Abstract
A vast majority of literature on the aged population is premised on the increased rate of chronic diseases despite the presence of family and community nursing, as well as increased levels of technology in the health care sector. One of the major factors contributing to these diseases is functional limitation. In a bid to eradicate this predicament, a number of health promotion programs/disease prevention programs have been developed. However, even with the presence of these programs, winning the fight against functional limitation is still challenging. This stems from diverse challenges facing intervention programs. Thus, this paper proposes a groundbreaking methodology for coming up with a suitable program to eradicate functional limitation amongst the elderly population. In a bid to change the attitude of the aged population towards accepting healthy lifestyles, this program calls for the need for adopting the socio-ecological model, the health belief model, and the change logic model. The success of the entire program is addressed through intervention plan, potential formative and summative approaches to the program, evaluation plan, data collection tools, and data analysis. To establish the effectiveness of the intervention, the program will adopt quantitative data analysis using MANOVA, Regression statistics, ANOVA, and t-test.
Introduction
In the recent past, the population of the elderly has increased in diverse parts of the world, especially in the developed countries. Schulz (2001) predicts that the population of the elderly will increase from the current 800 million to approximately 2 billion by the year 2050. However, recent statistics have confirmed that the aged people continue to experience health challenges despite the presence of community nursing and improved levels of technology in the health care sector (Robinson, Novelli, Pearson & Norris, 2007). Nevertheless, recent research has also been able to uncover the rationale of healthy lifestyle in countering functional limitation amongst the aged people.
Healthy lifestyle can be explained as the ability to identify and change from unhealthy behavior to the clinically recommended healthy behavior. Moreover, a healthy lifestyle for the aged population extends beyond healthy eating and frequent exercises to social support. Studies on elderly population continue to uncover that lack of social support increases the chances of functional limitation amongst the aged population (Haber, 2013). But even with the presence of social support, the diseases associated with functional limitation are on an upward trend. Thus, this paper will establish the impact of a viable health promotion program in facilitating a healthy lifestyle that will help reduce the rate of functional limitation amongst the elderly population.
Literature Review
The intervention programs aimed to reduce functional limitation amongst the elderly population are currently facing a prime challenge. This challenge entails establishing the best practices that would help attain the goal of reducing functional limitation amongst the elderly people. Because of this, health promotion/disease prevention programs are faced with diverse interpretations that aim to not only ensure that the aged people are educated enough to manage their lifestyle, but also to ensure that they protect themselves from any health hazards that may contribute to functional limitation. Sheriff and Chenoweth (2008) carried out a longitudinal study to establish the efficacy of the health promotion programs for the old aged and established a positive correlation between high levels of knowledge of healthy lifestyle and increased functional status. This is consistent with Bengtson (2009) findings, which suggest that disseminating knowledge of healthy lifestyle amongst the old people, as well as providing social support, reduces the chance of functional limitation amongst the aged population. However, this study does not provide room for generalization owing to a small sample size.
Another study carried out by Qi, Phillips, and Hopman (2006) reveals that while the elderly people demonstrate high levels of knowledge of a healthy lifestyle, only a few manage to adopt this lifestyle. Prohaska, Anderson, and Binstock (2012) affirm that this is attributed to their attitude and motivation towards life. Moreover, this state of affairs stems from some demographic characteristics of the participants, as well as the adopted methodology for the intervention. The presence of this discrepancy calls for the need for establish the relevant behavioral modification instruments that would help all the older people to adopt a healthy lifestyle.
Relationship to Individual Advanced Role
This program will promote advanced practice in nursing since it will help the nurses to adopt evidence-based practice while implementing an intervention program for the elderly people. This means that even though participants should be subjected to the same procedures for reliability purpose, the nurses and students will be in a position of taking into account the demographic and psychographic characteristics of the participants before deciding on the most critical methodology that would effectively promote the health promotion/disease prevention program. Moreover, the findings will encourage more students to explore diverse theories in a bid to establish the most viable theory within a given area of nursing practice.
Intervention Plan
The proposed intervention will be instrumental in coming up with a holistic plan for eradicating functional limitation amongst the elderly population. The socio-ecological model, the health belief model, and the change logic model will be considered as the most critical models for achieving this end. According to Harari and Legge (2001), the health belief model can be explained as a psychological model that seeks to not only explain health discrepancy but also predict the behaviour of the participants in relation to the intervention program (Dixey, 2012). Moreover, this theory suggests that the response to the health promotion/disease prevention programs is normally influenced by three major psychological factors: beliefs system, perceived benefits, and perceived barriers in the health promoting behaviours (Dixey, 2012). This highlights the need for adopting a positive attitude towards promoting healthy behaviours while eradicating functional limitation amongst the aged population.
In addition to a healthy lifestyle education, the intervention program will be a longitudinal study that will seek to incorporate both direct and continuous physical exercises for the elderly population. Each participant will be enrolled in a physical exercise program that is in line with his/her health requirement(s). After obtaining permission from the ethical board, the participants will be briefed on the proceedings of the intervention. And after the briefing, the health promotion/disease prevention program will take the approach of separating the intervention group from the control group. Professionals in the health sectors will design the education manual for health promotion. The area to be tested will include diverse aspects of healthy behavior and lifestyle, as well as diverse aspect of social support.
Thus, the program will test a number of subjects, including physical intervention, health responsibility, nutritional intervention, interpersonal relationships, memory enhancement, attitude towards old age, and social support. To increase the effectiveness of the program, each participant will receive handouts. During the intervention, the program will adopt groundbreaking messages for encouragement. These messages include the following: the most beneficial foods for the elderly have very few calories; lack of exercise causes premature old age; healthy lifestyle brings happiness in old age; and eating foods that are rich in vitamin B1 and B2 helps people recount their past wonderful memories, among other messages.
Potential Formative and Summative Approaches to the Program
In order to ensure that the intervention helps eradicate functional limitation amongst the elderly population, the program will adopt both summative and formative assessments. While the summative approach is critical in establishing the status of a patient at varying intervals during the intervention process, the formative approach is critical in establishing the overall benefit of the entire intervention program (Clarke & Dawson, 1999). Thus, the study will adopt the summative approach from the onset of the program in order to establish the most critical approach to undertake as the intervention program advances. This will commence by carrying a pre-test, which will be compared with the actual test after the end of the program.
The program will be comprised of four major sessions that are critical in eradicating functional inability amongst the elderly population. The first session will be administered immediately after assigning some participants in the intervention group. The intervention will begin with providing an overview of health promotion/ disease prevention program and the importance of accepting change. The interventionist will ask the participants to choose the most nutritious food for the elderly population. This will help the interventionist to establish their knowledge of healthy food. The success of this session will be evident after the interventionist communicates the need for knowledge and the need for a change of attitudes towards health promotion/disease prevention program.
The second session will adopt a similar format, but with specific focus on the healthy behaviors highlighted in the first session. These include physical activities and memory enhancement activities, among other behaviours. In the third session, the interventionist will review participants’ data and then affirm commitment towards the program’s deliverables. Thus, the interventionist will review the progress of the participants in relation to how they embrace the program. This will be achieved by evaluating the questions that seek to establish the level of motivation amongst the participants. The most critical aspect that the interventionist will seek to establish is the readiness to embrace changes that would help promote the best practice in the health promotion/disease prevention program. Finally, the interventionist will review the goals of the participants. This will help the participants make a comparison between the former attitude towards healthy lifestyle and the latter attitude towards the same.
The fourth session will include revising the plans for change with the participants. The assessment will entail establishing the extent to which the participants are able to integrate different plans in the change process. This session will also include providing the participants with the necessary support in order to prevent any possibility of returning to the old paradigms. Given the presence of diverse variables affecting functional limitation amongst the elderly population, the program will then adopt both the psychological model and the socio-ecological mode. The socio-ecologic model is a critical model in the health promotion programs since it seeks to establish the causes of health deficiency using diverse aspects, including the physical environment, individual level, interpersonal level, organisational level, and, finally, the community level (Leddy, 2006). Thus the program will take into account the demographic and psychographic characteristics of all the participants, including their gender, age house ownership, attitude towards life, perceived health status, current health status, health insurance status, education level, financial status, and employment status.
However, it is imperative to point out that the socio-ecologic model will be adopted during the formative approach. But this will be done after taking into account a number of assumptions. The first assumption is that the environmental factors affecting health promotion/disease prevention are extensive. This means that they extend beyond the physical environment, which includes noise, lighting, space arrangement, to genetics factor and personal attitude towards life and health. Moreover, since the socio-ecological model is able to facilitate multiple levels of analysis, it will be critical in evaluating the effectiveness of the health promotion program on diverse levels. Thus, ensuring success of the intervention program requires proper management of information, as this will help monitor the performance of the entire program.
And according to Leddy (2006), adopting the socio-ecologic model in the summative approach will be critical in ensuring that the health prevention program eradicates functional limitation amongst the elderly due to a number of reasons. First, it will help promote collaboration amongst the participants. Second, it will facilitate a continuous formulation of questions that can be used to assess attitudes and knowledge healthy lifestyle. Third, it will create an opportunity for frequent trails, and hence promote physical activities amongst the participants. Forth, through the social education program, the socio-ecologic model will help provide the patients with safer options for disease eradication programs using social support. Fifth, the strong tie built by the social ecologic model will help eradicate loneliness and, hence, reduce functional limitation. Seven, the socio-ecologic model will help eliminate all forms of social isolation, as well as discriminations, and hence eradicate functional limitation.
However, while the socio-ecologic model meets these requirements during the program intervention, it falls short of developing a viable evaluation plan after the end of the intervention program. And even as the model proposes for increased sharing of resources, it is imperative to note that sharing economic resources in a community has limits, especially in the capitalist nations. Because of this limitation, the intervention will adopt formative approach, based on psychological model. This model will seek to ensure that it assesses the attitude of the participants at the end of the program, in a bid to predict the behavior of the participants in the future.
The change logic model will also be adopted in order to ensure that the program assists the participants after the end of the intervention program. This will be facilitated by ensuring that each participant has established his/her desired area for improvement (Knowlton & Phillips, 2009). While a change of attitude towards functional limitation within the community will be considered as the main benchmark for eradicating functional inability, increase in knowledge and social cohesion with the community members will be considered as the sub-objectives. Designing a program that is able to counter all causes of functional inability will be considered viable for behavioral changes.
Evaluation Plan
The evaluation plan will entail making a quantitative evaluation and a comparison between the intervention group and the control group. Each group will be comprised of 80 participants who are 65 years and above. The evaluation program will be split into ten objectives:
- To calculate the association between functional limitation and frequency of healthy activities amongst the elderly population;
- To assess the association between functional limitation and demographic characteristics of the participants programs;
- To establish whether memory enhancement has a negative correlation with functional limitation amongst the elderly population;
- To appraise how nutritional intervention impacts health promotion/disease prevention plan;
- To establish the association between functional limitation and interpersonal relationships;
- To weigh the association between functional limitation and spiritual growth;
- To assess the association between functional limitation and social support;
- To establish the association between functional limitation and attitude towards old age;
- To evaluate the efficacy of health belief model in eradicating functional limitation amongst the elderly population; and
- To assess the extent to which the socio-ecological model is able to eradicate functional limitation amongst the elderly population.
The participants will be selected from the London city in order to ensure that the selected sample is comprised of people from diverse backgrounds. The study will adopt random sampling in order to create an avenue for generalizing the findings (Balnaves & Caputi, 2001). Assigning the participants to intervention group and the control group will be critical in creating inferences since this will create an avenue for making a comparison between the intervention group and the control group. Moreover, the random assignment of the participants to the intervention and the control group will eradicate the chances of having a significant difference between the two groups. The quantitative design will be critical in verifying the authenticity of the theories used in the intervention program.
To ensure that the evaluation is based on credible sources, the intervention will come up with an inclusion and an exclusion criterion for the participants. Thus, to be eligible for the study, the participants must be 65 years and above and must have been diagnosed with functional limitation. The intervention will opt to exclude participants that have participated in this kind of a study before. And to increase the validity of the findings, the study will ensure that the intervention group does not associate itself with the control group (Balnaves & Caputi, 2001). Moreover, to increase the validity of the program, the program administrators will urge all the stakeholders not to hold an intervention program of this nature within the area for a specified period. This will ensure that the evaluation of the entire program is groundbreaking.
Data Collection Tools
The instrument that will be adopted for collecting demographic data is a questionnaire, which will be customized in different languages. The reliability of the questions will be established after establishing a viable internal consistency between the items/questions in a scale, as well as using diverse tools for measurement. The intervention will use questionnaires because of a number of reasons. First, questionnaires have been proven critical in providing answers that require personal opinion. Second, questionnaires are easy to analyze and are familiar to most people than the case studies or focus groups. Third, questionnaires are very cost effective, as compared to other instrument of data collection (Balnaves & Caputi, 2001).
The questionnaires will be divided into three parts. The first part will collect data concerning background information of the participants. This will entail choosing from fixed responses. This will include information regarding gender, house ownership, age, perceived health status, current health status, health insurance status, education level, financial status, and employment status. The second questionnaire will measure healthy lifestyle. This will be based on Health-Promoting Lifestyle Profile version two (HPLP2). This tool will include 52 questions, and it will help evaluate lifestyle from six dimensions. These dimensions include interpersonal relations, physical activities, health responsibility, nutrition, and spiritual growth. A Likert scale consisting of seven-point scale will be used to evaluate these variables (where 1 = poor health lifestyle and 7= high healthy lifestyle).
The third questionnaire will adopt personal resource questionnaire (PRQ). This will evaluate the perceived social support for the elderly. This tool will measures support in five dimensions: assistance, affirmation of worth, intimacy, social integration, and nurturance on a seven-point Likert scale (where 1= strongly disagree and 7 = strongly agree). The forth questionnaire will adopt Diaz’s item scale, which consists of items/questions based on social connectedness and companionship. These items will be measured on a four-point Likert scale (where 1= never and 4= always). The fifth questionnaire will adopt Miller and Lefcourt’s Social Intimacy Scale, which consists of items that are based on close friendship or intimate relationship. This scale will consist 17 items and will use a ten-point Likert scale (where 1= very rare and 10= always).
Data Analysis
The intervention will ensure strict management of data by employing procedures for quality assurance. As such, the data collected will be transferred to the data storage area, commonly known as data warehouse. The data warehouse will update the new data in accordance to the date of import as well as date of export. Moreover, the safety of the data will emanate from the fact that the data manager will restrict unauthorized access to the data and will eliminate any discrepancy of the data by making a comparison between the warehouse log and the excel log.
Through the permission from the data manager, this data will subsequently be entered into SPSS software for analysis. This analysis will help assess the viability of the health promotion/disease prevention program in relation to reducing functional limitation. These results will take into account the participants’ characteristics, as this will help establish the intervening variables. Therefore, the statistical tests that will be used to analyze the data include Multivariate Analysis of Variance (MANOVA). This test will analyze the mean difference of attitudes between the intervention group and the control group in relation to health promotion and disease prevention variables. Regression statistics will analyze the effect of diverse interventions against heath promotion/disease prevention program. ANOVA will analyze the mean difference between the participants with diverse demographic characteristics. Finally, t-test will use pre-test and post-test to analyze individual’s difference in attitude towards the health promotion/disease prevention.
Summary
This paper has provided a proposal for evaluating the effectiveness of health promotion/disease prevention program in relation to eradicating functional limitation amongst the aged population. Thus, the proposal has highlighted a number of observations. First, it has provided a summary of the intervention plan by highlighting the intervention activities, as well as the rationale behind these activities. Second, the paper has provided a potential formative and summative approach to the program. While the summative approach takes center stage during the intervention period, the formative approach takes center stage at the end of the intervention program.
Moreover, the paper has highlighted the need for adopting socio-ecological model during intervention and health belief model at the end of the intervention program. Moreover, the paper has suggested the importance of change logic model in order to ensure sustainability of the new paradigms obtained from the intervention program. The evaluation plan that seeks to evaluate the success of the program in relation to the interventions programs used, as well as the theories and models that should be adopted within the program, has been clearly articulated. The paper has advocated for questionnaire as the most viable instrument for collecting data. Finally, the paper has highlighted how the collected data will be analyzed using SPSS package, and the statistical test that will be adopted, including MANOVA, Regression statistics, ANOVA, and t-test. Thus, following this proposal to the latter will help in coming up with a health promotion/disease prevention program that is critical in eradicating functional limitation amongst the aged population.
References
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