Participation in Cardiovascular Health Awareness Program (CHAP) by the Elderly Residents of Social Housing in Quebec: Social Network Analysis

Abstract

Background: The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular disease (CVD) prevention program in small to medium size communities in Ontario. Recently, CHAP has been adapted to target older individuals living in 14 social housing buildings in Ontario (7) and Quebec (7). The participation rates in the 10-months program varied across buildings in Quebec from 23.5% to 49.1%. Social network analysis (SNA) has been successfully used to assess and strengthen participation in health promotion programs. We applied SNA methods to investigate whether interpersonal relationships between tenants within buildings influence the participation in CHAP. Methods: We used sociometric questionnaires and complete network analysis, supplemented by qualitative interviews to examine relational dynamics of two buildings in Quebec with a low and a high attendance rates. All residents of the two buildings were eligible to be interviewed for the sociometric questionnaire. The participants for the qualitative part of the study were selected at random. Results: In total, 69 seniors participated in the study, including qualitative interviews. Among study participants selected for qualitative interviews, 10 attended almost all CHAP sessions, 10 attended once and 12 did not attend any. Quantitative results helped to identify well-known and appreciated local leaders. In building 1 which had a high attendance rate (34.3%), there was a main leader (In-degree or ‘named by others’ frequency 23.2%) who attended all sessions. In building 2 which had a low attendance rate (23.9%), none of the leaders had participated in CHAP sessions. Qualitative analysis showed that tenants who did not attend CHAP sessions (or other activities in the building) generally preferred to avoid conflicts, retaliation and gossip and did not want to get involved in clans and politics within the buildings. Conclusion: In order to increase attendance at CHAP sessions among residents of subsidized housings for seniors, we identified 4 potential strategies: increase participant confidentiality; deploy community peer-networks to enhance recruitment; pair attendants to ensure their future participation; intervene through an opinion leader or through bridging individuals.