Ana Jovicic

Facilitators and barriers for recruiting and engaging hard-to-reach older people to health promotion interventions and related research: a systematic review

Abstract Background Older people from particular groups engage less in health promotion interventions and related research, potentially generating inequities. This review aimed to identify barriers and facilitators to participation in health promotion interventions or health promotion-related research in groups of older people known to participate less. Methods We focused on older people from black and minority ethnic groups, older people in deprived areas, and those aged 85 years and older (oldest-old). We searched Medline, Cochrane Library, SCOPUS, Embase, PsychINFO, SSCI, CINAHL, and SCIE databases (Jan 1, 1990, to Dec 31, 2014) to identify eligible studies reporting facilitators and barriers of recruiting or engaging any of the three groups in health interventions or health promotion-related research (see appendix for search terms). Eligible study designs included surveys, qualitative interviews and focus groups, and mixed methods. Recruitment and engagement strategies reported were identified and analysed thematically for each group. Themes were identified by two researchers independently and agreed with the team. Findings 34 studies (three with oldest-old, 24 with black and minority ethnic groups, five within deprived areas, one with both oldest-old and black and minority ethnic groups, one with both oldest-old and deprived areas) were included. Half of studies reported mainly on recruitment; half on engagement. 16 studies focused on participation in interventions; 18 studies were on participation in related research. Facilitators for recruiting in deprived areas included targeting social aspects of participation and providing a personalised approach. Similarly, building trust was important for recruitment from black and minority ethnic groups and oldest-old. Facilitators for engaging black and minority ethnic groups included involving community leaders and recruitment during existing activities; for the oldest-old gaining family support was important. Facilitators across all groups included use of incentives and well-targeted advertising. Barriers among black and minority ethnic groups included fear of falling, poor knowledge of benefits, lack of self-confidence, family responsibilities, and cultural barriers (language, mixed-sex sessions, religious practices). Barriers among the oldest-old included tiredness and feeling too old for preventive health care. Negative social interaction with research staff was a barrier identified in deprived areas only. Barriers across all groups were lack of motivation, deteriorating health, costs, and lack of transportation. Interpretation This review has identified numerous facilitators and barriers for recruiting and engaging hard-to-reach older people in health promotion interventions and related research; these include specific facilitators and barriers for particular groups, which should be considered in practice. Funding This study was funded by the National Institute for Health Research (NIHR). AL is funded by the NIHR School for Public Health Research.

Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol

BackgroundMeeting the needs of the growing number of older people is a challenge for health and social care services. Home-based interventions aiming to modify health-related behaviours of frail older people have the potential to improve functioning and well-being. Previous reviews have focused on whether such interventions are effective, rather than what might make them effective. Recent advances in behavioural science make possible the identification of potential ‘active ingredients’ of effective interventions, such as component behaviour change techniques (BCTs), and intended intervention functions (IFs; e.g. to educate, to impart skills). This paper reports a protocol for a systematic review that seeks to (a) identify health behaviour change interventions for older frail people, (b) describe the content of these interventions, and (c) explore links between intervention content and effectiveness. The protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 guidelines.Methods/designStudies will be identified through a systematic search of 15 electronic databases, supplemented by citation tracking. Studies will be retained for review where they report randomised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community settings, written in English, and either published from 1980 onwards, or, for registered trials only, unpublished but completed with results obtainable from authors. Interventions will be coded for their content (BCTs, IFs) and for evidence of effectiveness (outcome data relating to behavioural and health outcomes). Analyses will describe characteristics of all interventions. Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence. The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness.DiscussionResults will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people, and highlight those more associated with positive changes in behaviour and health. Findings from this review will provide a useful basis for understanding, developing, and implementing behaviour change interventions in this field.Systematic review registrationPROSPERO CRD42014010370

Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study

Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty.