Achieving Health Promotion Behaviour Change Among Olde

1
Achieving Health Promotion Behaviour Change Among
Older Victorians

• Betty Haralambous, Kirsten Black, Melita
  Guimmara, Joan Nankervis
• National Ageing Research Institute

2
Todays presentation

• Background and aims of study
• Methodology and participants
• Participants concept of health
• Summary of barriers and enablers to health
  promoting behaviour
• Quotes to illustrate barriers and enablers
• Preliminary recommendations

3
Project aim

• To identify the enablers, barriers and
  structural supports that affect an older persons
  ability to comply with health promoting
  behaviours.
• Strategies will be recommended to further
  facilitate health-promoting behaviour

4
World Health Organisations definition of health
promotion

• the process of enabling people to increase
  control over, and to improve their health. To
  reach a state of complete physical, mental and
  social wellbeing, an individual or group must be
  able to identify and to realise aspirations, to
  satisfy needs, and to change or cope with the
  environment. Health is, therefore, seen as a
  resource for everyday life.. (1986, p2)

5
Methodology

• Literature review
• Scoping exercise
• Focus groups
• Falls Clinic MDS data analysis

6
Focus Groups

• 10 focus groups
• 5 with service providers (3 PCP 2 FBC)
• 5 with service users (3 PCP 2 FBC)
• 3 PCP catchments (1 inner metro, one outer metro
  1 rural)

7
Primary Care Partnerships

• Victorian Government initiative
• Alliances of primary care providers
• HACC, community health, General Practice, ACAS,
  psychiatric disability support dental health
• Usually 2-3 Local Government Areas
• BATS initiative aims to meet needs in a timely,
  cohesive and consistent way (DHS, 2000, p1)

8
Focus group topics

• What does health mean to you?
• What affects your sense of health and well-being?
• Do you believe that you (personally) can improve
  your health?
• Is there anything that you dont think you can
  change?
• What motivates you to take action to improve or
  look after your health? What prevents/constrains
  you from looking after your health?
• Are there any groups or individuals you may
  listen to who influence you taking action to
  improve or look after your health?

9
Profile of service user participants

• 36 participants (19 PCP and 17 FBC)
• 75 female
• Mean age 76 years (range62-90)
• Falls Clinic participants significantly older
  (79.3) than PCP participants (73.7)
• 44 lived alone
• 86 born in Australia
• Comorbidities FBC3.5 PCP2.9

10
(No Transcript)
11
Participants Self Rated Health
12
Profile of service provider participants

• 41 participants (30 PCP 11 FBC)
• 18 allied health, 6 medical, 5 assessment
  officers, 9 managers, 3 other

13
Participants concept of health
14
Concept of Health

• Similarities between service users and
  providers definition of health
• Both talked about social, physical, mental and
  spiritual health
• Maintaining independence
• Get out and about, maintain independence, keep
  contact with friends and family, socialise, be
  able to participate in the things you want to
  do. PCP service user

15
Social health

• Service provider and service user participants
  discussed the role of socialisation and social
  activity in relation to maintaining their health
• Socialising is very important otherwise you
  become a hermit in your own environment. It
  makes you happier and if youre happier youre
  healthier. PCP Service user
• Social activity helps your health. Makes you
  get out and not sit at homeIm in a senior
  citizens club mixing with people. FBC Service
  user

16
Physical health Service providers

• Service providers talked about function and
  absence of disease
• Having a normal level of functioning. FBC
  Service provider
• Being able to communicate PCP Service provider
• Absence of disease. FBC Service provider

17
Physical health Service users

• Service users related physical health with
  function but also the extent that they could
  undertake physical exercise
• Health means going to the gym 2-3 times a week.
  I do pump, aerobics. If I cant do this, Im
  devastated. Dont know what to do with myself.
  PCP service user
• Being able to do your garden. FBC Service
  user

18
Mental health

• Service users identified mental wellbeing as very
  important to their overall health. This included
  having a positive outlook and the use of services
  that support mental wellbeing (e.g. psychology).
• Mental health is very important. Its the main
  thing really mental attitude its all
  upstairs really. FBC service user
• I think its when you get out of bed in the
  morning and think well Ill make sure Im going
  to have a good day today and you have it. If
  youre going to get up and think oh God Im down
  today, youre going to get around like that.
  FBC service user

19
Spiritual health

• Faith and spirituality were reported as
  significant aspects of health and wellbeing
• A personal thing. For me I have a faith I
  believe in and I probably need to maintain that.
  Id like to maintain that throughout my whole
  life and that gives me a sense of peace, of
  tranquillity in my life. PCP service provider
• I believe in a lot of the Eastern philosophies
  I believe that if you change your thought-set
  that youll probably be healthier than what you
  are now PCP service user

20
Summary of key findings of barriers and enablers
to promoting health behaviours amongst older
people
21
Summary of findings Barriers(client level)

• Loss of physical function
• Social isolation/loss of spouse and social
  networks
• Lifestyles / Behaviours throughout life (SES and
  education)

22
Summary of findings Barriers(organisation and
macro levels)

• Negative attitudes about ageing
• Lack of access and knowledge about services
• Lack of transport
• Structural barriers such as lack of footpaths,
  poor lighting and accessing public transport
• Cost of services
• Demand on services

23
Summary of findings Enablers (client level)

• Motivation to maintain independence
• A positive attitude
• Having goals and social roles
• Support from family/carers buddy
• Able to drive/use public transport
• Health scare- perceived benefits of treatment
• Links between self-esteem and physical appearance

24
Summary of findings Enablers (organisation
macro levels)

• Relevant and flexible services that adapt to the
  clients needs
• Health professionals respecting clients and
  actively listening to achieve clients goals
• Culture respecting elders, shift promoting
  exercise as OK for older people
• Medias role in promotion positive ageing
• Physical activity programs fostering social
  interaction

25
Illustrating barriers and enablers

• Quotes from study participants

26
Barrier Loss of physical function

• Clients reported difficulties associated with
  getting older and the impact on function
• I dont have good health because of arthritis
  and my husband cares for me. Cant travel as
  much, cant go for long walks, hip op hasnt come
  up to standard - would love to go and dance again
  but cant. Products you cant open, milk
  bottles, pill bottles... They dont put things
  out for people with arthritis.
• PCP Service user

27
Barrier Social isolation

• Loneliness is the worst. If you live on your
  own, ... you see Ive always had a family, always
  had children around. Now theyve all left I
  live in a court but everybody goes to work. I
  live next door to my son, but he and his wife go
  to work and I dont see them. Theyre gone by
  the time I get up and sometimes I see them at
  night .
• PCP Service user

28
Barrier Ageist attitudes

• ...Its just that perception amongst a lot of
  our clients that part of getting older is slowing
  down and you expect to start falling over and you
  expect to start being sick and you cant do
  everything you used to do ten years ago. FBC
  Service Provider
• You give grandma the weights and before you
  know it shes bench pressing tractors, but
  everybody is anxious about the fact that this
  doesnt fit the myth. Doesnt fit how things
  should be. PCP Service Provider

29
Attitudes changing

• Ten years ago it wouldnt have been OK for a 70
  or 80 year old lady to be doing Tai Chi, but now
  it is happening all over the place. So I might
  give it a try because it is more acceptable.
  Even from the point of view of old ladies feeling
  ok to go out in public wearing a tracksuit and
  pair of runners. Theyre used to wearing high
  heels, pantyhose and a dress all of the time.
• PCP Service provider

30
Barrier Access and knowledge

• Difficulties accessing services such as GPs in
  rural areas and getting on transport.
• Service providers not knowing about services such
  as Falls Clinics.
• There are good cheap programs in the region,
  e.g. tai chi, strength training, gentle exercise,
  but they are difficult to access and there is
  lack of promotion. FBC Service provider

31
Barrier Impact of demand

• Not providing services in a timely manner was
  recognised as detrimental to health (eg physical
  deterioration waiting for an operation/
  deterioration in self esteem when community
  services werent available)
• Once they loose their self esteem they view
  themselves as being very old...Well you may be
  old but youre still valuable, still worth
  something. And if the services are interrupted
  they often personalise it and think they dont
  worry about me, Im forgotten, and it snowballs
  on. PCP Service provider

32
Enabler Motivated to be independent

• Have always been a strong man and go to the gym
  now to make myself stronger (following stroke).
  It makes me self-reliant, dont have to rely on
  anyone to push me around or look after me.
  Thats the motivation. PCP Service user
• I dread the thought that I would have to go
  into care. PCP Service user

33
Enabler Goals/social roles

• They older people will get better quickly if
  they have pets, people or garden who depend on
  them. They involve themselves in social groups,
  gardening groups and meaningful activity. PCP
  Service provider
• Having a goal is really important. PCP Service
  provider
• Pets are a good motivator. Reason to live. Give
  people a goal. PCP Service provider

34
Enabler Family influences

• Family was valuable in providing emotional and
  practical support in undertaking healthy
  behaviours
• Its very important to have family around you.
  They care about you more than anyone else.
  FBC Service user
• My son helps with all things - hes a doctor,
  gives me hip protector... Because if you fall on
  your hip and break your pelvis you may as well
  die fast. They (hip protectors) make you look
  horrible but at the same time its better than
  getting a broken pelvis. FBC Service user

35
Enabler Health Scare

• Back in 1983 when I had a heart attack I
  thought to myself Im not going to have one of
  those again. Ill listen to the people, to the
  medical profession, do everything they tell me,
  medical, physiotherapists or anything, I did it.
  And Im still alive and Im still going well.
  FBC Service user

36
Enabler Flexible service delivery

• Importance of health professionals providing a
  flexible service that met the needs of
  individuals
• I care for a 96 year old whos still at home
  and refuses to go out to day centres or anything
  organised but wants to go for a walk. So we take
  her for a little walk- not a big walk but a
  little walk- and she gets out in the sunshine,
  looks at the garden. It just gets her out of the
  four walls and I think that improves her state of
  health and mind. PCP Service provider

37
Enabler Health professionals respecting clients

• Also need to respect clients and actively listen
  to their point of view and goals
• I nearly drive my doctor mad asking him
  questions..but I like my doctor because he
  listens. Get an answer in a round about sort of
  way. They are good for recommending you to go to
  somewhere else that can help - like the Falls
  Clinic. Thats a sign of a good doctor - or if
  they ask you if you would like a second opinion.
  FBC Service user

38

• There were concerns raised by service providers
  that older people tended to not question their
  GP
• Some people believe everything their doctor has
  said. Its gospel. PCP Service provider
• I know my grandparents are very passive this
  is what the doctor says, we just go, we listen,
  we dont ask questions. I think they need to be
  educated to take a more active role and find out
  what is going on with them. FBC Service provider

39
Enabler Services promoting independence

• (When providing home care to someone we ask)
  What can you do for yourself? What do you need
  to be helped with? Not theyre going to come
  in and do everything for you. Youre saying to
  these people we still think youre valuable.
  PCP Service provider

40
Enabler Learning from cultures that value older
people

• To think that the older person has something to
  offer back to society. Its a mutually
  beneficial thing, not a burden. Same applies to
  Aboriginal community, elders have respect.
  Juvenile Justice in Shepparton use Aboriginal
  elders to deal with it because they have such
  status in the community, young people respond to
  them rather than a rap over the knuckles from the
  system. We can learn a lot from that example.
  PCP Service provider

41
Enabler Exercise Socialising

• I do water aerobics twice a week and after
  swimming we have a cup of coffee. I look forward
  to the aerobics and the cuppa afterwards - get a
  chat. FBC Service user
• I am a big walker, I walk everyday, Im a
  fanatic for walking. Niddrie walking group on a
  Friday for 1.5 hour, then I walk everyday with my
  next door neighbour, so thats an important part
  of my life, and the socialising. PCP Service user

42
Recommendations

• For service providers
• Flexible, client centred approach,
• Listening to clients
• Goal setting with client and carer
• Including social interaction in exercise programs
• Educating health professionals about services
• More broadly
• Media promotion of positive ageing
• Improved transport
• Learning from other cultures-respecting elders
• Services more adequately resourced