Abstract
BackgroundDespite the emphasis on holistic health promotion in community programs for older people, few studies explicitly consider how BioPsychoSocial (BPS) health elements are interconnected and function to improve Quality of Life (QoL). The Community for Successful Ageing (ComSA) program in Singapore focuses on Community Development (CD) initiatives for older people, accounting for BPS theory in its design and content. Biological (B) health is conceived as physiological and cognitive functioning and related biological self-care; Psychological (P) health as feelings of life satisfaction, and Social health (S) as perceived social support and civic engagement.Furthermore, three overlapping sub-constructs are theorized to connect these elements. Namely Bio-Psychological (BP) health in terms of self-perceptions of ageing; the Psycho-Social (PS) aspects of interpersonal communication; and the Socio-Communal (SC) health in terms of civic engagement. BPS health is conceived as distinct from QoL, defined as composed of control, autonomy, self-realisation and pleasure (measured by CASP-19) of the older person.We examined 1) interconnections of BPS constructs and related sub-constructs and 2) their associations with QoL to inform a practical, applied program theory.MethodsA baseline survey (n = 321) of program participants (Mean = 70 years, SD = 8.73). All continuous variables were binarized as ‘high’ if the scores were above the median. Multivariate logistic regression was used to assess 1) the adjusted effect of each BPS construct on CASP-19, and 2) the odds of scoring high on one BPS construct with the odds of scoring high on a related sub-construct (e.g. B and BP health).ResultsThe strongest relationship with QoL was markedly with BP self-perceptions of ageing (OR = 4.07, 95%CI = 2.21–7.49), followed by P life satisfaction (OR = 3.66, 95%CI = 2.04–6.57), PS interpersonal communication (OR = 2.42, 95%CI = 1.23–4.77), SC civic engagement (OR = 1.94, 95%CI = 1.05–3.57), and S social support (OR = 1.89, 95%CI = 1.06–3.38). Core B, P and S health were closely associated with their sub-constructs.ConclusionComSA CD is tightly coupled to its proposed program theory. It offers classes to improve B self-care and BP self-perceptions of ageing, group-based guided autobiography to improve P life-satisfaction and PS interpersonal communication, and community initiatives that encourage seniors to solve community issues. This holistic approach is likely to enhance ageing experiences and QoL.
Highlights
Despite the emphasis on holistic health promotion in community programs for older people, few studies explicitly consider how BioPsychoSocial (BPS) health elements are interconnected and function to improve Quality of Life (QoL)
Community for Successful Ageing (ComSA) CD is tightly coupled to its proposed program theory
We reported the odds ratio (OR) and its corresponding 95% confidence interval (95%Confidence Interval (CI))
Summary
Despite the emphasis on holistic health promotion in community programs for older people, few studies explicitly consider how BioPsychoSocial (BPS) health elements are interconnected and function to improve Quality of Life (QoL). The emphasis has shifted instead to adapting well [1,2,3] to age-related bio-physical and cognitive declines, potentially shrinking social network and quality of interactions, as well as psychological threats to the self from role transitions. This shift is consistent with existing thinking that emphasizes the resilient and dynamic nature of ageing and human development [4,5,6], as well as proactive and asset-based [7] health promotion. The program uses a community development approach [15], by first improving participants’ BPS health, galvanizing them to act on community issues that influence their health, all of which in turn are hypothesized to promote QoL
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