This action research aimed to identify and prioritize the social participation needs of older adults living in a rural area. Personal and environmental, but especially social, factors were reported as facilitators and barriers to the social participation of older adults living in the RCM. Among the nine needs identified, five were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, and 5) having access to meeting places near home and adapted to their health condition. Other needs concern (no preferred order): being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Prioritization of the needs of older adults with disabilities indicated that they mostly needed assistance, adapted activities, a support network and accessibility, while those living in a rural area primarily needed transportation and information about activities and services.
Despite the recent interest in the development of age-friendly communities, literature about the geography of aging, i.e., understanding the relationships between the physical/social environment and the elderly, is scarce , especially pertaining to the social participation needs of older adults in rural areas. As mentioned by Menec and colleagues , the age-friendliness of communities has received less attention in the context of rural settings compared to urban. The present study thus sheds new light on the needs of older adults in rural areas with a view to fostering the successful implementation of social participation initiatives. The results of this study are supported by a qualitative study  on age-friendly communities. Through focus groups with older adults and caregivers from ten rural communities, it identified barriers facing older adults and strategies to implement to promote their social participation. Factors such as adapted activities, transportation, prevention of isolation, access to outdoor spaces and buildings, and information about activities were related to social participation in age-friendly rural communities. In Canada, all provinces have initiated age-friendly community processes , and approximately 800 communities have launched age-friendly initiatives. An age-friendly community encourages active aging by optimizing opportunities for health, participation and security, by adapting its structures and services so they are accessible to, and inclusive of, older people with varying needs and abilities . Eight issues and concerns have been voiced by older people as the characteristics of an age-friendly community: 1) outdoor spaces and buildings, 2) transportation, 3) housing, 4) opportunities for social participation, 5) respect and social inclusion, 6) civic participation and employment, 7) communication and information, and 8) community support and health services. Similar to the social participation needs pinpointed in the present study, most common projects identified in a consensus conference in Manitoba were related to outdoor spaces, buildings, communications and activities (e.g., walking groups, contacting isolated older adults) . However, these projects vary across communities and change over time, suggesting that social participation needs may also vary from one community to the next or over time. Spina and Menec found that the ability of rural communities to become age-friendly was influenced by contextual factors such as size, location, demographic composition, ability to secure investments, and leadership .
Also consistent with the needs identified in this study, one Canadian study used the photovoice technique with 30 participants in one urban and three rural age-friendly communities in Manitoba. It found that to promote health and well-being and facilitate independent living, it is important to ensure that older adults have access to a broad range of community supports, such as the provision of services, counselling, congregate meals, volunteer drivers, and a medical equipment-lending program . For example, congregate meals benefit people who live alone and have difficulty going grocery shopping by providing needed nutrients as well as the opportunity for social interaction. Waiting lists for medical and long-term care are a key concern generally, and rural areas present unique challenges, with their transportation difficulties and greater proportion of older adults . Transportation links older adults, not only to healthcare services, but also to community life, including local businesses, services and opportunities for social participation. Hence, the absence of affordable and accessible transportation may contribute to social isolation. Finally, in addition to transportation, affordability influences many aspects of older adults’ lives, including housing, the social environment, activities and volunteering, community supports, and health services , as suggested in the present study.
Interestingly, in the present study the needs prioritized for older adults with disabilities or living in a rural area were different from those of older adults in general. This points up the importance of doing personalized needs assessments, even within the same region. Transportation and information needs of older adults living in a rural area were so strongly prioritized by the participants that it was difficult to identify priorities among other needs. These results are in line with previous studies which observed that transportation and communication were vital to enhance the social participation of people living in rural areas . Although one cross-sectional quantitative study found that social participation was similar across different types of residential areas in Quebec (Canada), associated area-specific environmental variables were identified . Specifically, in rural areas, while controlling for age, gender, living situation, family income, depressive symptoms and disability, greater social participation was associated with greater accessibility to key resources, having a driver’s license, children living in the neighborhood, and more years spent living in the current dwelling. In fact, social participation needs may vary from one community to the next in the same area since rural communities are not all homogeneous [29, 30]. According to Bryant and Joseph (2001), there are three types of rural communities: 1) the relatively isolated and declining ‘remote hinterland’, 2) the more populated and prosperous ‘rural hinterland’, and 3) the rapidly expanding and transitioning ‘urban countryside’. Such diversity requires a multisite approach that considers not only proximity to cities as a means of differentiating between rural places but also the emergence of distinct combinations of demographic, socioeconomic and policy challenges across rural space. For example, in the present study, the smallest village had 100 inhabitants and was 60 minutes from an urban center, while the largest village had 3,200 inhabitants and was 15 minutes from an urban center. Such different realities might explain why transportation and information are more significant issues for populations further from the city, and their need to address these important challenges to promote social participation.
Strengths and limitations of the study
To our knowledge, this action research is the first to identify and prioritize the social participation needs of older adults living in a rural RCM using a process in which stakeholders played a significant role. In accordance with the guidelines of Raymond and colleagues , this action research directly involved older adults, caregivers and community members from many different backgrounds, and therefore provides an inclusive understanding of the needs of older adults in a rural area. The study was based on a strong partnership with the community and involved a personalized approach to the experiences and cultures of older adults in the RCM. Moreover, as recommended by Laperrière , having several sources of data and participants allowed triangulation, rich information and good internal validity. The limitations included recruitment based on a convenience strategy, where the sample may include more active or healthier older adults, although participants with disabilities, older men and English-speaking older adults were specifically recruited. Older adults with different social participation needs, including men and ethnic minorities, might be underrepresented. As with other qualitative studies, the findings of this study are time- and context-sensitive and influenced by the researchers. Despite using various strategies (no “correct answers”, confidentiality assured and homogenous groups), the nature of the questions could also have been subject to a social desirability bias and limited the sharing of facilitators, barriers and needs. Lastly, the study involved only one RCM and needs to be reproduced in other areas.