Patient educationA 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
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.
References (52)
- et al.
Correlates of self-rated successful aging among community-dwelling older adults
Am. J. Geriatr. Psychiatry
(2006) - et al.
Measurement and predictors of resilience among community-dwelling older women
J. Psychiatr. Res.
(2008) - et al.
An evaluation of a self-management program for patients with long-term conditions
Patient Educ. Couns.
(2015) - et al.
Association between participation in community groups and being more physically active among older adults from Florianópolis, Brazil
Clinics (Sao Paulo)
(2011) Enhancing mastery and sense of coherence: important determinants of health in older adults
Geriatr. Nurs.
(2001)Editorial—promoting positive ageing
Hong Kong J. Mental Health
(2014)World Population Ageing
(2013)- et al.
The new ageing: self connection and social values
- American Psychology Association. The road to resilience. 2015. Available from...
- et al.
Resources revisited: salutogenesis from a lay perspective
J. Adv. Nurs.
(1999)
Unraveling the Mystery of Health: How People Manage Stress and Stay Well
The salutogenic model as a theory to guide health promotion
Health Promot. Int.
The sense of coherence: an historical and future perspective
The experience of older people living independently in Singapore
Int. Nurs. Rev.
The multiple meaning of home as experienced by very old Swedish people
Scand. J. Occup. Ther.
Do increases in patient activation result in improved self-management behaviors?
Health Serv. Res.
Socioeconomic position, resilience, and health behaviour among elderly people
Int. J. Public Health
Relationship among psychological well-being, coping, resilience and depression of older adults: an exploratory study
Hong Kong J. Mental Health
Integrative review: salutogenesis and health in older people over 65 years old
J. Adv. Nurs.
Guest editorial
Perspect. Public Health
Self-care program for older community-dwellers: protocol for a randomized controlled trial
Cent. Eur. J. Nurs. Midwifery
People’s Association About Us
Senior Activity Centre
A power primer
Psychol. Bull.
Considerations in determining sample size for pilot studies
Res. Nurs. Health
Quality of life and psychosocial health of older people who were living alone or with another older person in Singapore
Hong Kong J. Mental Health
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2021, Journal of Pediatric NursingCitation Excerpt :Healthcare providers can, therefore, develop sense of coherence enhancement programs that equip children and adolescents with skills in manageability, comprehensibility, and finding meaning in their current situations. Given the reported effectiveness of therapy and patient education in promoting sense of coherence among healthy adolescents, elderly, and patients with dementia or psoriasis (Krause, 2011; Langeland et al., 2013; Mayer & Boness, 2011; Odajima et al., 2017; Tan et al., 2015), future studies can perhaps adopt these methods and evaluate them to align these to the needs of children and adolescents with chronic illnesses. The absence of studies on the application of the salutogenesis approach in pediatric healthcare settings also calls for more research that focuses on developing and testing salutogenesis-focused methods or measures to improve the health outcomes of this vulnerable population.
- 1
Study conception and design, acquisition, analysis and interpretation of the data, drafting and critical revision of the manuscript, and supervision.
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Analysis and interpretation of the data, drafting and critical revision of the manuscript.
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Study conception and design, analysis and interpretation of the data, drafting and critical revision of the manuscript, and supervision.