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Promoting Social Capital, Self-management and Health Literacy in Older Adults Through a Group-based Intervention Delivered in Low-income Urban Areas: Results of the Randomized Trial AEQUALIS
Sergi Blancafort
Fundació Salut i Envelliment UAB
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5508-4702
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
Background
Evidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality.
Methods
Pragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015-2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention.
Results
390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (-0.62 [-1.10, -0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (-1.26 [-1.90, -0.63]), and at follow-up (-0.95 [-1.62, -0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG.
Conclusions
This study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas.
Trial registration: ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02733523
Keywords
Social Medicine, Public Health, Primary Health Care, Healthcare Disparities, Aging, Self-Management, Health Literacy, Social Capital
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CURRENT STATUS: Published
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Posted 25 Sep, 2020
Published
On 07 Jan, 2021
Published
On 07 Jan, 2021
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Editorial decision: Minor revision
On 10 Nov, 2020
Review #2 received
Received 03 Nov, 2020
Review #1 received
Received 16 Oct, 2020
Reviewer #3 agreed
On 01 Oct, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Reviewer #1 agreed
On 28 Sep, 2020
Reviewer #2 agreed
On 28 Sep, 2020
Editor assigned
On 20 Aug, 2020
Editor invited
On 19 Aug, 2020
Submission checks complete
On 10 Aug, 2020
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Promoting Social Capital, Self-management and Health Literacy in Older Adults Through a Group-based Intervention Delivered in Low-income Urban Areas: Results of the Randomized Trial AEQUALIS
Sergi Blancafort
Fundació Salut i Envelliment UAB
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5508-4702
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 25 Sep, 2020
Published
On 07 Jan, 2021
Published
On 07 Jan, 2021
No community comments so far
Editorial decision: Minor revision
On 10 Nov, 2020
Review #2 received
Received 03 Nov, 2020
Review #1 received
Received 16 Oct, 2020
Reviewer #3 agreed
On 01 Oct, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Reviewer #1 agreed
On 28 Sep, 2020
Reviewer #2 agreed
On 28 Sep, 2020
Editor assigned
On 20 Aug, 2020
Editor invited
On 19 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Version (no preprint)
Posted 13 Jul, 2020
This version was not preprinted
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
Background
Evidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality.
Methods
Pragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015-2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention.
Results
390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (-0.62 [-1.10, -0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (-1.26 [-1.90, -0.63]), and at follow-up (-0.95 [-1.62, -0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG.
Conclusions
This study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas.
Trial registration: ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02733523
Figure 1
Figure 2