Clinical trial NCT02733523: Self-management, Health Literacy and Social Capital in Socioeconomically Disadvantaged Older Adults
Official title: Promoting Self-Management, Health Literacy And Social Capital In Socioeconomically Disadvantaged Older Adults To Reduce Later Life Health Inequalities: A Randomized Clinical Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Health Status Disparities
Subjective Health
Self Care
Social Capital
Health Literacy
Aging
Lead sponsor: Fundacio Salut i Envelliment UAB
Sponsor class: OTHER
Collaborators: name: Recercaixa
name: Equip Atencio Primaria Sardenya
First posted: 2016-04-11
Enrollment: 390
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: 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.


Eligibility criteria: 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

Primary outcomes:
measure: Self-perceived health
timeFrame: at 3 months (just after the intervention)
Secondary outcomes:
measure: Self-perceived health
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Health related quality of life
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Self-rated quality of life
timeFrame: t month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Loneliness
timeFrame: t month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Depressive symptoms
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Physical activity
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Short Physical Performance Battery
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Health service use
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Unintended effects
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Self-care / healthy habits
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Health literacy
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Social capital
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Social support
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
measure: Social participation
timeFrame: at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
Other outcomes:
Locations:
Study officials:
affiliation: Fundació Salut i Envelliment UAB
name: Laura Coll-Planas, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Fundació Salut i Envelliment UAB
name: Sergi Blancafort, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Equipo Atencio Primaria Sardenya
name: Rosa Monteserin, MD PhD
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Foster G, Taylor SJ, Eldridge SE, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005108. doi: 10.1002/14651858.CD005108.pub2.
citation: Fried LP, Carlson MC, Freedman M, Frick KD, Glass TA, Hill J, McGill S, Rebok GW, Seeman T, Tielsch J, Wasik BA, Zeger S. A social model for health promotion for an aging population: initial evidence on the Experience Corps model. J Urban Health. 2004 Mar;81(1):64-78. doi: 10.1093/jurban/jth094.
citation: Ahnquist J, Wamala SP, Lindstrom M. Social determinants of health--a question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes. Soc Sci Med. 2012 Mar;74(6):930-9. doi: 10.1016/j.socscimed.2011.11.026. Epub 2012 Jan 21.
citation: Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999 Aug;89(8):1187-93. doi: 10.2105/ajph.89.8.1187.
citation: Nyqvist F, Forsman AK, Giuntoli G, Cattan M. Social capital as a resource for mental well-being in older people: a systematic review. Aging Ment Health. 2013;17(4):394-410. doi: 10.1080/13607863.2012.742490. Epub 2012 Nov 27.
citation: Blancafort Alias S, Monteserin Nadal R, Moral I, Roque Figols M, Rojano I Luque X, Coll-Planas L. Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS. BMC Public Health. 2021 Jan 7;21(1):84. doi: 10.1186/s12889-020-10094-9.
citation: Coll-Planas L, Blancafort S, Rojano X, Roque M, Monteserin R. Promoting self-management, health literacy and social capital to reduce health inequalities in older adults living in urban disadvantaged areas: protocol of the randomised controlled trial AEQUALIS. BMC Public Health. 2018 Mar 13;18(1):345. doi: 10.1186/s12889-018-5219-x.