) transportation/accessibility; 3) finances. Solutions identified by PLMC were 1) wearing headphones, 2) weather appropriate clothing, 3) activity modifications; Study partners: 1) accessibility/motivation, 2) transportation services and convenience, and 3) free/lower cost activities. Surface cultural adaptions (language) included preferred terms of ‘memory challenges’ for dementia and ‘Black.’ Deep cultural adaptations (values/beliefs) included adding family, awareness/exposure to nature activities. ‘Content’ adaptations included preferred nature activities of water Zumba, fishing, and camping. ‘Contextual’ modifications for program delivery were a ‘green activity pill box’ to schedule weekly activities as a visual reminder, a buddy system, and monetary incentives for motivation. Referral pathways included direct referrals in electronic health records, or in-person from healthcare providers. Findings can guide piloting the program and cultural adaptation of other interventions.