Abstract
BackgroundThis systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas.MethodsEight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people.ResultsTwenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions.ConclusionsThis review identified facilitators, barriers and strategies for engaging ‘hard to reach’ older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.
Highlights
This systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas
This review reports potential facilitators, barriers and strategies to engagement in research on health promotion in groups of older people known to participate less, including the oldest old, older people from black and minority ethnic groups (BME), and older people living in deprived areas
To our knowledge no previous systematic reviews on the oldest old, older people from BME groups and older people living in deprived areas have reviewed engagement in a broad range of health promotion interventions
Summary
This systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. The oldest old (people aged 80 years and over), older people living in deprived areas and older people from black and minority ethnic groups (BME) have more health problems and health care disparities compared to the general older population [3, 4]. The oldest old is the fastest growing age group in the population [5, 6], making them an important target for health interventions This group is a diverse section of the population, ranging from relatively healthy, independently living individuals to very frail individuals with multiple diseases, poor physical functioning and cognitive problems, presenting unique challenges for undertaking research on health promotion [7], and they are often excluded from studies [8, 9]. No systematic reviews on the oldest old have to our knowledge considered a broad range of health promotion interventions within the review
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