Self-management, Health Literacy and Social Capital in Socioeconomically Disadvantaged Older Adults

Study Overview
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Brief Summary
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Motivations: Socio-economic and education determinants have a big impact on health outcomes, in terms of worse health status in populations living in more disadvantaged conditions. Social capital, self-management and health literacy are some of the intermediate determinants, with the potential to mitigate health inequalities through interventions driven by local health agents. These three determinants are intensely interlinked and have, separately, impacts on self-perceived health. Social capital is defined in this project as an umbrella concept, which includes quantitative aspects of social resources (structural social capital: social networks and contacts, social and civic participation) as well as qualitative or subjective aspects (cognitive social capital: perceived social support, feeling of belonging and trust) and covers relations between subjects at a micro or individual level (family and friends) as well as at a macro or community level. Health literacy is understood as cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Both are key aspects for self-management behaviours. The target of our research project are older people living in urban socioeconomically disadvantaged areas, since ageing is in itself an inequality axis and urban environments concentrate the highest health disparities. Objectives: With the aim to reduce health inequality, an intervention has been designed to promote self-management, health literacy and social capital among older people who perceived their health as fair or poor and are living in urban socioeconomically disadvantaged areas with the aim of improving their self-perceived health. Secondarily, the efficacy of the intervention will be analysed in terms of increasing self-management, health literacy and social capital (social support and social participation), quality of life, mental health and healthy lifestyles. In third place, behavioural health patterns will be identified in relation to health literacy, social capital, gender, socioeconomic and educational level, and they will be linked to the intervention efficacy levels.

Official Title
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Promoting Self-Management, Health Literacy And Social Capital In Socioeconomically Disadvantaged Older Adults To Reduce Later Life Health Inequalities: A Randomized Clinical Trial

Conditions
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Health Status Disparities, Subjective Health, Self Care, Social Capital, Health Literacy, Aging

Intervention / Treatment
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* Behavioral: Program Sentirnos bien (Feeling well)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: community-dwelling older adults living in the urban areas of Barcelona, Blanes or Reus in socio-economically disadvantaged neighbourhoods. perception of their health as regular or bad according to the first question of the 12 items Short Form Survey from the RAND Medical Outcomes Study. Exclusion Criteria: dependency to go to the local primary care center cognitive decline or dementia as diagnose any health condition that contraindicates physical activity terminal illness severe mental health disorders that difficult participating in a group dynamic

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Program Sentirnos bien<br>The intervention Program Sentirnos bien is based around a group dynamic, held once a week during 3 months, aimed at: Promoting the uptake of self-care healthy habits Promoting social capital at individual level: Promoting health literacy | Behavioral: Program Sentirnos bien (Feeling well)<br>* Group-based intervention delivered face-to face and held once a week during 3 months. It comprises: Promoting the uptake of self-care healthy habits: providing information, setting personal goals and sharing experiences to facilitate behavioural change, specially on physical activity and healthy dietary habits. Promoting social capital at individual level: facilitating mutual knowledge and mutual support among participants and fostering participation in sociocultural and community activities in the neighbourhood through visits to the community assets accompanied by volunteers. Promoting health literacy: improving navigation through the health care system, communication with health professionals, as well as the understanding and decision making when buying food.<br>|
| No Intervention: Control arm<br>The control arm will receive no intervention. Once the trial is finished, i.e. after the last follow-up evaluation, this arm will receive the intervention (waiting-list approach). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-perceived health | Same question than the 12 items Short Form Survey from the RAND Medical Outcomes Study. Answers will be recategorized as positive perception (excellent, very good or good) vs negative (regular or bad) | at 3 months (just after the intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-perceived health | Thermometer from 0-100 | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Health related quality of life | 12 items Short Form Survey from the RAND Medical Outcomes Study. | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Self-rated quality of life | Thermometer from 0-100 | t month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Loneliness | Scale Gierveld and De Jong | t month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Depressive symptoms | Geriatric Depression Scale | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Physical activity | International Physical Activity Questionnaire (IPAQ) | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Short Physical Performance Battery | Functional test that scores performance in three physical aspects: balance, strength and gait speed. | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Health service use | Times attending primary and hospital health care | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Unintended effects | Questions ad hoc to assess effects not intended by the intervention perceived negatively by the participant. | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Self-care / healthy habits | Scale ASA (Appraisal of Self-Care Agency Scale) | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Health literacy | questions from the European Health Literacy Scale (HLS EU-16) | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Social capital | 2 questions from the European Values Survey | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Social support | Questionnaire Inventario de recursos sociales en ancianos from Díaz Veiga | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) | 
| Social participation | Questionnaire Escala Este II de Soledad - Índice de participación social subjetiva | at month 3 (just after the intervention) and at month 12 (9 months after the intervention) |