Healthy Ageing: prevention of loneliness among elderly people: evaluation of a complex ...

217 Pages·2013·2.06 MB·English

Healthy Ageing: prevention of
loneliness among elderly people
Evaluation of a complex intervention
in public health practice

Rianne Honigh - de Vlaming
Thesis committee

Promotors
Prof. dr. ir. C.P.G.M. de Groot
Personal chair at the Division of Human Nutrition
Wageningen University

Prof. dr. ir. P. van ’t Veer
Professor of Nutrition and Epidemiology
Wageningen University

Co-promotor
Dr. ir. A. Haveman-Nies
Assistant professor, Division of Human Nutrition
Wageningen University

Other members
Prof. dr. C.M.J. van Woerkum, Wageningen University
Dr. M.J. Aartsen, VU University Amsterdam
Prof. dr. J.A.M. van Oers, National Institute for Public Health and the Environment,
Bilthoven / Tilburg University
Prof. dr. G. Kok, Maastricht University

This research was conducted under the auspices of the Graduate School VLAG
(Advanced studies in Food Technology, Agrobiotechnology, Nutrition and Health
Sciences).
Healthy Ageing: prevention of
loneliness among elderly people
Evaluation of a complex intervention
in public health practice

Rianne Honigh - de Vlaming

Thesis
submitted in fulfilment of the requirements for the degree of doctor
at Wageningen University
by the authority of the Rector Magnificus
Prof. dr. M.J. Kropff,
in the presence of the
Thesis Committee appointed by the Academic Board
to be defended in public
on Friday 19 April 2013
at 4 p.m. in the Aula.
Rianne Honigh - de Vlaming

Healthy Ageing: prevention of loneliness among elderly people. Evaluation of a
complex intervention in public health practice.
210 pages

Thesis, Wageningen University, Wageningen, the Netherlands (2013)
With references, with summaries in English and Dutch

ISBN 978-94-6173-504-1
Ogen heb je om te zoeken
Naar wat mensen nog ontbreekt
En een hart om uit te zeggen
Wat een ander moed in spreekt

Voeten heb je om te lopen
Naar een mens die eenzaam is
En een hart om waar te maken
Dat geen mens een eiland is

Abstract

Introduction
Concerns about the ageing population and formal responsibilities of local
governments to promote social cohesion and to enhance participation of vulnerable
groups in society placed loneliness prevention high on the local policy agenda of
Dutch municipalities in the past decade. The study described in this thesis was part
of the Healthy Ageing programme of the Academic Collaborative Centre AGORA
and aimed to contribute to more effective, evidence-based and problem-oriented
approaches to healthy ageing at the local level.

Aim
The general aim of this thesis was to evaluate the effectiveness of a local
intervention project – called Healthy Ageing – targeting loneliness among non-
institutionalised elderly people. Healthy Ageing consisted of five intervention
components, namely, a mass media campaign, information meetings, psychosocial
group courses, social activities organised by neighbours, Neighbours Connected,
and training of intermediaries.

Methods
First, the influence of socio-demographic and health characteristics on changes in
loneliness over time and municipal differences in the prevalence of loneliness were
investigated. Data were gathered from 9,641 persons who participated in the
Elderly Health Survey of the community health service, GGD Noord- en Oost-
Gelderland (former GGD Gelre-IJssel), in 2005 or 2010. Second, the overall-effect
of Healthy Ageing on the initial outcome loneliness literacy, intermediate outcome
social support, and ultimate outcome loneliness was evaluated using a quasi-
experimental pre-test post-test design, including an intervention and control
community. Baseline and follow-up measurements, in 2008 and 2010 respectively,
were available for 858 non-institutionalized elderly people. The Loneliness Literacy
Scale was developed within the context of this thesis and was pre-tested in a
separate study among 303 elderly persons who also participated in the quasi-
experimental study. Finally, delivery, reach, and acceptance of the individual
intervention components was studied in several satellite studies. Data were
collected by different means, e.g. project records and surveys among participants.
Furthermore, the acceptability of the mass media communication materials,
information meetings, and psychosocial courses of Healthy Ageing was studied by
in-depth interviews with 14 clients of the meal delivery service in the intervention
community.
Results
Overall and across municipalities, average loneliness scores did not significantly
differ between 2005 and 2010. However, among the subgroup with mobility
disabilities, loneliness was significantly higher in 2010. Furthermore, mobility
disabilities and marital status were the most important factors explaining
differences between municipalities. With regard to the evaluation of Healthy
Ageing, the satellite studies showed that the reach and intensity of the intervention
components were modest. Furthermore, from the interviews it appeared that the
mass media communication materials were not successful in attracting attention
because interviewees did not expect health information from these communication
channels, the perceived personal relevance of the message was low, and the
presentation was not attractive. Moreover, the content of the intervention
components was not well received because the objectives and intervention
components did not connect well with the priority group’s daily life. In addition, it
appeared from the quasi-experimental study that 39% of the study participants
from the intervention community was familiar with Healthy Ageing at follow-up.
Overall, the intervention group scored more favourably on the loneliness literacy
subscales, motivation (4.4%), perceived social support (8.2%), and subjective norm
(11.5%) than the control group. However, no overall effects were observed for the
intermediate and ultimate outcomes, total social support and loneliness after two
years.

Conclusion
Given the modest overall intervention exposure, the effect of Healthy Ageing on the
loneliness literacy subscale, motivation, is plausible, whereas on the subscales,
perceived social support and subjective norm, probable, and on the subscale, self-
efficacy, unlikely. Furthermore, whether the initial effects will carry forward to the
intermediate and ultimate outcomes needs to be confirmed. The modest effects of
Healthy Ageing can partly be explained by the challenges on organisational level
which delayed and suppressed project implementation. Furthermore, the project
might have benefited from a more systematic approach in order to ensure better
alignment between the intervention components and formulated objectives. Finally,
target group differentiation is highly recommended. This evaluation of Healthy
Ageing illustrates how researchers can cope with the evaluation challenges of
complex interventions which cannot be fully controlled. In turn, this provides
valuable lessons for the development of intervention programmes and evaluation
designs in public health practice.
Table of contents

Chapter 1 11
General introduction

Chapter 2 31
Determinants of trends and regional variation in loneliness among
Dutch older people over the period 2005–2010

Chapter 3 47
Evaluation design for a complex intervention program targeting
loneliness in non-institutionalized elderly Dutch people

Chapter 4 65
Loneliness Literacy Scale: Development and Evaluation of an Early
Indicator for Loneliness Prevention

Chapter 5 83
Acceptability of the components of a loneliness intervention among
elderly Dutch people: a qualitative study

Chapter 6 103
Process- and effect evaluation of a two-year complex intervention
project targeting loneliness in non-institutionalized elderly Dutch
people

Chapter 7 125
General discussion

Appendices 149

Summary 185

Samenvatting (Summary in Dutch) 193

Dankwoord (Acknowledgements) 201

About the author 207