Patient education
A salutogenic program to enhance sense of coherence and quality of life for older people in the community: A feasibility randomized controlled trial and process evaluation

https://doi.org/10.1016/j.pec.2015.08.003Get rights and content

Highlights

  • Salutogenesis-based self-care is an effective primary health promotion approach.

  • Salutogenesis-based self-care program improves sense of coherence and psychological aspect of quality of life.

  • Salutogenesis-based self-care program improves self-care abilities.

  • Engagement with personal and external resources enhances self-care abilities.

Abstract

Objective

To determine the feasibility of a salutogenesis-based self-care program on quality of life, sense of coherence, activation and resilience among older community dwellers.

Methods

This is a feasibility randomized controlled trial. Sixty-four older community-dwellers were recruited from a Singapore senior activity center and randomly assigned to intervention and control groups. The intervention group attended a 12-week Resource Enhancement and Activation Program. The outcomes were assessed with the Chinese versions of World Health Organization Quality of Life Scale, Sense of Coherence, Patient Activation Measure, and Connor–Davidson Resilience Scale. Process evaluation was conducted using focus groups with the intervention group.

Results

At the end of the program, the intervention group showed significant improvement in the Sense of Coherence scale and the psychological subscale of the WHO Quality of Life scale compared with the control group. Three themes emerged from the process evaluation: participation in the program, reflection on the experience, and improving the experience.

Conclusion

A salutogenic self-care approach could be a potential health promotion strategy for older people.

Practice implications

With improved sense of coherence and psychological aspect of quality of life, older people’s self-care ability may improve, leading to better health and better quality of life.

Introduction

Population aging is a global issue [1]. In particular, many countries in Asia are encountering a dramatic reduction in fertility in the last decades alongside lower mortality and higher life expectancy [2]. For years, aging has been associated with physical, mental and functional decline, and old people are perceived as a burden to the society [1]. However, there has been a shift in paradigm towards motivating older people to enhance their health and well-being, with an emphasis on resilience and resources [3]. Resilience is an important internal resource involving the development of thoughts, actions and behaviors to adapt well to threats or significant sources of stress [4]. Resources may be internal or external. Internalized resources are resources familiar and accessible to people [5], [6].

Salutogenesis is a positive self-care approach that focuses on factors that support health and well-being, as well as strengthen a person’s health maintenance processes [7]. Sense of coherence (SOC) is an important concept in salutogenesis theory and consists of three domains: comprehensibility, manageability and meaningfulness [8]. SOC is a disposition that enables one to preserve health as one perceives challenges as predictable and within control, and thus be motivated to identify and use resources efficiently.

Older people prefer to age-in-place and stay in their own homes because they can enjoy safety, independence and autonomy in a familiar and meaningful environment [9], [10]. Thus, it is vital that older people assume responsibility for self-care. People adopt self-care behavior if they feel activated [11]. Resilience enables individuals to adapt successfully when confronted with stress. Resilience is associated with physical activity, emotional well-being, social support, health-promoting behaviors, better self-care, and self-rated successful aging [12], [13], [14], [15]. A strong SOC is required to initiate and sustain self-care behavior. Having good social support and effective coping strategies are associated with a stronger SOC, which in turn correlates with better self-perceived quality of life (QoL) among older people [16].

A review of existing literature found that there is a paucity of studies that utilize salutogenesis to develop and evaluate programs that promote self-care among community-dwelling older people [17]. To our knowledge, SOC and QoL have not been evaluated by any interventional study involving a self-care program grounded on the salutogenesis theory for community dwellers aged 65 and over [16]. There is thus a need to fill the knowledge gap. Hence, we proposed a study based on a randomized controlled trial (RCT) to evaluate a self-care program entitled Resource Enhancement and Activation Program (REAP). The protocol of this RCT has been published elsewhere [18].

This paper reports this feasibility RCT. The study has two aims. Firstly, to evaluate the effectiveness of a self-care program in promoting SOC, activation, resilience and QoL for community dwellers aged 65 and over. It was hypothesized that compared with those in the control group, participants who completed the REAP would report significant improvement in their SOC, activation for self-care, resilience and QoL. The second aim was to explore the participants’ views towards the usefulness of the REAP and highlight areas for improvement in its content and delivery.

Section snippets

Design

This feasibility RCT used a two-group pre- and post-test design and the process evaluation. The process evaluation used a descriptive qualitative approach to explore older community dwellers’ experience with REAP through focus groups. The study was conducted between February 2013 and August 2013.

Sample and setting

Community clubs and senior activity centers (SAC) offer a range of socio-recreational activities for, and community outreach to, older people [19], [20]. These centers are usually equipped with exercise

Randomized controlled trial

The study protocol and recruitment criteria were announced to 112 attendees of the SAC selected for the study. Seventy-one eligible prospects expressed interest. Subsequently, 64 (90.1%) older people agreed to participate and were randomly assigned to the intervention and control groups. In the intervention group, 93.8% (n = 30) of the participants completed REAP and the follow-up measurements, and in the control group, 90.6% (n = 29).

Table 1 shows that except for household status, the demographics

Discussion and conclusion

Using an RCT design, this study compared the impact of REAP on QoL, SOC, activation of self-care and resilience of older community dwellers. Except for the household status, the demographics and the baseline outcome measures of the intervention and control group were comparable. The higher proportion of older women in this study may be attributed to the fact that older women are more likely than older men to participate in community activities [32], [33], are more engaged in health-related

Role of funding and conflict of interest

This study was partially funded by the Upsilon Eta Chapter, The Honor Society of Nursing (Singapore). The authors declare no conflicts of interest.

Acknowledgements

We are grateful to the older people who participated in this study, the volunteer assistant facilitators, and the management of the senior activity center where this study was conducted.

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