Research is required on the preventive health care and medical needs of middle-aged and elderly adults, including the prevention and management of chronic diseases; the competence to access, understand, and use health information; and the ability to seek health care services.To evaluate the effectiveness of a participatory action research (PAR)-based health literacy program aimed at improving the health behaviors and health empowerment of middle-aged and older adults in Taiwan.
Methods:
This was an intervention study. We used a quasi-experimental design that involved administering surveys at the baseline, immediately after the intervention, and 6 months and 12 months after the intervention. This study was conducted from 2015 to 2017.
Four communities, two metropolitan areas and two suburban areas, in Northern Taiwan.
Participants were considered eligible if they were aged 50 years or older, spoke Mandarin Chinese or Taiwanese, lived in the community, and had ability to perform activities of daily living. The intervention group comprised 80 middle-aged and older adults, and the comparison group comprised 70.
The intervention group participated in a PAR-based health literacy program, whereas the comparison group did not. The PAR-based health literacy program was designed based on the principles of health literacy and PAR, as well as on preventive health care and medical needs among middle-aged and elderly adults. The PAR-based health literacy program intended to promote the competence of participants regarding access to, comprehension of, and usage of health information; health empowerment; health promotion; and proper use of health services. The PAR-based health literacy program consisted of 12 sessions, each lasting 120 minutes. Each session had a specific objective related to health literacy competence. Participants achieved learning goals through group discussion, experience sharing, in-session exercise, field trips, videos, games, and personal reflection.
The Short-Form Mandarin Health Literacy Scale (s-MHLS), a health behavior questionnaire, and a health empowerment questionnaire were collected. The s-MHLS (0–11 points) was developed by scholars and experts from different fields led by the National Health Research Institutes. The scale consists of “dialogue in outpatient clinics” and “medicine information.”Health behaviors were assessed in 3 months to understand changes in chronic disease prevention and control. These included weight control, regular exercise, healthy diet, correct use of medicine, having access to health information, following the nursing staff’s orders, undergoing health screening, and being cheerful. The health empowerment questionnaire consisted of 31 items. A confirmatory factor analysis model was fitted to these items, and the following values were obtained, indicating satisfactory internal consistency: normed fit index = 0.79, relative fit index = 0.746, comparative fit index = 0.837, and root mean square error of approximation = 0.104. The full score for each part was within a range of 88 points. Higher scores indicate better health empowerment. The Cronbach α was 0.93, indicating satisfactory internal reliability.
Results:
Data were collected from four communities during the study period. The mean age of participants in the intervention group was 68.99 ± 7.69 years, and they were 2.4 years older than those in the comparison group (p = 0.70). The average s-MHLS scores of the intervention and comparison groups were 6.469 ± 4.40 and 7.17 ± 4.37, respectively, a difference (low) of 0.71 points, which was not significant (p = 0.33). Compared with the comparison group, participants in the intervention group had superior results in body weight control, regular exercise, healthy eating, correct use of medication, and maintaining a good mood (p < 0.05). Results from the health empowerment showed no significant differences between the two groups (p = 0.78). The program had a short-term impact on health behaviors, but effectiveness could not be sustained over time .
Conclusion:
Health literacy is significantly related to age and education. Most relevant studies have indicated that health literacy correlates with age, ethnicity, and education. Poor health literacy was observed in people of a higher age, African or Latin American descent, or with an education level lower than high school (Schillinger et al., 2003; Mancuso & Rincon, 2006; Levinthal et al., 2008). This finding is consistent with that of our study. The purpose of cultivating health literacy is to induce health behaviors. However, improvements in health behaviors do not occur overnight and long-term intervention is necessary. Kim (2014) also adopted the community group approach and included middle-aged and older residents with hypertension as participants. The results showed that diverse teaching strategies can motivate patients with hypertension to voluntarily engage in blood pressure control. The purpose of adopting teaching strategies based on health literacy is to motivate participants to develop sufficient health literacy and voluntarily exhibit more health behaviors and more interaction with other people; thus, they can ultimately understand their own strengths and weaknesses in health maintenance. PAR-based intervention is a form of health empowerment. The main purpose of PAR is to allow participants to learn how to search for and use information by collecting relevant data, participating in activities, and reflecting on the activities. PAR targeted at older people is not limited to skill and ability building. It should also focus on establishing mutual trust and communication between researchers and participants. Therefore, research is a process of constant mutual learning and learning how to solve problems. The ultimate purpose of developing health literacy is to make correct health decisions, that is, empowerment. Schulz and Nakamoto (2013) argued that empowerment has three aims: (1) to increase patients’ autonomy in making health decisions; (2) to assume responsibilities in health care provision and to manage the cost of health care; and (3) to improve health results. Most of the items observed in this study exhibited no significant difference. This is possibly because participants in the intervention group were older than those in the comparison group and exhibited relatively poor health literacy. Furthermore, researchers can continue the program in the future to examine the long-term impacts.
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