Peer Review Report For: 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 [version 1; peer review: 1 approved]

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Background Whilst life spans are increasing globally, health spans are not. There is a critical need for “Healthy Ageing”, particularly in low- and middle-income 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 K eeping O lder people healthy, de S igning and evaluating effective HE alth S ervices to maintain functional A b I lity (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 on-the-spot care, personalized health advice, patient-facing written guidance, specialist referrals, and home visits if individuals are home-bound. 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, person-centred assessment and management approach, ready for scale-up across sub-Saharan Africa.

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