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

Abstract

BackgroundEvidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality. MethodsPragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015-2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention. Results390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (-0.62 [-1.10, -0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (-1.26 [-1.90, -0.63]), and at follow-up (-0.95 [-1.62, -0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG. ConclusionsThis study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas.Trial registration: ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02733523

The Multidimensionality of Low Health Literacy in Older Adults: A Scoping Review of International Studies

“…Four dimensions encompassing the low HL of older adults were mapped: (1) patient dimension (Aranhaet al, 2015; Blancafort Alias et al, 2021; Chin, Payne, et al, 2015; Do et al, 2020; Gazmararian, 1999; Hester, 2009; Hochhauser et al, 2019; Kim, 2009; León-González et al, 2018; Mõttus et al, 2014; Romero et al, 2018; Santos & Portella, 2016; C. A. Smith et al, 2017; K.…”

“…H. Smith et al, 2014; Souza et al, 2014; Toci et al, 2015; Verney et al, 2019; Vogt et al, 2020; Warren et al, 2016; Wolf et al, 2007; Zhang et al, 2020), (2) healthcare system dimension (Chin, Payne, et al, 2015; Delavar et al, 2020; Gazmararian, 1999; Hester, 2009; Hochhauser et al, 2019; Mayo-Gamble & Mouton, 2018; Romero et al, 2018; Santos & Portella, 2016; K. H. Smith et al, 2014; Souza et al, 2014; Verney et al, 2019; Vogt et al, 2020; Warren et al, 2016), (3) social/economic dimension (Blancafort Alias et al, 2021; Do et al, 2020; Hochhauser et al, 2019; Kim, 2009; Liu et al, 2018; Mõttus et al, 2014; Romero et al, 2018; Santos & Portella, 2016; Souza et al, 2014; Toci et al, 2015; Verney et al, 2019; Warren et al, 2016; Wolf et al, 2007), (4) health condition dimension (Aranha et al, 2015; Delavar et al, 2020; Eronen et al, 2021; Goda et al, 2020; Hochhauser et al, 2019; Kim, 2009; Kim & Yu, 2010; Liu et al, 2018; Mayo-Gamble & Mouton, 2018; Mõttus et al, 2014; Romero et al, 2018; Souza et al, 2014; Toci et al, 2015; Verney et al, 2019) (Figure 2). The dimension related to patients implies aspects intrinsic to the individual that can impact HL leading to low self-management, such as: deficit of health knowledge, low educational level, aging, and communicational...…”

“…Evidence showed that the disparity between the complexity of vaccine-related information and the ability of older adults to discern on it was a major cause of this problem (Zhang et al, 2020). Health inequalities are still marked by the deficit of family and/or social support experienced by this population, requiring society to establish inclusive policies for older adults, preventing them from social isolation, and increasing their sense of belonging to a social group from which they can effectively benefit from health knowledge (Blancafort Alias et al, 2021; Leite et al, 2008; Romero et al, 2018).…”