The decisional balance sheet to promote healthy behavior among ethnically diverse older adults.

By the year 2030, one of five Americans will be at least 65 years old (Balfour et al., 2009). Reports indicate that approximately 78% of U.S. health care dollars are spent on chronic disease, and these expenses rise dramatically as people develop multiple conditions (Anderson & Horvath, 2004). Given that 85% of older adults have at least one chronic condition and 62% have multiple chronic conditions (Anderson & Horvath, 2004), the increasing older adult population could add considerable strain to the U.S. health care system. To avert these future costs, it will be critical for all health stakeholders to engage in proactive approaches to prevent these conditions. Two behaviors associated with the decreased risk of chronic disease are regular physical activity and daily fruit and vegetable consumption. Regular physical activity among older adults is associated with reduced risk of cardiovascular disease, thromboembolic stroke, hypertension, type 2 diabetes mellitus, osteoporosis, obesity, colon cancer, breast cancer, anxiety, and depression (Haskell et al., 2007). Furthermore, an epidemiological review reported fruit and vegetable consumption protective against numerous cancers, coronary heart disease, stroke, and cataract formation (Van Duyn & Pivonka, 2000). Although older adults commonly suffer from hypertension, heart disease, arthritis, eye disorders, and diabetes (Anderson & Horvath, 2004), they are the least physically active of all age groups (CDC, 2003) and many believe there is no point in improving their diet (Resnick & Daly, 1998). From the years 2000 to 2030, the demand for older adult living communities is projected to double (Bernstein & Edwards, 2008). Despite the convenience of these localized settings, previous promotional efforts report difficulty in motivating older adults (Mihalko & Wickley, 2003). Less success among older adults may result from their passive approach to health care (Bastiaens, Van Royen, Pavlic, Raposo, & Baker, 2007), their multiple medical needs (Haber, 1994), and/or limited physician time devoted to preventive health (Fried & Guralnik, 1997; Langford, 2004; Thorpe & Howard, 2006). Previous reports suggest simple and minimally intense health promotion programs that aim to inform and empower older adult participants, rather than overwhelm them (Fox, Breuer, & Wright, 1997; Hochhalter, Song, Rush, Sklar, & Stevens, 2010; Tennstedt, 2000). One theory-based health promotional tool fitting this description is the decisional balance sheet. Decisional balance is a measure of attitude that captures how individuals weigh the consequences of a specific behavior in terms of pros and cons (Prochaska, Redding, & Evers, 1996). The decisional balance sheet program provides basic health knowledge and empowers individuals to take personal control over their own health (Janis & Mann, 1977). Specifically, participants discuss and record their perceived gains and losses associated with behavior adoption. This approach has been successful in the promotion of cancer screening among Chinese women (≥50 years) (Strong & Liang, 2009) and diabetes screening among middle-aged adults (40–69 years) (Kellar et al., 2008); however, there is minimal to no report on programs designed to promote older adults’ physical activity and/or fruit and vegetable consumption. The current study tested the implementation of a decisional balance sheet physical activity program and fruit and vegetable program; specifically describing the efficiency and effectiveness of programs adapted for older adults residing in community living homes.