Co-develop physical activity intervention with community-dwelling older adults : a community-based participatory research approach

Abstract

This thesis aims to develop a social-ecological based physical activity (PA) intervention model that connects community-dwelling older adults, social service agent and the freely accessible built environment resources in Hong Kong for disease prevention and health promotion. Using the community-based participatory research (CBPR) approach to develop the intervention, older adults of the community collaborated with the author and social worker and became active contributors in disease prevention and health promotion in their community. The new intervention model encourages older adults to make the best use of resources in their immediate home and neighbourhood environment to perform PA that complies to the World Health Organization PA guideline for older adults.

The first study explored older adults’ PA experiences in “Elderly fitness corners” (EFCs) in parks by interviews and observations. Findings of the first study demonstrated that EFCs are not merely a space for physical exercise, but a place that connects older adults to their peers and nature. Data revealed that older adults performed freestyle and unstructured PA routines at the EFCs without much concept in the frequency, intensity, type and, duration of PA that can achieve health benefits. This provides ground for the need of health education on PA. The second study applied community-based participatory methodologies (i.e. qualitative GIS and photovoice) to explore community-dwelling older adults’ active locations, awareness and, perceptions of EFCs in a low-income neighbourhood in Hong Kong. Key findings revealed that older adults were aware of EFCs, yet most of them did not use it. Older adults perceive positively on EFCs. However, at the same time, they thought the space is crowded, far, unsafe, and affected by weather conditions. Also, in terms of usage, some expressed that although there is instruction available, they have poor vision and do not have adequate literacy to understand the instruction board. Some expressed that they were afraid of injury; they thought the exercise is monotonous, and there is inadequate promotion on the facility. The main study is the development of the social-ecological based PA intervention using the CBPR approach and the evaluation of it using mixed-methods. The author, community-dwelling older adults, and social worker collaborated and formed a working group and gone through ten sessions of meetings to decide the delivery methods and the content of the PA intervention. As a result, a 5-week PA educational intervention, and a neighbourhood-tailored PA manual was developed. All the parties delivered the intervention together in the community. A mixed-methods evaluation of the intervention revealed that the PA intervention effectively changed a significant portion of participants from not complying to WHO PA guideline for older adults to the compliance of the guideline. The PA behavioural change was maintained at six months follow up. There were also significant changes in exercise attitudes, blood pressure level, and balance ability. Qualitative data validated quantitative data and complemented quantitative data by showing the intervention increased social connectedness and successfully increased participants’ usage and knowledge of PA facility and equipped participants to better utilize PA facilities in the neighbourhood.