Generativity in Later-Life: The Interplay Between Retirement Status and Human, Social, and Financial Capital.

Generativity has been increasingly recognized as an important component of healthy aging. Although the desire to be generative is influenced by societal and cultural expectations, the relative influence of its driving factors by retirement status, a significant life-course transition, is underexplored. This study examined how later-life generativity is driven by the interplay between retirement status and financial, human and social capital. An online survey targeting Hong Kong adults aged 45+ was conducted. Linear regression models were stratified by retirement status (working and retired) to examine the effects of financial (income, assets, and financial satisfaction), human (education and health-related measures), and social capitals (productive and social engagement) on generativity. Among those working, higher generativity was associated with financial, human, and social capitals that facilitated material provision. Among those retired, human and social capitals that supported the transmission of knowledge and experience were more important for generativity. For both groups, support from close social networks was the strongest predictor. Different cultural demands, dictated by retirement status, play a crucial role in determining how older adults feel like they can contribute to subsequent generations. These findings can inform policies and programs that seek to support healthy transitions into retirement.

Later-life depressive symptoms during the Covid-19 pandemic: Investigations of individual, cumulative, and synergistic effects of social isolation.

OBJECTIVES: This study examines associations between social isolation and depressive symptoms among Hong Kong Chinese adults aged 65 and older by investigating the distinct effects of individual indicators, cumulative index, and typologies of social isolation during the Covid-19 pandemic. METHODS: We used a sample of 260 older adults from a cross-sectional, city-wide online survey targeting 1,109 aged 45+ adults through purposive sampling. Seven indicators of social isolation (not married; living alone; not engaging in social/organizational activities; no social contact with friends or families; lack of family and friends networks; loneliness) using Cornwell & Waite's framework were selected to construct three unique types of social isolation measures. We used latent class analysis (LCA) and regression models to examine the effects of varied typologies of social isolation on depressive symptoms. RESULTS: Individual model of social isolation showed that lack of social contact and feeling lonely were significant predictors of depressive symptoms. A strong linear-trend gradient effect of cumulative social isolation on depressive symptoms was also observed. The LCA model identified four typologies of social isolation (socially isolated; living alone but socially engaged; married but lacking social ties, and not socially isolated); those in the 'socially isolated' and 'married but lacking social ties' groups had the most depressive symptoms. CONCLUSION: Three operationalizations of social isolation demonstrated different utilities and implications in assessing the impacts of social isolation on depressive symptoms. Social contacts and loneliness, rather than living status or other characteristics of isolation, were the factors most strongly associated with depressive symptoms. Support programs should target lonely older adults who lack social engagement opportunities, as they are at increased risk of depression.

Civic Activities and Mental Health in Later Life: The Moderating Role of Generative Concerns.

This study examined the moderating mechanisms of generative concerns (perception of making contributions to others) between generative civic activities and mental health among middle-aged and older adults. A total of 1,109 community-dwelling adults aged over 45 were recruited through an online survey. Generative civic activities (political participation and volunteering), generative concerns (the Loyola Generativity Scale), and two outcomes of mental health (depressive symptoms and mental wellbeing) were measured. Linear regression models and simple slope analyses were used to probe the moderating effects of generative concerns, stratified by age (45-64 years and 65+). Generative activities, but not concerns, were associated with lower depressive symptoms among middle-aged and older adults. Generative concerns and activities were related to better mental wellbeing among middle-aged adults. Generative concerns moderated the associations between civic activities and depressive symptoms. Those with higher generative concerns but lower civic activities had higher depression scores. Conversely, a stronger reduction in depressive symptoms by engaging in civic activities was found only when individuals had greater concerns. No moderating effect was found on mental wellbeing. The positive effect of civic engagement on reducing depressive symptoms depends on generative concerns, particularly among older people and those with greater concerns. Bridging the gap between perceived generative concerns and actual civic actions may improve later-life mental health.

COVID-19 response strategies: considering inequalities between and within countries.

Globally, the COVID-19 pandemic has been uncharted territory, and countries and governments have faced the challenge of implementing response strategies to manage local transmission. High-income settings have the resources to devote significant resources to testing, isolation, and contact tracing. Lower-income settings are pressured to emulate such initiatives, but often lack the resources and infrastructure to do so. We highlight the impact of these between-country inequalities, the within-country inequalities, and the potential magnification of unintended consequences due to COVID-19 control measures.

The relationship between social capital and self-rated health: a multilevel analysis based on a poverty alleviation program in the Philippines.

BACKGROUND: Poor health is both a cause and consequence of poverty, and there is a growing body of evidence suggesting that social capital is an important factor for improving health in resource-poor settings. International Care Ministries (ICM) is a non-governmental organization in the Philippines that provides a poverty alleviation program called Transform. A core aim of the program is to foster social connectedness and to create a network of support within each community, primarily through consistent community-led small group discussions. The purpose of this research was to investigate the relationship between social capital and self-rated health and how ICM's Transform program may have facilitated changes in those relationships. METHODS: Three types of social capital were explored: bonding-structural, bridging-structural and cognitive. Using cross-sectional data collected before and after Transform, multilevel modelling was used to examine their effects on self-rated health between the two time points. RESULTS: The analyses showed that while social capital had minimal effects on self-rated health before Transform, a series of associations were identified after the program. Evidence of interdependence between the different types of social capital was also observed: bonding social capital only had a beneficial effect on self-rated health in the presence of bridging social capital, but we found that there was a 17 percentage point increase in self-rated health when individuals possessed all possible bridging and bonding relationships. At the same time, our estimates showed that maximising all forms of social capital is not necessarily constructive, as the positive effect of cognitive social capital on self-rated health was weaker at higher levels of bridging social capital. CONCLUSIONS: The results from this study has shown that building social capital can influence the way people perceive their own health, which can be facilitated by intervention programs which seek to create bonding and bridging relationships. Transform's intentional design to learn in community could be relevant to program planners as they develop and evaluate community-based programs, making adaptations as necessary to achieve organisation-specific goals while acknowledging the potential for varied effects when applied in different contexts or circumstances.

Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020.

Background: The COVID-19 pandemic has severely impacted populations globally, and knowledge, attitudes and practices (KAPs) surrounding the virus have necessarily evolved. This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization that runs the "Transform" poverty alleviation program. The main objective of this study was to describe the changes in COVID-19 KAPs among households experiencing extreme poverty in the Philippines over an 8-month period. Methods: A KAP questionnaire was integrated into the household survey collected as part of ICM's regular monitoring and evaluation of "Transform". Data collection for the first survey was conducted between February 20 and March 13, 2020, and the second survey was conducted between November 12 and December 12, 2020. Frequencies and proportions were calculated to describe the respondents' responses and the Kruskal-Wallis test was used to assess if there were significant differences in KAP identification between the two time points. Results: We observed a distinct increase across all KAP domains. Over 90% of study participants were able to correctly identify COVID-19 transmission modes and preventive measures, and an even higher percentage reported adopting these measures. However, the intention to seek care from public hospitals for COVID-19 symptoms dropped from 43.6% to 28.4%, while reports of self-treatment using stored medicines or antibiotics increased. Trust in community members and local health authorities was correlated with higher knowledge and practice scores. Conclusions: Our study results reflect the extraordinary speed of information dissemination and behaviour change globally over the course of the pandemic, but they also highlight the changes in KAP that show the additional challenges faced by populations experiencing poverty in the Philippines. Prioritization of reducing inequities in the implementation and adoption of the evolving public health measures will be integral as the pandemic continues.

Generativity and Gendered Pathways to Health: The Role of Human, Social, and Financial Capital Past Mid-Life.

Generativity has recently received increasing attention as a key contributor to healthy aging. Personal resources and social expectations are shown to influence the desire to be generative and that generativity affects later-life health. However, whether generativity has a mediating role in linking its driving factors and health, and how gender may affect these pathways, is underexplored. Cross-sectional online data from 1085 Hong Kong residents aged 45+ were collected between November and December 2020. Latent variable path analysis was used to examine the mediating effect of generativity between human, social, and financial capital, and physical and mental well-being. Gendered pathways were investigated using multi-group analysis. Results showed that human, social, and financial capital contributed to better health through generativity, and gendered pathways were observed. Human capital had a stronger effect on generativity for men, but for women, social capital was vital for increased generativity and consequently improved health. Findings suggested that health benefits of generativity depend on different capital drivers and differ by gender. Implications for program development that aim to facilitate health should include generativity components that maximize physical and psychosocial engagement so that individuals can reap the health benefits through contributions to others.

Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study.

BACKGROUND: The presence of COVID-19 in low- and middle-income countries (LMICs) is raising important concerns about effective pandemic response and preparedness in the context of fragile health systems and the pervasiveness of misinformation. The objective of this study was to gain an understanding of how COVID-19 was perceived by households experiencing extreme poverty in the Philippines. METHODS: This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO) that runs a poverty-alleviation program called Transform targeted towards extreme low-income households. We integrated knowledge, attitudes, and practices (KAP) questions into ICM's cross-sectional program monitoring and evaluation systems from February 20 through March 13, 2020. Frequencies and proportions were calculated to describe the respondents' responses, and the Kruskal-Wallis test and binomial logistic regression were undertaken to determine the socio-demographic characteristics associated with COVID-19 KAPs. RESULTS: In total, 2224 respondents from 166 communities in rural, urban and coastal settings were surveyed. Although the survey was administered during the earlier stages of the pandemic, 94.0% of respondents had already heard of COVID-19. Traditional media sources such as television (85.5%) and radio (56.1%) were reported as the main sources of information about the virus. Coughing and sneezing were identified as a transmission route by 89.5% of respondents, while indirect hand contact was the least commonly identified transmission route, recognized by 72.6% of respondents. Handwashing was identified by 82.2% of respondents as a preventive measure against the virus, but social distancing and avoiding crowds were only identified by 32.4% and 40.6%, respectively. Handwashing was the most common preventive practice in response to COVID-19, adopted by 89.9% of respondents. A greater number of preventive measures were taken by those with more knowledge of potential transmission routes. CONCLUSIONS: There is a need for targeted health education as a response strategy to COVID-19 in low-income settings, and it is important that strategies are contextually relevant. Understanding KAPs among populations experiencing extreme poverty will be important as tailored guidance for public health response and communication strategies are developed for LMICs.

Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines.

INTRODUCTION: Social trust is an important driver of health seeking behaviours and plays a particularly important role for diseases that have a high degree of stigma associated with them, such as tuberculosis (TB). Individuals experiencing poverty also face additional social and financial barriers in accessing care for TB. We examined an active case finding (ACF) initiative embedded in a program targeting those living in poverty (Transform) implemented by International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO), and analyzed how different forms of social trust may affect the initial uptake of ACF. METHODS: Program monitoring data and a cross-sectional survey conducted at the beginning of Transform included six dimensions of social trust: satisfaction with family life, satisfaction with friendships, and level of trust in relatives, neighbours, pastor or religious leader, and local government officials. Amongst individuals suspected of having TB who received referrals post-screening, multilevel modelling examined the effects of social trust on rural health unit (RHU) attendance. RESULTS: Among the subset of 3350 individuals who received TB screening in 51 communities, 889 (26.5%) were symptom positive and required referral to the RHU, but only 24.1% of those who received referrals successfully attended the RHU. Multilevel regression analysis showed that for each unit increase on the Likert scale in baseline level of family satisfaction and level of trust in relatives, the odds of attending an RHU was 1.03 times (95% CI: 0.99, 1.07) and 1.06 times greater (95% CI: 1.00, 1.11), respectively, independent of other factors. CONCLUSION: These results suggest that social trust in family members could play a valuable role in addressing stigma and rejection, both cited as barriers to higher screening rates. It is recommended that ACF programs that target TB, or other diseases that are stigmatized, prioritize trust-building as an important component of their intervention.