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

Aging Clinical Trial

— AEQUALIS  

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02733523
• Other study ID #: FSIE-Recercaixa2014
• Status: Completed
• Phase: N/A
• First received: February 10, 2016
• Last updated: February 6, 2018
• Start date: January 2016

Study information

• Verified date: February 2018
• Source: Fundacio Salut i Envelliment UAB
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 390
• Est. primary completion date: May 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 60 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Aging
• Health Literacy
• Health Status Disparities
• Self Care
• Social Capital
• Subjective Health

Intervention

Behavioral:
• Program "Sentirnos bien" (Feeling well)
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.

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
Fundacio Salut i Envelliment UAB	Equip Atencio Primaria Sardenya, Recercaixa

References & Publications (6)

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. — View Citation

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005. Review. — View 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. Review. — View 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. — View 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. — View 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. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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	Self-perceived health	Thermometer from 0-100	at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
Secondary	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)
Secondary	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)
Secondary	Loneliness	Scale Gierveld and De Jong	t month 3 (just after the intervention) and at month 12 (9 months after the intervention)
Secondary	Depressive symptoms	Geriatric Depression Scale	at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
Secondary	Physical activity	International Physical Activity Questionnaire (IPAQ)	at month 3 (just after the intervention) and at month 12 (9 months after the intervention)
Secondary	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)
Secondary	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)
Secondary	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)
Secondary	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)
Secondary	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)
Secondary	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)
Secondary	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)
Secondary	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)