Developing a community-based intervention for Dutch older adults in a socioeconomically disadvantaged community.

Unhealthy eating and low levels of physical activity are major health risks, especially for older adults and people with a low socioeconomic status. The aim of this article is to describe the development of a community-based intervention aimed at promoting physical activity and healthy eating among people aged 55 years and over, in a socioeconomically disadvantaged community. The Intervention Mapping protocol was used to develop the intervention. We conducted a literature search, consultation with community partners and inhabitants, and a quantitative study, in order to obtain insight into the determinants of the target population and to identify appropriate theory-based methods and practical strategies for behavioural change. An assessment was performed of the problem with respect to health behaviour and the underlying determinants. Findings were translated into program, performance and change objectives which specify determinants related to behavioural change. Theory-based methods and practical applications were selected, resulting in a plan for adoption and implementation. The intervention included a local media campaign, social environmental approaches and physical environmental activities in the community, with an intermediating role for inhabitants and health professionals in the promotion of the campaign. An evaluation plan was produced to evaluate the effectiveness of the intervention. The Intervention Mapping protocol was a helpful instrument in developing a feasible, theory and evidence-based intervention tailored to a specific target population in the area of health promotion. The systematic and structured approach provided insight into the relationship between the objectives, methods and strategies used to develop the comprehensive intervention.

Moderators of physical activity and healthy eating in an integrated community-based intervention for older adults.

BACKGROUND: An integrated community-based intervention was developed to stimulate physical activity (PA) and healthy eating in older adults in a socioeconomically disadvantaged area. This study aims to assess whether its short-term effects among older adults vary by sociodemographic, psychosocial and health-related variables. METHODS: The study was a controlled pre-post quasi-experimental design (intervention condition n = 430; control condition n = 213), with a baseline measurement and a 9-month follow-up measurement. The intervention consisted of a local media campaign and environmental approaches. Changes in PA and fruit and vegetable consumption (FVC) were dependent variables assessed at 9-month follow-up. Sociodemographic, psychosocial and health-related variables at baseline were tested as potential moderators of the effects of the conditions. RESULTS: We found different types of moderators in particular for transport-related PA and FVC. Regarding sociodemographic characteristics, gender was a moderator for household-related PA, and educational level for transport-related PA and FVC. Self-efficacy, as a psychosocial variable, was a moderator of transport-related PA and vegetable consumption. Concerning health-related outcomes, baseline levels of transport-related PA and fruit consumption were moderators for transport-related PA and fruit consumption. If adjusted for multiple testing, only three moderators persisted: educational level regarding vegetable consumption, and baseline levels regarding transport-related PA and fruit consumption. CONCLUSION: The effects of the community intervention vary somewhat by sociodemographic, psychosocial and health-related variables. The intervention seems to be especially beneficial to those who are most in need of more PA and healthy eating.

Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community.

The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430 randomly selected older adults participating in the intervention group and 213 in a control group at baseline. The intervention included a local media campaign and environmental approaches (e.g., community involvement) and was implemented during a 3-month high-intensity period, followed by a 6-month low-intensity one. Levels of physical activity and fruit and vegetable consumption were assessed at baseline and at 3 and 9 months after baseline. At the follow-up measurements, the intervention had reached respectively 68 and 69% of the participants in the intervention group. No significant differences were found between the intervention group and the control group in changes to any outcome except for transport-related PA at 3 and 9 months follow-up. The systematically developed community-based intervention reached a relatively large proportion of the participants, but had only small effects on the levels of physical activity and healthy eating in older adults in the short and medium term.

The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators.

Inadequate health literacy is a common problem among older adults and is associated with poor health outcomes. Insight into the association between health literacy and health behaviors may support interventions to mitigate the effects of inadequate health literacy. The authors assessed the association of health literacy with physical activity and nutritional behavior in community-dwelling older adults. The authors also assessed whether the associations between health literacy and health behaviors are mediated by social cognitive factors. Data from a study among community-dwelling older adults (55 years and older) in a relatively deprived area in The Netherlands were used (baseline n=643, response: 43%). The authors obtained data on health literacy, physical activity, fruit and vegetable consumption, and potential social cognitive mediators (attitude, self-efficacy, and risk perception). After adjustment for confounders, inadequate health literacy was marginally significantly associated with poor compliance with guidelines for physical activity (OR=1.52, p=.053) but not with poor compliance with guidelines for fruit and vegetable consumption (OR=1.20, p=.46). Self-efficacy explained 32% of the association between health literacy and compliance with physical activity guidelines. Further research may focus on self-efficacy as a target for interventions to mitigate the negative effects of inadequate health literacy.