Experiences and views of older people on their participation in a nurse-led health promotion intervention: "Community Health Consultation Offices for Seniors"

Promoting the empowerment and emancipation of community-dwelling older adults with chronic multimorbidity through a home visiting programme: a hermeneutical study

INTRODUCTION

Nurse-led preventive home visiting programmes can improve health-related outcomes in community-dwelling older adults, but they have not proven to be cost-effective. Home visiting programmes led by nursing students could be a viable alternative. However, we do not know how community-dwelling older adults with chronic multimorbidity experience home visiting programmes in which nursing students carry out health promotion activities. The aim of the study is to understand how community-dwelling older adults with chronic multimorbidity experience a home visiting programme led by nursing students.

METHODS

A qualitative study based on Gadamer's hermeneutics. Thirty-one community-dwelling older adults with chronic multimorbidity were interviewed in-depth. Fleming's method for conducting hermeneutic, Gadamerian-based studies was followed and ATLAS.ti software was used for data analysis.

RESULTS

Two main themes were generated: (1) 'The empowering experience of a personalised health-promoting intervention', and (2) 'The emancipatory effect of going beyond standardised self-care education'.

CONCLUSIONS

The home visiting programme contributed to the community-dwelling older adults feeling more empowered to engage in health-promoting self-care behaviours. It also improved the older adults' sense of autonomy and self-efficacy, while reducing their loneliness and addressing some perceived shortcomings of the healthcare system.

CLINICAL RELEVANCE

Older adults participating in a home visiting programme led by nursing students feel empowered to implement self-care behaviours, which has a positive impact on their perceived health status. Nurse leaders and nursing regulatory bodies could collaborate with nursing faculties to integrate preventive home visiting programmes led by nursing students into the services offered to community-dwelling older adults with chronic multimorbidity.

Health Professionals' Experiences with Health-Promoting Dialogues for Older Home-Dwellers-A Qualitative Study

Home-dwelling older people without healthcare services might develop vulnerability and health-related issues that should be detected proactively by service providers. Health-promoting measures directed towards the target group could facilitate living longer and better at home, as well as delay the need for healthcare services. One approach is through health-promoting dialogues between the municipality and healthcare professionals. This study aims to explore the experiences of healthcare professionals involved in health-promoting dialogues with home-dwellers aged over 75 years without health service decisions in Norway. Data were collected through three focus groups. Thematic analysis was applied to the data resulting in the emergence of one major theme, "challenging dialogues", comprising three sub-themes: "promote the individual's perspectives", "uncovering vulnerability", and "ambiguity of the dialogues". The health-promoting dialogue uses a resource perspective for the elderly to remain independent in old age and can reveal vulnerability and underlying needs. The purpose of the dialogue appears ambiguous for the target group, which leads to unclear service expectations and frequent rejections of the offer. Nevertheless, this health-promoting service has a clear purpose of identifying and meeting the needs of the target group in a broader sense during the ageing process.

Where Are All the Men? A Qualitative Review of the Barriers, Facilitators, and Recommendations to Older Male Participation in Health Promotion Interventions

OBJECTIVE

Older men have lower participation rates than females in health promotion interventions. We conducted a qualitative review of 20 years of existing research across a variety of academic search databases to outline the barriers, facilitators, and recommendations for this imbalance.

DATA SOURCE

A systematic search was conducted across Google Scholar, PubMed, MEDLINE, CINAHL, Academic Search Premier, Psychology and Behavioral Sciences Collection, and Web of Science from dates January 1, 2000 - December 31, 2020.

STUDY INCLUSION AND EXCLUSION CRITERIA

Abstracts were screened based on: original research, English language, recruitment or participation, health promotion or health program, and male gender.

DATA EXTRACTION

Of 1194 initial search results, 383 article abstracts were thoroughly screened for inclusion and 26 articles met inclusion criteria.

SYNTHESIS

Included studies were coded and analyzed using Grounded Theory.

RESULTS

Barriers included masculine gender roles as well as program scope, environment, and gender of the instructors and other participants. Facilitators included creating social groups of older males that participate in a variety of activities together, including hobbies and health promotion, over a long period of time.

CONCLUSION

Health promotion interventions should involve men in all aspects of program planning and implementation, take into account men's existing relationships and interests to create gender-sensitive programming, and clearly delineate the benefits to participation.

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial

BACKGROUND

In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only.

METHODS

A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data.

RESULTS

Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention.

CONCLUSION

Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention.

TRIAL REGISTRATION

This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

Self-managing physical and mental health: A qualitative study on older adults' views and support needs in the Netherlands

To help older adults stay healthy and independent, different stakeholders have developed self-management programmes that aim to support older adults in maintaining or improving physical and mental health. These programmes do not always match older adults' needs and preferences. The aim of this study was to gain insight into independently living older adults' views and support needs in self-managing physical and mental health. A qualitative study was performed to collect data. Sixteen independently living older adults from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis. The results demonstrate that older adults who live independently believe that maintaining physical and mental health is an important pre-condition for remaining independent and living a meaningful life. They are positive about their health, tend to keep on going with an optimistic attitude and choose activities that suit them regarding type and intensity. The older adults believe deterioration is a normal part of getting older. They focus on preservation and adapt to their natural decline. However, some older adults struggle with their deterioration but prefer self-management rather than seeking professional support. To reach the target group, it has been suggested that nurses and other healthcare professionals tailor their support to the way older adults view and manage the maintenance of both physical and mental health.

Health Promotion and Disease Prevention in the Elderly: The Perspective of Nursing Students

Health promotion and disease prevention are closely linked to health literacy. Therefore, intervention to increase individuals' knowledge is essential if action is to be taken to promote a healthy lifestyle with support from health professionals for decision making on choices leading to behavioral change. Taking into account the growing aging population, nurses and nursing students have to develop interventions to promote health and prevent disease in these people, in order to keep them healthy and with quality of life. This study aims to understand how nursing students' experiences in a clinical teaching context contributed to the development of their competencies in the promotion of health and prevention of disease in the elderly.

METHOD

Qualitative, exploratory, and descriptive study carried out with ten students about to finish a graduate nursing course in a higher education institution in the South of Portugal. This study was carried out through narratives, one of the most common data collection procedures in social and health investigations. The content analysis technique, more specifically the thematic categorical analysis, was used for data analysis. The study received authorization from the Ethics Committee of the institution where it took place.

RESULTS

Three categories were found: "Strategies to promote health and prevent disease in the elderly", "Health improvements from the implementation of the strategies to promote health and prevent disease in the elderly", and "The impact your participation in these strategies to promote health and prevent disease in the elderly had on your formative process".

CONCLUSION

The students developed competencies during their clinical teaching experiences through the implementation of strategies of health promotion and disease prevention adapted to/focused on the needs of the elderly.

Introduction to the JPIC issue, Aging in older adulthood: Community-level intervention programming and partnerships providing older adults with community health promotion opportunities

Community-level health promotion programs offer opportunities to improve the lives of older adults and improve the cultural narrative about aging. However, age-discrimination, ageism, and negative attitudes about aging, across the systematic ecological community levels have undermined older adult health. While the longevity of a society is a marker for success worldwide, age-discrimination and ageism, seen through limited community-level health advancement opportunities, have thwarted progress toward societal elderhood, even in the most developed and advanced nations. As a society, we need to continue to push for community-level prevention and intervention across the older age spectrum, to continue human advancement through late life.

Conversations about wellness: A qualitative analysis of patient narratives post annual wellness visit

Support for successful aging in place requires an understanding of the factors that impede or support health promotion behaviors. Nurse-led monthly follow-up calls between annual wellness visits (AWV) offer the opportunity to both provide support and collect data which can inform development of effective health promotion strategies. The aim of this research was to provide ongoing support for health promotion efforts and explore factors playing a role in meeting AWV recommendations. A total of 144 visit summaries for 47 Medicare beneficiaries (65+) who had completed an AWV within the last year were analyzed using a thematic approach. Themes were organized into 7 categories with findings indicating the complexity of factors which influence health promotion behaviors. The importance of ensuring personalization of health promotion recommendations using data collected during the AWV and provision of ongoing support between visits may enhance health outcomes.

Older people living at home: experiences of healthy ageing

AIM

The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support.

BACKGROUND

The purpose of WHO's Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons.

METHOD

This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis.

FINDINGS

The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: 'Embracing life', 'Dealing with challenges' and 'Considering the future'.

Constant Daily Exercise to Keep the Doctor Away: A Study of Adherence to Physical Exercise Using a Gym in Individuals Older Than 55 Years

The purpose of this study was to examine the role of using a gym as a mechanism for adherence to regular physical exercise among individuals with aged 55 and over. This was a grounded theory research design. Data were collected from face-to-face interviews and observations among 15 people who attended the gym regularly and then analysed via content analysis. Three categories emerged from the present study regarding the adherence to regular physical exercise: (1) meaningful starting points, (2) reinforcement by motivators, and (3) adherence through positive changes. Results of this study can help health policymakers, managers of gyms/fitness centres, and gym instructors to design and implement programs.

Enabling sustained communication with patients for safe and effective management of oral chemotherapy: A longitudinal ethnography

AIMS

To examine how patients received, understood, and acted on healthcare professional communication about their oral chemotherapeutic regimen throughout their treatment.

DESIGN

A longitudinal ethnographic study.

METHODS

Over 60 hr of observational data were recorded, in the form of field notes and audio-recordings from interactions among nine oncology doctors, six oncology nurses, eight patients, and 11 family members over a period of 6 months in outpatient departments in one hospital in Northern Ireland. Sixteen semi-structured interviews with patients and three focus groups with healthcare professionals were also carried out. This study took place from October 2013-June 2016. Data were thematically analysed.

RESULTS

Three themes where identified from the data. These were initiating concordance through first communication about oral chemotherapy; which focused on initial communication during oncology consultations about oral chemotherapy, sustained communication of managing chemotherapy side effects; which was about how communication processes supported timely and effective side effect management and un-sustained communication of oral chemotherapy medication-taking practice; when patients and healthcare professionals failed to communicate effectively about chemotherapy medication-taking.

CONCLUSION

The two most important factors in ensuring the optimal management of oral chemotherapeutic medicines are early recognition and appropriate response to side effects and the maintenance of safe and effective medication administration. This study found that oncology doctors and nurses engaged in sustained communication about the side effects of chemotherapy but did not focus their communication on safe administration after the first consultation.

IMPACT

Based on this evidence, we recommend that healthcare professionals who provide oral chemotherapy for home administration should review their processes and procedures. Healthcare professionals need to ensure that they embed frequent communication for the duration of treatment between themselves and patients, including open discussion and advice, about side effects and medication administration.

Validity and reliability of the Turkish version of Geriatric Health Promotion scale

BACKGROUND

A measure for healthy lifestyle behaviours of older adults would enable the development of effective and target-based health promotion strategies.

AIM

This study aimed to test the validity and reliability of the Turkish version of Geriatric Health Promotion scale among older people in Turkey.

DESIGN

This was a methodological study that was conducted between June and August 2018.

METHODS

A total of 321 volunteer older individuals, who were admitted to local health centres, participated in this study. A questionnaire, including sociodemographic data form, and the Geriatric Health Promotion scale were used to collect data. Content and construct validity was established using validity analyses.

RESULTS

The reliability of the scale was confirmed by its internal consistency (α = .82) and test-retest reliability (0.86). Exploratory factor analysis for the six-factor construct explained 64.7% of the total variance. Factor loads of each item ranged from 0.44 and 0.91. Confirmatory factor analysis indicated that the theoretical constructs had a perfect fit with data obtained. These data establish that the Turkish version of the Geriatric Health Promotion scale was valid and reliable.

CONCLUSION

The Turkish version of the Geriatric Health Promotion scale is a reliable and valid instrument that can be used in the evaluation of health-promoting behaviours among older individuals.