Health Promotion Project Proposal and Needs Assessment 3 Answer

Evidence-based plan addressing the health issue

Introduction

The problem of social isolation or loneliness is growing among older Australians and this issue was further compounded during the COVID-19 pandemic. Social isolation is defined as the state of having minimal contact with others (Smith et al., 2020). However, it should not be confused with loneliness as loneliness is a subjective feeling. In normal circumstances also, older adults are at high risk of being socially isolated compared to the young age group. Social isolation is an issue that it is often overlooked and it’s effect on health is underestimated. With the increase in ageing population in Australia, the issue of social isolation is further becoming common. According to Gorenko et al. (2021), the COVID-19 pandemic and the restriction of quarantine had a negative impact on older adults. The COVID-19 pandemic increased the number of older adults who are socially adults. Paying attention to the issue of social isolation is important because of its detrimental impact such as increase in risk of stress, depression and anxiety. According to Sepúlveda-Loyola et al. (2020), social isolation is a major risk factor that is associated with poor physical and mental health: increase in blood pressure, depression, obesity, heart disease and diminished immune system.

Thus, the prevalence of social isolation in elderly people and it’s negative consequences on physical and mental health suggest the need to identify approaches to decrease social isolation in the target group. The aim of the report is to develop a health promotion project based on needs analysis from research literature. The report will define action areas and define evidence-based plan for targeting the action area. The report will also define potential barriers in addressing the actin area and the key stakeholders who can engage in the process to address the action areas.

Results of Needs Analysis

The health promotion plan for elderly people will be developed informed by one or more of the action areas of the Ottawa Charter. The Ottawa Charter for health promotion laid down actions to achieve health for all and the five action areas that were identified included creating supportive environment for health, building healthy public policy, strengthening community action, developing personal skills and re-orienting health services (World Health Organization, 2022). For this health promotion project, the action area of developing supportive environment for health has been targeted. Creating supportive environment implies improving the living condition by increasing access to appropriate services and facilities. In case of the problem of social isolation in elderly people, supportive environment means increasing access to age-centric and community based social programs such as social clubs, senior centres and volunteer programs (Thompson, Watson & Tilford, 2018). The need for such program has been found based on needs analysis from research literature.

Research literatures mainly identified incidence of social isolation among older adults during the COVID-19 pandemic. According to Scarfe et al. (2022), during the COVID-19 pandemic, the older Australians were mostly vulnerable to isolation and psychosocial harms. This occurred as older Australians aged above 60 years were advised to self-isolate to decrease the risk of infection and death. However, such restrictions were associated with great impact on social and emotional well-being as the situation contributed to loneliness, social isolation, high rate of anxiety and depression. The social networks of older adults were restricted due to quarantine. In this situation, older adults mostly relied on informal means of support. They mostly connected with online and digital technologies to connect with loved ones and coordinate with local volunteers. Thus, the study reflects the need of the older adults and also shows the importance of social networks in promoting well-being in older adults. The study revealed that access to informal social networks acted as a protective factor for older adults. Similar means of support is needed even after the pandemic.

The health promotion targets implementing social support programs to promote psychological well-being and reduce social isolation among older people in Australia. This is important because older adults have many social needs and they social relationships and interactions. According to Abdi et al. (2019), when older adults fail to sustain relationships, they start experiencing social isolation. High prevalence of loneliness was identified as a major concern in this group and it suggested the need to provide access to meaningful social support. The evidence by Fakoya, McCorry and Donnelly (2020) further explored the challenges for older adults due to loneliness and social isolation. Social isolation was found to be a risk factor of all cause mortality and engagement in negative behaviour such as smoking, lack of exercise, obesity and high blood pressure. In addition, loneliness increases the rate of cognitive decline and mental health conditions such as depression and dementia. The burden of the problem is understood from the statistics that around 50% of the individuals aged above 6 years are at risk of social isolation. Due to growing burden of loneliness, there has been a growing policy interest in loneliness and social isolation. More number of programs that support older adults are needed to address the problem.

Another reason for targeting social support network is that having a supportive environment was found to be associated with health and well-being among older adults. This required a focus on the built environment too. The World Health Organization emphasized on the importance of built environment for seniors. Improvements in the built environment can decrease the risk of health complications for elderly (WHO, 2016). Older people may experience anxiety, disability and depression if they do not get ideal home and neighbourhood environment. In contrast, good built environment can lead to better physical and mental health. For instance, seniors who live in walkable neighbourhoods have been found to have decreased depressive symptoms (Tan et al., 2022). The study by Lyu and Forsyth (2022) explored if the build environment is the cause behind loneliness in older adults. It was found that loneliness was influenced by personal factors and social environments. Build environment can shape loneliness and social isolation. Some examples of the built environment that is associated with less loneliness are walkability, green space and overall neighbourhood environment. Thus, based on benefits identified above, the health promotion plan proposes building an active living environment for older Australians in the community. It should allow elderly clients to engage in some activities, socialize with others and do meaningful activities. Such environment is likely to minimize the mental health impact of social isolation among older adults.

Evidence-based Plan for the Action Area

The Ottawa Charter action area of creating supportive environment has been implemented in many settings in different forms. It is in the form of dedicated social intervention and community support programs. The study by Tong et al. (2021) identified that both individuals and group interventions have been implemented in the past to address social isolation in elderly clients. Based on the review of different studies implementing social support intervention, it was categorized into two types: structural social support and functional social support. Out of eight group interventions, six were found to be associated with improvement in structural social support. Studies which targeted clients with social isolation had better outcome on all dimensions compared to studies without any specific targets. Similarly, interventions implemented in social and public spaces had better outcomes. The study by LaRocca and Scogin (2015) explored the impact of cognitive behavioural therapy on social support and quality of life in older adults. The participants were randomized to CBT group or the minimal support conditions. The CBT treatment consisted of 16 sessions. The key components of the interventions were relaxation, activity scheduling and changing unhelpful thoughts. The social support given through CBT was found to influence the overall quality of life. High social support is a marker for certain skills such as feelings of encouragement, openness to try new behaviour and more use of acquiring new skills. This program gave participants the opportunity to practice new skills and use emotional resources effectively. The skill of therapist is essential in this regard to provide adequate support. It can decrease interpersonal conflicts. These lessons can be used to inform current health promotion project.

The Ottawa Charter action area that informs this health promotion plan is the creating supportive environments for the target population by implementing social support programs and interventions in Australia. However, the novel aspects of this social networking program are that it targets tailoring intervention as per the sociocultural needs of the client. For instance, older people above 75 years may not be interested in such programs. Such individuals will need facilitated support to minimize feelings of social isolation and loneliness. In addition, there are many older adults in Australia who belong to ethnic minority group and have different cultural practices. It is planned to make the social support program personalized for these groups to eliminate sociocultural barriers (Liu et al., 2020). For instance, the social needs of Aboriginal and Torres Strait Islanders are very different. Their meaningful of kinship is diverse and they have different culture and language. Thus, conversations and activities need to be personalised according to the cultural values, needs and interests of the elderly population froup. For those, who are already affected by loneliness and social isolation, support through telehealth interventions would be required. In addition, addressing the social isolation issue requires the intersectoral action. Thus, partnership and collaboration between the heath, aged care and social care workers will be required.

Potential Barrier to Addressing the Action Area

The successful implementation of the social program may be affected by many barriers. Firstly, reaching the older people who are socially isolated may be difficult. It may require developing adequate assessment criteria to select the right population group. Thus, the eligibility criteria will as be as follow:

• Elderly people living alone
• Those living with any health problem or disability
• Those with exposure to significant life events such as loss of spouse or loved ones (Thompson, Morris & Bird, 2022).

Different methods of assessment will be required as many older people will be reluctant to identify themselves as being socially isolated because of the stigma associated with the condition (Barreto et al., 2014). Thus, evidence-based assessment method will be required to identify vulnerable groups and expose them to social support interventions.

The second barrier to the successful implementation of the project could be the cost or financial aspects. The main rationale for this is that the change may require changing existing infrastructure and adding additional components to enhance social support for older adults in Australia. This will require great investments and arranging funds would be a challenging task. In addition, the success of the project will depend on GPs, other health services providers and social care workers. The GPs role would be crucial in conducting assessment and identifying vulnerable groups. In addition, they can also play a role in providing better referrals to address social isolation (Freedman & Nicolle, 2020). In addition, training personnel need to be recruited to implicate dedicated social support programs for the older Australians.

Key Stakeholders

To make the health promotion project successful, there is a need to involve different stakeholders in the project. Firstly, the support of the local government in South Australia will be important. This is required to get funding and other implementation related support for the social support program. The target locations which have been targeted are home, social setting and residential aged care. By including these three groups, it is possible to include all vulnerable elderly clients exposed to social isolation risk in the program. Other important stakeholders will be counsellors, social support experts, social workers, health care professionals and GPs. They can collaborate together to plan evidence-based social support interventions that can address social isolation in the target group. The counsellor can engage in partnership with elderly clients with serious social isolation issues (Nitsch, 2013). They can deliver structured CBT or social support activities to help them develop new skills and learn ways to cope with the illness. In addition, health care professionals can play a role in providing appropriate referral pathways to address their loneliness. They can direct client to appropriate services.

Critical Reflection on the Health Promotion Project Proposal

The completion of the above health promotion proposal was a useful learning experience for me as it helped me understand the importance of the Ottawa Charter action areas in addressing a population related issue. Based on the preparation for the project, I identified social isolation as a major risk factor for poor health in elderly client. Based on needs assessment, it was identified that social support or social connectedness is crucial for healthy ageing (Wu & Sheng, 2019). During the COVID-19 pandemic, highest incidence of social isolation and depression in older adults were seen due to sudden self-quarantine rules and loss of access to social contact. In addition, evidences showed that social support increased psychological health of older adults. Thus, based on the needs analysis, the Ottawa Charter action area of creating supportive environment was identified as the most suitable for the health problem. However, based on analysis of the Ottawa Charter from the post-colonial perspective, I could identify many gaps or challenges in its implementation. For instance, the Ottawa Charter masked underpinning power imbalances and Western centric worldviews. The conference was held based on a new interest on global health but unmet needs of the west (McPhail-Bell, Fredericks & Brough, 2013). Hence, many contextual factors were ignored. During the application of the Ottawa Charter, I could identify this gap too. This is said because such of the Ottawa Charter was dependent on various factors.

For instance, I selected creating supportive environment but there were many barriers that could affect the success of the plan. I realized that such form of change need infrastructure reform as well as change in the overall nature of intervention. Hence, the success was dependent on meeting holistic needs of client, the duration of the programs and the types of staff involves. The action area could eventually contribute to better quality of life in elderly client. All those groups who were eligible according to the selection criteria would gain benefit from the action areas outlined in the report above. However, while planning the activities as per the Ottawa Charter action areas, it has been found that voices of certain group were missing in the Charter. For instance, it did not consider the challenges for culturally diverse population groups or those with perceived stigma. Through critical reflection, I could identify the weakness in the plan and made changes accordingly. I could sense this because based on my real-life experience; I have faced challenges in terms of language in any new country. Similarly, Aboriginal and Torres Strait Islanders have different world view about health and considering the cultural view of this group is important (McPhail-Bell, Fredericks & Brough, 2013). Thus, Ottawa Charter was found to be based on western-centric worldviews and it silences the voices of the Indigenous group. However, through critical reflection and analysis, I planned to address this gap by planning ways to meet the needs of the Indigenous group. Hence, the health promotion project is based on non-western world views as initial limitation of the Ottawa Charter has been rectified.

References

Abdi, S., Spann, A., Borilovic, J., de Witte, L. and Hawley, M., 2019. Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC geriatrics , 19 (1), pp.1-15.

Barreto, M., van Breen, J., Victor, C., Hammond, C., Eccles, A., Richins, M. T., & Qualter, P. (2022). Exploring the nature and variation of the stigma associated with loneliness. Journal of Social and Personal Relationships , 39 (9), 2658-2679.

Fakoya, O. A., McCorry, N. K., & Donnelly, M. (2020). Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC public health , 20 , 1-14..

Freedman, A., & Nicolle, J. (2020). Social isolation and loneliness: The new geriatric giants: Approach for primary care. Canadian Family Physician , 66 (3), 176-182.

Gorenko, J. A., Moran, C., Flynn, M., Dobson, K., & Konnert, C. (2021). Social isolation and psychological distress among older adults related to COVID-19: a narrative review of remotely-delivered interventions and recommendations. Journal of Applied Gerontology , 40 (1), 3-13.

LaRocca, M. A., & Scogin, F. R. (2015). The effect of social support on quality of life in older adults receiving cognitive behavioral therapy. Clinical gerontologist , 38 (2), 131-148.

Liu, J., Wei, W., Peng, Q., & Xue, C. (2020). Perceived health and life satisfaction of elderly people: Testing the moderating effects of social support, attitudes toward aging, and senior privilege. Journal of Geriatric Psychiatry and Neurology , 33 (3), 144-154.

Lyu, Y., & Forsyth, A. (2022). Planning, aging, and loneliness: reviewing evidence about built environment effects. Journal of planning literature , 37 (1), 28-48.

McPhail-Bell, K., Fredericks, B., & Brough, M. (2013). Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter. Global Health Promotion , 20 (2), 22-29. 

Nitsch, M., Waldherr, K., Denk, E., Griebler, U., Marent, B., & Forster, R. (2013). Participation by different stakeholders in participatory evaluation of health promotion: A literature review. Evaluation and Program Planning , 40 , 42-54.

Scarfe, B., Adams, C., Gringart, E., McAullay, D., Sim, M., & Strobel, N. (2022). Maintaining social and emotional wellbeing among older adults during periods of increased social isolation: lessons from the COVID-19 pandemic. Australian Journal of Psychology , 74 (1), 2141584.

Sepúlveda-Loyola, W., Rodríguez-Sánchez, I., Pérez-Rodríguez, P., Ganz, F., Torralba, R., Oliveira, D. V., & Rodríguez-Mañas, L. (2020). Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. The journal of nutrition, health & aging , 24 , 938-947.

Smith, M. L., Steinman, L. E., & Casey, E. A. (2020). Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox. Frontiers in public health , 403.

Tan, T. H. (2022). Perceived environmental attributes: their impact on older adults’ mental health in Malaysia. International Journal of Environmental Research and Public Health , 19 (6), 3595.

Thompson, C. Morris & Bird, S. (2022). Evaluation of the Improving Social Connectedness of Older Australians project pilot. Informing future policy considerations Retrieved from: https://www.health.gov.au/sites/default/files/documents/2022/03/iscoa-project-pilot-evaluation-informing-future-policy-evaluation-of-the-improving-social-connectedness-of-older-australians-project-pilot-informing-future-policy-considerations.pdf

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education , 56 (2), 73-84

Tong, F., Yu, C., Wang, L., Chi, I., & Fu, F. (2021). Systematic review of efficacy of interventions for social isolation of older adults. Frontiers in Psychology , 12 , 554145.

World Health Organization. (2016). Urban green spaces and health (No. WHO/EURO: 2016-3352-43111-60341). World Health Organization. Regional Office for Europe.

World Health Organization (2022). Health promotion. Retrieved from: https://www.who.int/teams/health-promotion/enhanced-well-being/first-global-conference/emblem#:~:text=It%20incorporates%20five%20key%20action,%2C%20mediate%2C%20and%20advocate)

Wu, F., & Sheng, Y. (2019). Social support network, social support, self-efficacy, health-promoting behavior and healthy aging among older adults: A pathway analysis. Archives of gerontology and geriatrics , 85 , 103934. 

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