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

Promoting Self-Management, Health Literacy And Social Capital In Socioeconomically Disadvantaged Older Adults To Reduce Later Life Health Inequalities: A Randomized Clinical Trial

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.

Study Overview

• Status: Completed
• Conditions: Aging; Self Care; Health Literacy; Social Capital; Subjective Health; Health Status Disparities
• Intervention / Treatment: Behavioral: Program "Sentirnos bien" (Feeling well)

• Study Type: Interventional
• Enrollment (Actual): 390
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Program "Sentirnos bien"; The intervention Program "Sentirnos bien" is based around a group dynamic, held once a week during 3 months, aimed at: Promoting the uptake of self-care healthy habits; Promoting social capital at individual level:; Promoting health literacy	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.
NO_INTERVENTION: Control arm; The control arm will receive no intervention. Once the trial is finished, i.e. after the last follow-up evaluation, this arm will receive the intervention (waiting-list approach).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

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

Collaborators and Investigators

• Sponsor: Fundacio Salut i Envelliment UAB
• Collaborators: Recercaixa; Equip Atencio Primaria Sardenya
• Investigators: Principal Investigator: Laura Coll-Planas, MD, Fundacio Salut i Envelliment UAB; Principal Investigator: Sergi Blancafort, PhD, Fundacio Salut i Envelliment UAB; Principal Investigator: Rosa Monteserin, MD PhD, Equipo Atencio Primaria Sardenya

Publications and helpful links

General Publications

• 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.
• 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. doi: 10.1002/14651858.CD005108.pub2.
• 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. doi: 10.1093/jurban/jth094.
• 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.
• 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. doi: 10.2105/ajph.89.8.1187.
• 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.
• Blancafort Alias S, Monteserin Nadal R, Moral I, Roque Figols M, Rojano I Luque X, Coll-Planas L. 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. BMC Public Health. 2021 Jan 7;21(1):84. doi: 10.1186/s12889-020-10094-9.
• Coll-Planas L, Blancafort S, Rojano X, Roque M, Monteserin R. Promoting self-management, health literacy and social capital to reduce health inequalities in older adults living in urban disadvantaged areas: protocol of the randomised controlled trial AEQUALIS. BMC Public Health. 2018 Mar 13;18(1):345. doi: 10.1186/s12889-018-5219-x.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2016
• Primary Completion (ACTUAL): May 1, 2017

Study Registration Dates

• First Submitted: February 10, 2016
• First Submitted That Met QC Criteria: April 5, 2016
• First Posted (ESTIMATE): April 11, 2016

Study Record Updates

• Last Update Posted (ACTUAL): February 7, 2018
• Last Update Submitted That Met QC Criteria: February 6, 2018
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: FSIE-Recercaixa2014

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO