Study Design
A concurrent mixed methods design was utilized with the integration of qualitative exploratory findings to complement the quantitative analyses conducted among 400 older adults aged 65 years and above residing in a rural area.
Sample size and sampling technique
The sample size was calculated based on a prior study (21) that reported a self-care prevalence of 65% among older adults, with a 95% confidence interval and 5% margin of error.
A multistage random sampling technique was used to select study participants. First, out of 30 rural areas, 5 were randomly selected. Then, 4 colonies/areas were randomly chosen from each area. Finally, from each colony/area, 20 households with older adults were randomly selected. The final sample included 80 participants from each group, for a total of 400 older adults. Purposive sampling of 30 participants who were used to ensure the inclusion of adequate representation based on sex, age, education, and morbidity status
Study variables
The sociodemographic information collected included age, sex, marital status, education, income, and number of chronic conditions.
Self-efficacy was measured using the 10-item General Self-Efficacy Scale (22), which assesses the perceived ability to cope with difficult demands in life on a 4-point Likert scale. The total score ranges from 10–40 points and is categorized as low (10–20), moderate (21–30), or high (31–40).
Health literacy was measured by a validated single-item screening question “How often do you need help reading health information?”, with responses coded as inadequate (always/often), marginal (sometimes), or adequate (rarely/never) health literacy (23).
The self-care practices assessed included diet, exercise, medication adherence, blood glucose monitoring, foot care, and stress management. The health-seeking behaviors included cancer screening, doctor visits, emergency/hospital visits, telehealth use, and traditional medicine use. Both were measured through self-reports.
A phenomenological approach using semistructured open-ended questions explored participants’ lived experiences, beliefs, challenges, motivations, and community perceptions related to self-care and healthcare utilization.
Data Collection Procedure Data were collected by 4 trained research assistants through in-person interviews with older adults at their place of residence using a structured questionnaire. The questionnaire captured all the study variables and was piloted before use. The interviews lasted approximately 30 minutes. The questionnaires were checked for completeness before data entry. After completing the questionnaire interviews, qualitative in-depth interviews were conducted with a subsample of 30 participants to gain deeper insights into their self-care practices and health-seeking behaviors.
Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee before study commencement. Informed written consent was obtained from all participants before the interview. Participants were informed of their right to voluntarily participate and withdraw at any time. Confidentiality was maintained using unique identifiers and secure data storage.
Operational Definitions
Self-care practices: Specific behaviors and activities undertaken by individuals to promote health, prevent disease, limit illness, and restore health. These included diet, exercise, medication, chronic condition monitoring/managing, foot care for diabetes, and stress management techniques.
Health-seeking behaviors: Actions and activities undertaken by individuals to prevent health problems or treat illness, such as attending regular health screenings/doctor checkups for prevention and promptly seeking medical care during acute illness/exacerbations of chronic conditions. This encompasses cancer screening, doctor/emergency room visits, hospitalizations, telehealth use and traditional Ayurveda/homeopathy treatment.
Data analysis
Descriptive analyses were conducted with frequencies and percentages for categorical variables. Pearson’s chi-square tests were used to examine the relationships between predisposing factors, patient needs, self-efficacy, health literacy, and self-care/health-seeking behaviors. Multivariate logistic regression analysis was carried out. SPSS ver 20 was used for quantitative analysis, and Nvivo was used for qualitative analysis. The interviews were audio-recorded, transcribed verbatim, and translated before coding. Thematic analysis was also conducted to identify emerging patterns and themes related to barriers and facilitators impacting health behaviors. p < 0.05 indicated statistical significance.