Community commitment via participation in community groups is associated with improved health outcomes in older adults and has a ripple effect on development of the community. However, factors associated with community commitment have not been examined. To the best of our knowledge, this was the first study to examine the associations of community commitment with individual factors and group-related factors among older adults participating as leaders or members in community groups. The participants in this study were considered to be representative of community-dwelling older adults who participate in community groups in urban areas. The mean age was 78.3 years for the total population, 76.7 years for leaders, and 78.4 years for members. Fewer leaders than members were under medical treatment for all items, which is inconsistent with previous studies on differences between group leaders and members. In a previous study, African Americans aged 18 years and older were the target population, but there was no report of leader/member-specific group activities for older adults only. Because of differences in the target population, the results of the present study may not be consistent with those of the above study, and further research is needed.
The mean CCS score was 17.2 for the total population, 18.4 for leaders, and 17.2 for members. It has been reported that the mean CCS score among older people over 65 years old living in urban areas is 14.5. Our study population participated in regular group activities in the community, and they had higher CCS scores than the general population of older adults. Moreover, because leaders are required to collaborate with various local organizations in the management of group activities, they may have wider connections with the community and greater community orientation than group members. This result may be related to the fact that members of the general population are expected to be the primary resource in the community whereas leaders are expected to serve as advanced resources in community health networks and organizations.
Whether leader or member, we found an association of CCS scores with SF-15, WHO-5, LSNS-6 scores and a perception of deriving pleasure from group participation. As for the relationship between the SF-15 and CCS, there are reports that the greater the sense of belonging to a community, the better the health behavior of individuals[45–47]. The SF-15 scale encompasses not only self-efficacy in weight control and medication management but also in utilization of community resources, such as knowing about community resources and being able to consult with local professionals when in need. Improving comprehensive health behaviors through health-promoting group activities, which is one of the objectives of group activities, may also be important in increasing community commitment. As for the relationship between mental health (WHO-5) and the CCS, it has been pointed out that an increased sense of belonging to a community via community participation, rather than mere participation in community activities, is associated with mental health among older people[48, 49]. As for the relationship between social network (LSNS-6) and the CCS, previous studies have reported that talking frequently with neighbors was significantly related to both the desire to participate in community activities and the level of community commitment. Studies in urban areas of Canada have shown a significant association between a sense of belonging to a community and social capital, such as having family and friends, which is consistent with our study. As for the relationship between the perception of pleasure from group participation and the CCS, it can be said that positive perceptions of community activities and the community may increase owing to the pleasure derived from group activities in the community[52, 53]. If participants perceive pleasure from community-based group activities, this may promote greater social interaction and health-promoting behaviors as well as lead to greater commitment to the community[54, 55].
Sufficient economic status, frequency of going out, years of group participation, and perception of a role in the group were significantly associated with high CCS scores for members but not for leaders. The number (percentage) of respondents who reported sufficient economic status was 51 (94.4%) for leaders and 749 (86.5%) for members (Table 1). The mean ± SD of the frequency of going out was 5.4 ± 1.5 days for leaders and 5.1 ± 1.8 days for members (Table 3). As for sufficient economic status and frequency of going out, it is possible that a ceiling effect occurred in leaders, such that only members showed a significant association. Poor economic conditions can lead to limited social activity and declining health, which can also reduce interaction with and activity in the community. As for members with a lower economic situation and frequency of going out, CCS scores may also be decreased. An individualized approach tailored to the physical and living conditions of people with lower socioeconomic status may be necessary. Community groups can be an opportunity for older adults to secure regular opportunities to go out within the community and at low cost. In supporting community group activities, it may be necessary to consider the cost burden and ease of access for group participants.
One of the outstanding factors in this study was the relationship between role in the group and community commitment. Regarding roles, it has been reported that work and family roles are important to one's identity at older ages. A previous study among older adults reported that taking on a leadership position in an organization can reduce the risk of dementia by approximately 20% in young-old people. Other previous studies of geriatric residents have shown that high levels of social participation and having an important role in an organization have a protective effect against depressive symptoms in women and that there is an interaction between social participation, status in an organization, and rural residence among men. It is also possible that members, who make up most participants in group activities, are able to enhance their sense of belonging to the community through their roles in group activities. Therefore, it is important for older people to become involved in group activities so that participants, especially members, can find some kind of role to increase community commitment among participants and enhance the wider effect on the community.
The supplementary qualitative analysis yielded seven categories of role cognitive content among older participants in group activities. These categories will be helpful in developing policies for group activities. The categories were interpreted identically for leaders and members, but there were some differences in the code. For example, resource mobilization was answered with respect to ward officials by leaders and with respect to community members by members. For working cooperatively with the local community surrounding the activity, this result was consistent with those reported in previous studies. Additionally, participatory decision-making was only identified among members. This may have occurred owing to the likelihood that leaders easily came up with roles related to leadership tasks. In this study, the CCS score was approximately 1.5 times higher for the total population and approximately 1.4 times higher for members who answered "yes" to perception of a role in the group. Whereas there are reports on the importance of a group role[57, 58], there are others reports cautioning against making such roles too burdensome for participants. Thus, to increase community commitment, apart from thinking of leaders as advanced resources for the community, it is important to appropriate their roles so that group participants can better recognize their own roles.