Engaging hard-to-reach groups in health promotion: the views of older people and professionals from a qualitative study in England

Abstract

BackgroundOlder people living in deprived areas, from black and minority ethnic groups, and aged over 85 years are often considered hard-to-reach. This qualitative study aimed to explore their views on health promotion services, with a view to help inform best practice on engagement. MethodsOlder people were recruited through primary care and community-based groups. 19 participated in an interview (n=15) or focus group (n=4); including some overlaps, 16 were from a deprived area, 12 were in black and ethnic minority groups, and 5 were aged 85 years or older. Cross-sector professionals across England with experience of working with one or more of the groups were identified with online searches and snowball sampling. 31 of 44 professionals completed an online survey. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. FindingsOlder people from all hard-to-reach groups described some health-promoting activities they practised themselves, including lifelong lifestyle approaches, with a focus on maintaining independence. All groups reported cost and access considerations as barriers to participation in health promotion. Among older people in deprived areas, facilitators included monetary incentives and interventions held locally or accessible through free transport. Barriers included reluctance to seek medical help, mistrust of professionals, and negative social relationships with other participants. Professionals' successful strategies targeting this group included personalised health education focusing on their interests and engaging local services, community, peers, and family. Older people from black and ethnic minority groups reported that social opportunities and peer support facilitated engagement. Barriers focused on cultural and language differences. These barriers were also reported by professionals who reported culture-specific, tailored information alongside good relationships with community groups and families as important. For the oldest-old, home visits were popular. Poor health and lack of interest in health promotion were major barriers. Face-to-face contact and involving individuals from an early stage were reported as successful strategies by professionals. InterpretationThis is one of few studies conducted in England investigating views of both hard-to-reach older people and professionals working with them. Study limitations include selection bias because only those interested responded. Specific facilitators and barriers identified by older people and professionals may shape best practice on increasing engagement with health promotion services for hard-to-reach groups. FundingNational Institute for Health Research (NIHR). AL is funded by the NIHR School for Public Health Research.