The impact of health promotion on health in old age : results from community-based studies in rural Bangladesh

Background: It is common knowledge that Bangladesh has a high prevalence of illness among its older people and that the government healthcare services offer them inadequate support. Despite this, however, information about older people s health and illnesses as a function of health promotion is scant.

Aims: To examine the impact of a health promotion intervention on health in old age; to examine associations between bone and joint diseases and health-related quality of life; and to study associations between social capital and quality of life among older people in rural Bangladesh.

Methods: This thesis is compiled based on two intervention studies and two cross-sectional studies. Data for Studies I, III and IV were derived from the Primary Healthcare in Later Life: Improving Services in Bangladesh and Vietnam (PHILL) project. Data for Study II were derived from the Poverty and Health in Aging (PHA) project. The projects were located in one of the 64 districts of Bangladesh and situated 70 kilometers southeast of the capital Dhaka. In the PHILL project, eight villages were selected through simple random selection and all the older people (≥60 years) who were residing in the selected villages (n=1,135) were chosen for the study. In PHA (n=850) older people were selected through simple random selection from two purposively selected research blocks. Health promotion interventions in PHILL included physical activity, advice on healthy food intake and other aspects of management. To create an enabling environment, social awareness was provided by means of information about the contribution of and challenges faced by older people at home and in the community, including information about their health and healthcare. The intervention activities were provided to older people themselves, their caregivers, household members, community people, and healthcare providers for a period of 15 months. During analyses, participants in the intervention area were further stratified into compliant (n=315) and non-compliant (n=110) groups based on reported compliance with the intervention activities. Arthritis-related illness and bone and joint diseases were indicated by the presence of any form of arthritis, joint and back pain. Health-related quality of life (HRQoL) was measured using a multi-dimensional generic instrument. Quality of life was assessed using a single global question.

Results: Study I revealed that older people who adhered to health promotion activities reported significantly less arthritis-related illness and less healthcare expenditure. Study II showed that bone and joint diseases were significantly associated with various dimensions and overall HRQoL. Furthermore, being an elderly woman and being a woman with self-reported joint and back pain were associated with lower scores in various dimensions of HRQoL. Study III indicated that, in the non-compliant group, the probability of increased HRQoL scores was less likely only in overall HRQoL. In the control group, the probability of increased scores was less likely in the physical, social, spiritual, environment dimensions and overall HRQoL. Study IV revealed that low social capital, both at the individual and community levels, was significantly associated with poor quality of life.

Conclusions: This thesis suggests that the provision of community-based health promotion intervention among older people could help to both reduce the burden of arthritis-related illness and its related healthcare expenditure, and improve their health-related quality of life.

List of scientific papers

I. Rana AK, Lundborg CS, Wahlin A, Ahmed SM, Kabir ZN (2008). "The impact of health education in managing self-reported arthritis-related illness among elderly persons in rural Bangladesh." Health Educ Res 23(1): 94-105.
https://pubmed.ncbi.nlm.nih.gov/17301056

II. Rana AKMM, Wahlin Å, Streatfield PK, Kabir ZN (2009). "Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh." Ageing & Society. [Accepted]
https://doi.org/10.1017/S0144686X09008411

III. Rana AK, Wahlin A, Lundborg CS, Kabir ZN (2009). "Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh." Health Promot Int 24(1): 36-45.
https://pubmed.ncbi.nlm.nih.gov/19136677

IV. Nilsson J, Rana AK, Kabir ZN (2006). "Social capital and quality of life in old age: results from a cross-sectional study in rural Bangladesh." J Aging Health 18(3): 419-34.
https://pubmed.ncbi.nlm.nih.gov/16648394