Older participants were mainly women aged 65-92, French-speaking, with more than seven years of education, living with their spouse, and residing in the RCM for over 15 years (Table 1). Three out of five older participants reported at least one disease and about two out of five felt depressed. Caregivers were women aged 43-86, with the majority having a high school diploma (Table 1). Half the caregivers cared for a parent and had done so for more than five years. Most lived with a spouse or family member, reported no disease and did not feel depressed (Table 1). Healthcare and community organization managers and employees, partners and key informants were mostly women and the majority had at least five years of experience within the RCM (Table 1). From the interviews and focus groups involving all these participants and from discussions with the governance committee, important factors for the social participation of older adults, i.e., facilitators and barriers, were identified, followed by social participation needs. Lastly, participants prioritized these needs.
Factors reported as important for social participation
All factors that influence social participation were reported as potential facilitators or barriers, depending on each participant’s experience (Table 2). For example, a family can be supportive, visit often and facilitate the social participation of one older adult, while a family living far away, unavailable to help, might be a barrier for another. However, five factors, three personal and two from the social environment, were principally facilitators, while one personal factor was mainly a barrier (Table 2).
Among personal factors, desire, motivation, interests and habits with respect to being socially active were important for social participation (Table 2), as highlighted by participants from one group of older adults (O): ‘My husband and I have been involved with many organizations since we were young […]. We did a lot of volunteering and we still do […]. When there are volunteer dinners, we go! We don’t miss anything!’ (O6: number identifies the discussion from which the quote was taken). The desire of older adults to be involved in the community and volunteer was also an important factor (Table 2), as reported in another group of older adults: ‘I’d like to help someone who is unable to go out.’ (O8). Finally, the health of older adults was also influential (Table 2), as described by one group of workers from healthcare and community organizations: ‘[My mother] is in great shape. She is involved in a lot of things.’ (Workers, W1).
Among physical environmental factors, the availability and accessibility of infrastructures and meeting places were important for social participation (Table 2): ‘Not all towns and villages have meeting rooms.’ (O2). Distance to resources, recreational facilities and social partners were also reported as factors that influenced social participation: ‘There’s one thing with paratransit; it’s easier for older adults in the city to use [compared to those living in rural areas]. They’re closer to it.’ (Community partner, C2).
Finally, many social environmental factors such as the availability and organization of various resources such as transportation, assistance, adapted activities, volunteers and information were reported as important for the social participation of older adults living in the rural RCM (Table 2): ‘We know, transportation is a limitation here […] Since it is limited here, older adults cannot take part in certain activities.’ (Healthcare and community organization managers, M3). The support, presence and habits of family and friends in interacting were also important, as noted by these older adults with disabilities: ‘My husband pushes me [in the wheelchair]. Also, when we visit our children, one of my sons brings me up to his house. Our children are very helpful.’ (O4-Disability).
Factors that influence social participation were often reported as being interrelated. For example, when health was not an issue, organizing transportation was easier when older adults still drove their own car. However, when older adults who lived far from the main town experienced declining health, the availability of volunteers to assist and transport them became important. Discussing facilitators and barriers in focus groups beforehand generated a better understanding of the overall situation and helped the process of identifying needs.
Social participation needs of older adults
Nine needs emerged from the discussion concerning factors influencing social participation (Table 3). One third of those needs focuses on adapting activities or the physical environment (accessibility, adapted activities and transportation), another third mainly targets the initiation of activities (information, identification and personalized approach), while the remaining needs relate to the social environment (assistance, support network and recognition).
First, needs were related to the adaptation of activities or physical environment, such as having access to meeting places, as mentioned by the group of English-speaking older adults: ‘[We need] a center where we could go, you know, a place we could go to.’ (O7-English). Places for socializing and doing activities include community halls, local businesses and churches. These places must also be adapted to health conditions, with access ramps and suitable maintenance, including snow removal. Having access to activities adapted to their needs is important for older adults: ‘We need to find activities, either walking or … I don’t know… cycling. However, 70-year-olds won’t be cycling. We need to try to vary the activities offered.’ (O2) or ‘Just an afternoon of getting together and we could do whatever people bring with them, it’s still a social exchange.’ (O7). Activities should be interesting for older adults, tailored to their schedule, offered at a reasonable cost, in their main language and suited to their health conditions. The last need identified involved information about access to transportation options: ‘We will need to have transportation, which can be carpooling, partnering, etc.’ (Healthcare and community organization managers, M2) and ‘People should know transportation services that can go and get people in the villages, take them to the community center or any other activity.’ (O8). All kinds of transportation were discussed, including public transportation, assisted transportation and individual transportation [own car]. As for activities, transportation must be suited to the schedules, budget and health conditions of older adults, including those with mobility issues.
Second, regarding initiating activities, older adults need to be better informed about social opportunities, as illustrated by this quote from one group of healthcare and community organization workers: ‘We should find ways to ensure that information gets to people, that people understand how to access resources, as clearly as possible.’ (Workers, W2). Such information can reach older adults themselves or anyone interacting with them, for example, their family or healthcare providers. Second, it is necessary to reach out to older adults who are isolated, as reported by one group of managers: ‘Nowadays, nobody knows “who” is isolated, “who” has needs in the municipality. This information is lacking.’ (Healthcare and community organization managers, M1) and by one older adult: ‘It’s not just waiting for the older adults to get moving, it’s getting [information to them] in their homes.’ (O8). More isolated older adults need to be identified, located and helped when they have less contact with others. Often, older adults also need to be personally invited and welcomed to activities: ‘It’s not because they don’t want to, but I have the feeling that it would take someone to come pick them up, someone who can motivate them.’ (Workers, W1). Upon arrival at activities, this personalized approach should include a warm welcome, which could be from family members, relatives, healthcare providers, community organizations, volunteers or other contacts.
Among needs related to the social environment, some older adults need assistance in initiating or taking part in activities in the community: ‘Some older adults could go [to the activity], but they would need to be accompanied for a while, so they don’t show up alone.’ (Community partners, C1). Such support could be provided when the older adult does an activity for the first time, or more regularly, to ensure that a routine is established to participate in the activity. Social support from a network is also important to simply socialize, to provide psychological support, or to help with domestic tasks (for example): ‘There are people who need our help. Just to talk… they are alone. They are just happy when we go and talk to them.’ (O2). Being valued and recognized was one of the nine needs of older adults, as noted by one group of managers: ‘We have to value our older adults if we want them to participate socially. They need to feel that they’re important, that they have something to say, and that they’re still helpful.’ (Healthcare and community organization managers, M4). Such acknowledgement refers to the feeling of making a significant contribution to the community, having status in society, and being respected and appreciated by others.
Specifically, these nine needs identified by all types of participant mainly targeted older adults, not stakeholders, the community or healthcare organizations. Two needs, i.e., ‘being healthy’ and ‘wanting to participate’, were both indirectly considered under the needs ‘having access to activities suited to their needs’ and ‘being personally invited and welcomed to activities’, respectively. As they involved mainly personal factors and might be seen as prerequisites for social participation, these two needs were not directly targeted in the following step.
Prioritization of needs
Overall prioritization, i.e., when the perspectives of the three populations were merged, suggested six important needs for older adults in the RCM (Figure 1; above 200 points), some of which are interrelated. For example, needs for information, assistance and transportation were frequently discussed as being closely related to the social support network that could inform, transport and accompany the older adult. Specific prioritization, i.e., considering each population separately, revealed differences in social participation needs (Table 3). When targeting older adults in general, the main needs were information, adapted activities, support network and identification. For older adults with disabilities, the needs prioritized were assistance, adapted activities, accessibility and transportation. Finally, transportation and information were two central needs of older adults living in a rural RCM.