Scaling community-based nutrition education for ageing populations: a train-the-trainer model

Background

Ageing populations require sustainable health systems that emphasise upstream lifestyle interventions, yet workforce constraints limit delivery. Train-the-Trainer (TTT) models enable local health champions to deliver health education but real-world evidence in ageing services remains limited. This programme was piloted at Changi General Hospital, Singapore, training staff from Active Ageing Centres (AAC), which provide community support for seniors. This model may apply to other settings seeking to strengthen community health workforce capacity.

Objectives

To evaluate a 6-month TTT nutrition education programme delivered by dietitians to AAC staff, covering 6 modules across 2 days: (Day 1) healthy ageing and bone/digestive health, and (Day 2) obesity, diabetes, hyperlipidaemia and hypertension. This study examined whether trainees improved in knowledge and confidence to deliver AAC education talks. Pre- and post-training knowledge (Day 1: 19 items; Day 2: 40 items) and confidence (4-point ordinal scale) were assessed using structured questionnaires. Paired analyses were conducted using Wilcoxon signed-rank and exact McNemar tests. Competency assessment and delivery of talks, with feedback from seniors, have been planned for Q3 2026.

Results (Preliminary)

Eleven AAC staff participated; most were female (81.8%), with over half aged >40 years and 36.4% having >4 years of AAC experience. Knowledge: On Day 1, median scores improved significantly from 16 to 18 (p = 0.035), driven by the healthy ageing module. On Day 2, median scores improved significantly from 29 to 34.5 (p = 0.031), with strongest gains in obesity, diabetes and hyperlipidaemia modules. Confidence* improved significantly on both days (Day 1: p = 0.002; Day 2: p = 0.031), suggesting increased readiness to deliver the talks.

Conclusions

Train-the-trainer models enable community delivery of lifestyle interventions by local health champions, supporting scalable community health promotion for seniors.

Key messages

• Train-the-trainer models enable delivery of nutrition education by the community for the community, building capacity among local health champions for upstream health promotion.

• This approach supports ageing-in-place through scalable, community health promotion, helping address workforce constraints and strengthening sustainable health systems.