1. Introduction
Objectives: Integrated care is considered an appropriate approach in geriatric health due to the provision of long-term, comprehensive, and quality care [1]. The ultimate goal of this care is to increase the quality of care, improve the quality of life of the elderly and reduce the costs imposed on the health system [2]. The World Health Organization defines integrated care as managed services provided in diagnostic, treatment, and palliative care and for individuals seeking health promotion and disease prevention [3]. The important challenge of this care system is that it has been designed for sick and disabled elderly and lacks community-based health promotion services [4]. In other words, healthy older people are neglected in this approach to care, which contradicts the justice-oriented nature of health services [5]. This study aimed to improve the quality of healthy geriatric care in a comprehensive health service center.
2. Methods
This community-based participatory study was conducted in 4 stages; Explaining and approving the problem, designing change programs, implementation and evaluation programs from 2016 to 2018 with the participation of 11 health care providers, 54 elderly people, and 54 family members in Shahid Motahari Comprehensive Health Center in Mashhad, Iran. The above center provides services related to the first and second levels of primary health care and provides services to different age groups based on the formation of electronic health records and service packages. Since the change program was conducted in the health center environment, all health workers were included in the study. A public call was used to involve the elderly. Participants were involved in all stages of the research, such as data collection, focus groups, development, and implementation of protocols. Qualitative data collection tools were interviews, focus group discussions, and field note-taking, while quantitative data was SERVQUAL questionnaire [6]. 
The implementation problems were identified through interviews with 8 personnel members and 19 elderly people. The main problems of not implementing a healthy aging program in the health center were: Lack of clear concept of healthy aging for personnel, lack of proper structure for the healthy aging program, the inability of personnel to implement the healthy aging program. The list of problems was provided to the involved group for approval. During a group discussion session, the participants approved the prioritized problems and received suggested solutions from them. Solutions were prioritized based on urgency, majority agreement, feasibility, upstream aging documents, and research team readiness. Through a focus group discussion, the change programs were designed in 4 cycles; improvement and modification of physical structure, personnel empowerment, preparation of healthy elderly care records, and home visit by the participants. The change programs were implemented in the comprehensive health center for 2 years. After implementation, the data were collected through quantitative and qualitative methods and compared with the previous ones. 
3. Results
In this study, 11 health center personnel, including 8 health care providers, 1 physician, 1 secretary, 1 service personnel, along with 54 healthy elderly and their families, participated. The Mean±‌SD age of health care providers was 32.4±2.7 years, with a mean work experience of 8.3 years. The Mean±‌SD age of the elderly was 64.3±3.9 years, and 51.8% were male. The mean total score of service quality according to the elderly and families in the pre-intervention stage was 63.02±9.46 and 61.83±9.05, respectively. These values reached 130.09±14.75 and 122.65±13.56 in the post-intervention stage, which this difference was statistically significant (P=0.001). In other words, the implementation of change programs could improve the quality of services provided in the comprehensive health center.
In the qualitative section, the results of interviews with participants, before and after the implementation of change programs showed that dissatisfaction of the elderly and families changed to their satisfaction, rule-based changed to organized care, lack of awareness of healthy elderly changed to recognizing a healthy elderly person and assessing their needs, lack of education for healthy elderly people changed to a regular educational program based on the needs of the elderly, lack of inability of personnel changed to the ability and skill of personnel in working with healthy elderly, lack of communication with families changed to family participation in caring for healthy elderly. 
The results of combining quantitative and qualitative data showed that the most important factors affecting the quality of a healthy geriatric program were; Modification of the physical and spatial structure, empowerment of personnel, and standardization of care. Thus, according to the changes, the satisfaction of the healthy elderly and their families increased in five areas of service quality, including; Accountability, assurance, empathy, physical environment, and confidence. These changes in the health care team cause: increased responsibility, functional independence, decision-making authority, accountability, improving inter-professional relationships, and providing organized care for the elderly and their families, the outcomes of which are satisfaction, confidence, and willingness of the healthy elderly and family to return to the health center. 
The new concept of content analysis was dynamic care, the main categories of which included; standard care for a healthy elderly person, creating interest and improving personnel performance in working with healthy elderly people, following up on care through scheduled home visits, and regularly teaching geriatric health promotion programs to personnel, the elderly, and families.
4. Discussion
This community-based participatory study with active, participatory, continuous, comprehensive, and supportive care improved the quality of healthy geriatric services. Improving the structure, equipment, and physical space, empowering personnel, and standardizing care were among the factors influencing the improvement of the quality of the integrated care program in line with “healthy aging.” Providing standard and organized geriatric care with responsibility, authority, accountability, inter-professional relationships, and home visits, scheduled and organized training promotes a sense of trust and confidence, awareness, consultation with health care personnel, and satisfaction and satisfaction in healthy elderly and their families. 
The results can be used in the process of empowering comprehensive health center personnel to care for the elderly. Since in the field of community health, work with individuals, families, and groups should be done in the context of the community and in fact, the community is the main area of health services; thus, the community-based approach in the present study can be a practical model for similar studies.
Ethical Considerations
Compliance with ethical guidelines
In this study, all ethical principles have been observed. Participants were allowed to leave the study whenever they wished. Participants were also aware of the research process. Their information was kept confidential.
Funding
This research is supported and approved by Tarbiat Modares University Vice Chancellor for Research Instructor done.
Authors' contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors express their gratitude to all the elderly and their families and the staff of Motahhari Health Center who participated in this study.