Factors Influencing Health Promoting Behaviors among the Elderly Under the Universal Coverage Program, Buriram Province, Thailand ppt

tailieuhay_2389
tailieuhay_2389(15453 tài liệu)
(3 người theo dõi)
Lượt xem 0
0
Tải xuống
(Lịch sử tải xuống)
Số trang: 5 | Loại file: PDF
0

Gửi bình luận

Bình luận

Thông tin tài liệu

Ngày đăng: 14/03/2014, 20:20

Mô tả: AsiaJournalofPublicHealth,JanuaryJune2010 Vol.1No.115FactorsInfluencingHealthPromotingBehaviorsamongtheElderly UndertheUniversalCoverageProgram,BuriramProvince,ThailandKanitthaChamroonsawasdi*SukanyaPhoolphoklang**SuthamNanthamongkolchai*ChokchaiMunsawaengsub**DepartmentofFamilyHealth,FacultyofPublicHealth,MahidolUniversity,Bangkok,Thailand**DepartmentofCommunity HealthNursing,FacultyofNursing,Thammasart University,ThailandARTICLEINFOArticlehistory:Received23May 2010Receivedinrevisedform 25June 2010Accepted9July 2010AvailableonlineJuly 2010Keywords:ElderlyHealthPromotingBehaviorsUniversalCoverageProgramCorrespondingAuthor:Chamroonsawasdi K,DepartmentofFamilyHealth,FacultyofPublicHealth,MahidolUniversity,Bangkok10400,Thailand.Email: phknt@mahidol.ac.thAsiaJPublicHealth 2010;1(1):1519INTRODUCTIONConcerning unavailability andinaccessibility of healthcare services and limitedaffordability of poor people, the Thai governmentlaunchedtheuniversalcoverageprogramknownas“30 baht scheme” in 19911.  The purpose of thisprogram was to increase equity utilization ofhealthcare services by providing standard careandreducing medical care costs for Thai people. Theprincipleofthisprogramwasfocusedonpreventiveand promotive strategies to promote healthylifestyleofpeopleratherthancurativestrategies1aswell as to prevent unnecessary utilization ofhealthcareservices12.Atpresent,thenumber of elderlyhasbeenincreasing annually year by year and the exemptfrommedicalfeescriterionletstheelderlybecomea major group whoutilize healthcare services. InABSTRACTObjective:Acrosssectionalsurveyresearchaimedatstudyingfactorsinfluencinghealthpromotingbehaviors(HPB)oftheelderlyundertheuniversal coverage program. Materials and methods: The samplegroup was 341 elderly in Buriram Province.  A multistage samplingtechniquewasusedtoselectthesample.Datawerecollectedbyusinginterviewquestionnaireduring1731October,2005andwereanalyzedbyfrequency,percentage, mean,standarddeviation, Pearson’s ProductMomentCorrelationandstepwisemultipleregressionanalysis.Results:Theresultsshowedthat53.7%oftheelderlyhadHPBatmoderateleveland30.2%hadHPBathighlevel. FactorssignificantlypredictingHPBamongtheelderly werehavingoccupation,knowledgescoreonHPB,havingcurrentillnessforonemonth,experienceobtainingknowledgeorinformation on HPB from health personnel, and social support fromfamily.ThesefactorswereabletopredictHPBoftheelderlycorrectly42.1%. Conclusion: From these findings, the authors recommendhealthproviderstopromoteelderlyHPBinallcommunitiesbygivingknowledge on HPB through various means, enhancing social supportfrom family and paying attention to unemployed groups to encouragethemindailypractice ofHPB.AsiaJournalofPublicHealthJournalhomepage:http://www.ASIAPH.orgOriginalArticlesAsiaJournalofPublicHealth,JanuaryJune2010 Vol.1No.1162007, the estimated total number of Thai elderlywas around7 millionand in the next12 years thenumber will increase to 11 million or equal to 17percentofallagegroups3.Theelderlyhasbecomeamajorgroupofpublichealthconcernbecausetheyare living with health deterioration in all aspects,physical,mentalandpsychosocial.Threefourthsofthe elderlyhavechronic healthproblems.Thetopfive health problems are; muscular pain (75.1%),joint pain (47.5%), restlessness (38.7%), headache(36.8%),andvisualproblems(33.2%).Thechronicdiseases found among the elderly are high bloodpressure (20%), digestion and stomach problems(11.4%)anddiabetes(8.3%)4.Healthproblemsofthe elderly result from poor health promotingbehaviors5whichmayleadtochronicdiseasessuchas cardiovascular disease, hypertensive disorder,diabetes mellitus and mental health problems.   Anational survey onhealth promotingbehaviors andlifestyles ofthe elderlyin 2007 foundthat 28% ofthemhaddailyexercise,13%hadregularsmoking,3% had daily drinking alcohol, 63% ate fruits andvegetables daily and 74.1% had annual physicalcheck up6. The World Health Organizationemphasizes health promoting behaviors as a keystrategytomaintainhealthstatusoftheelderlyandassist them to survive with a good quality of lifewithout depending on any family members or thesociety7.From previous findings, factors related tohealthpromotingbehaviorsoftheelderlywereage,sex, education, economic status, chronic illness,perceived health status, perceived selfefficacy,perceivedbenefitsofpractice,perceivedbarrierstopracticeandsocialsupportfromfamily811.Buriram province is located in thenortheastern part of Thailand where the totalnumber oftheelderlyhas annuallyincreased.Thepercentage of the elderly in this province hasincreasedfrom4.2percentsin1980to6.3percentsin 1990, 8.9 percents in 2000 and 9.9 percents in200612.  Around 89.2 percent of them wereregistered under the universal coverage program.Thetop3problemsthat the majority of them faceare respiratory problems, muscular weakness andpain13.TohelptheelderlyinBurirumprovincetomaintain good health status under the universalcoverage, the health promoting behaviors and itsinfluencing factors based on Pender’s healthpromoting model14and PRECEDEPROCEEDframework of Green LW and Kreuter MW15areexplored.  Fruitful findings would be used as aguideline for planning effective implementingstrategiestopromotehealthylifestyleandbehaviorsamong the elderly under the universal coverageprograminthisprovinceinthefuture.MATERIALSANDMETHODSA crosssectional study was conducted tocollectdatabyinterviewquestionnaireduring1731October,2005.Thepopulationwere theelderlywhohad their residence in Buriram province. Thesamples were the elderly who were able tocommunicate,whoheldahealthgoldcard,whohadnoserioushealthproblemsandwhowerewillingtoparticipate in this study by signed consent form.The sample size was calculated. Total sample sizewas341cases.Themultistagesamplingtechniquewas used to select the elderly from each of thetarget6villagesobtainedfromthe3districtsofthenorthern,centralandsouthernpartoftheprovince.The research instrument was an interviewquestionnaire to examine the predisposing factorscomposed of demographic characteristics,knowledge on HPB and perception of illness;enabling factors composed of accessibility tohealthcare services and reinforcing factorscomposed of perception on benefits of gold cardand social support from family. The questionnaireconsisted of 7 parts.  Part 1 was demographiccharacteristics of the elderly which were sex, age,marital status, education, occupation, income,having chronic and present illness during onemonth, experience receiving knowledge orinformation on HPB from health personnel, andpeople who live with participants.  Part 2 was 25questions on knowledge on health promotingbehaviors based on a concept of HealthpromotingLife Style of Walker SN et al16. Part 3 was 5questions on perception of chronic and currentillness. Part 4 was 8 questions regardingaccessibility to healthcare services.  Part 5 was 8questions on perception toward benefits of goldcard.  Part 6 was 15 questions on social supportfromfamilybasedonconceptsofTardyCH17.Part7 was 25 questions on health promotingbehaviorsof the elderly adapted from Health PromotingLifestyle Profile (HPLP)16in 6 domains such aseatingbehavior,exercise,healthresponsibility,selfactualization, stress management and interpersonalrelationship.Contentvaliditywasexaminedby4expertsanda reliability test given to30 elderly who wereliving in Sao Dieo subdistrict, Buriram province.TheCronbrach’salphacoefficientofeachpartwasas follows: knowledge on health promotingbehaviors = 0.80, perception of illness = 0.65,perceptionofbenefitsofgoldcard=0.60andsocialsupportfromfamily=0.80.EthicalapprovalTheresearchproposalwasapprovedbytheCommittee on Human Rights Related to HumanExperimentation, Mahidol University (MU132/2005).AsiaJournalofPublicHealth,JanuaryJune2010 Vol.1No.117DataanalysisFrequencies,percentage,meanandstandarddeviation were used to describe demographiccharacteristics, perception of illness andaccessibility to healthcare services. Pearson’sproductmomentcorrelationcoefficientwasusedtofind out factors correlated to the health promotingbehaviors of the elderly. In addition, stepwisemultiple regression was used to determine thepredicting factors of health promoting behaviors.Thelevelofstatisticalsignificancewasatp<0.05.RESULTSDemographiccharacteristicsItwasfoundthat66.4%oftheelderlywerefemaleandhalfofthem(50.4%)wereintheage6069yearsold.Morethanhalf(62.5%)weremarried,54% lived with their spouse, son and daughter,83.3% completedprimaryschool level, and62.5%had their own occupation. Twothirds of them(67.7%) had income equal or less than 1,000baht/month where 74.8% had a source of incomefrom a son or daughter.  Concerning adequacy ofincome,37% hadenoughbutnotforsaving,while31.7% had inadequate income and had to borrowfrom others. Threefourths of them (75.4%) had ahigh level of knowledge on health promotingbehaviors. Nearly half (46%) perceived that theyhad some chronic illness  of which the highestranked were hypertension (37.4%) followed bypepticulcer(25.2%)anddiabetesmellitus(19.4%),and68.6%perceivedpresentillnessasmuscularorjointpainandbodypain.Seventypercentofelderlyutilizedacommunity hospital most whenthey hadbecomesickandamongwhich100%usedthegoldcardandperceived that it was convenient totraveltohealthfacilitiesbyvehicles.Nearlyhalf(45.8%and45.8%)perceivedthatbenefitsofthegoldcardandsocialsupportwereatalowlevel.HealthpromotingbehaviorsoftheelderlyunderuniversalcoverageConcerning each domain of the study’sHPB,itwasfoundthatmorethanhalfofthemhadahigh HPB level on interpersonal relationship(68.8%),followedby eatingbehavior(56.7%),andself actualization (52.9%), while the high HPBscores were found to have been lower amongexercise (20.4%), stress management (28.4%) andhealth responsibility by having an annual physicalcheckup(39%).Morethanhalfoftheelderly(53.7%)hadatotal score of health promoting behaviors atmoderate level while onethird (30.2%) were at ahigh level.  Mean scores of health promotingbehaviors (HPB) were equal to 50.82+9.03, minmax=3168(Table1).Table1 HealthpromotingbehaviorscoresLevelofhealthpromotingbehaviorscoresNumber(n=341)PercentLow(040marks) 55 16.1Moderate(4155marks) 183 53.7High(5675marks) 103 30.2Mean+SD=50.82+9.03,Min=31,Max=68FactorsassociatedwithHPBFrom Chisquare test of predisposing,enabling and predisposing factors which weresignificantly associated with HPB were having anoccupation, having present illness for one month,andexperienceobtainingknowledgeorinformationonHPBfromhealthpersonnel.From Pearson’s correlation analysisbetween numeric variables of predisposing,enabling and reinforcing factors and healthpromoting behaviors of the elderly under theuniversal coverage, it was found that age, income,knowledge on HPB, perception of illness,perception of benefits of gold card and socialsupportwerecorrelatedwithHPB(Table2).Table 2 Pearson’s correlation between age, income,knowledge on HPB, perception of illness, perceptionon benefits of gold card, social support and HPB oftheelderly(n=341)Variables Pearson’sCorrelationCoefficientpvalueAge 0.228 <0.001Income 0.231 <0.001KnowledgeonHPB 0.208 <0.001Perceptionofillness 0.309 <0.001Perceptiononbenefitsofgoldcard0.326 <0.001Socialsupport 0.403 <0.001Predicting factors on HPB of the elderly usingstepwisemultipleregressionanalysisThe significant predicting factors on HPBof the elderly consisted of having an occupation,knowledge on HPB, present illness during onemonth, experience to obtain knowledge orinformation from health personnel on HPB andsocialsupport.Thismodel wasabletopredicttheHPBamongtheelderlyasbeing42.1%(Table3).Table 3 Predicted factorsofHPB among the elderlybystepwisemultipleregressionanalysis(n=341)StepwisemultipleregressionPredictorsB Beta pvalueHavingoccupation 0.324 0.270 <0.001KnowledgeonHPB 0.142 0.136 <0.001Presentillnessduringonemonth0.351 0.268 <0.001AsiaJournalofPublicHealth,JanuaryJune2010 Vol.1No.118Table 3 Predicted factorsofHPB among the elderlyby stepwise multiple regression analysis (n=341)(cont.)StepwisemultipleregressionPredictorsB Beta pvalueExperiencetoobtainknowledgeorinformationonHPBfromhealthpersonnel0.173 0.139 <0.001Socialsupport 0.264 0.253 <0.001B0=6.64;R2=0.482;AdjustedR2=0.421DISCUSSIONHealthpromotingbehaviorsoftheelderlyundertheuniversalcoverageFifty three percent of the respondents hadtheirHPBatamoderatelevel,while30%wereatahighlevel.WhenconsideringeachdomainofHPB,interpersonal relationship, eating behavior and selfactualization were found to be most practicedamong the elderly, while exercise was found tohave been practiced at the lowest.  These findingswere similar to the previous studies done by SeoHM and Han YS18, Anise Man SW, et al19andKyeong YS, et al12.  This may be due to thelimitation of their body fitness when getting olderbecauseexerciseinducedmoreofafeelingofbeingtired than among those who are young. Practicingexercise had the lowest score of all the presentstudy’s HPB domains. Concerning the mostpracticed HPBs, interpersonal relationship, eatingbehavior and self actualization were daily lifepractices.  The elderly need social contact withothers because they are human beings.Additionally, they eat vegetables and fruitsto helpeasyexcretionandreducefatandnegativeeffectsofspice in spicy food and to reduce digestion andabsorptionproblem.FactorspredictingHPBoftheelderlyFrom the findings, having an occupation,knowledge onHPB, present illness for one month,experiencetoobtainknowledgeorinformationfromhealth personnel on HPB and social support fromfamily were the significant predicting factors ofHPB of the elderly under universal coverage. Thehighest level predicting factor was having presentillness for one month. When having a presentillness, the elderly need to see the doctor or visithealthfacilities.Theywillreceivepropertreatmentas well as receive knowledge or information onHPB from health personnel to motivate them topractice more.Theresult was similar tothestudyofLeeTWetal20,StollerEPandPollowR9.Theelderlywhohavetheirownoccupationwillhaveasourceofincometoelevatetheirlivingarrangements which increases their perception onselfefficacytolivewithoutpassivelydependingontheirsonsordaughters.ThisfindingwascongruentwiththestudydonebyKimHJetal11andKyeongYS et al12.  Social support from the family wasfound to be positively correlated with the HPB oftheelderly.Itcanbeexplainedthattheelderlyneedto depend on the support from family in terms offinancial support, living arrangement, healthinformation as well as psychological support tomotivate them to reach their optimum during thelast period of life6. The elderly who have strongsocialsupportfromfamilywillenhancetheirsenseof wellbeingthat facilitate moreHPB while thosewhohaveweaksocialsupportwillfeelalackofselfefficacy in the practice of HPB.  This result wassimilartothestudyofKattikaTandKusolS21andKim HJ et al10.  The fourth and fifth predictingfactors of HPB in the elderly were experience toobtain knowledge or information on HPB fromhealth personnel and knowledge on HPB.  Thesecan be explained as knowledge and understandinginHPBwhichwillinfluencemotivationsormodifyattitudesofpeopletopracticeofhealthpromotion22.Thisfinding wassupportedbythestudy ofHuangLHetal23andCoulsonIetal24.ThemoretheHPBknowledge, the more the frequency of practice onHPB amongtheelderlywasfound.Regarding the results of the study,recommendationsareasfollows:1. Health promoting behaviors of the elderlywere still at the moderate level.   The routineservicesfortheelderlyshouldimprovetheabilityofhealth personnel to provide knowledge andinformation on HPB through different channelssuchasfacetoface,demonstrations,pamphletsandhomevisits,aswellastomotivatethecaregivertomotivate the elderly to engage in daily practice ofHPB.2.Healthcareservicesshouldemphasizegivinginformation on HPB among the elderly who areunemployed and stay at home for continuouspracticeofHPB.3.  The healthcare services should encouragefamily members of the elderly to pay attention toHPB of the elderly and to give untiring socialsupport to increase their motivation to practice onHPB.ACKNOWLEDGEMENTSThe authors would like to thank all healthpersonnel and the village headman of Buriramprovincewhofacilitatedthedatacollectingprocess.Also,wewouldliketo giveaspecialthankstoallelderlywhodevotedtheirtimetoparticipateinthisstudy.Theauthorswouldfinallyliketogivethanksto Eric Curkendall from the Mahidol UniversityFaculty of Public Health, Office of InternationalAffairsforhisassistanceeditingthismanuscript.AsiaJournalofPublicHealth,JanuaryJune2010 Vol.1No.119REFERENCES1.TowseA,MillsA,TangcharoensathienV.Learning from Thailand’s healthreforms.BMJ2008;328:1035.2.BureauofHealthPolicyandPlanOffice,PermanentSecretaryOffice,MinistryofPublicHealth.A handout on universal health care coverage.NonthaburiProvince: Ministryof PublicHealth,2001.3.KanchanajittraC,PodhisitaC,ArchavanitkulK,PattaravanichU, SiriratmongkonK,SeangdungH,etal.Thaihealth2007.InstituteofPopulationandSocialResearch,MahidolUniversity,NakornPathom:InstituteofPopulationandSocialResearch,2007.4.NationalStatisticOffice,MinistryofInformationand Technology.Asurvey report of elderlyinThailand in 2002,Bangkok : Chan ChomPub,2003.5. Palank CL.Determinantsofhealth promotionbehavior:Areviewofcurrentresearch.NursingClinicsofNorthAmerica1991;26: 81532.6.BureauofHealthPolicyandStrategies,MinistryofPublicHealth.Thailandhealthprofile:Reporton health situationand healthbehavioraloftheThaiElderly2009;4: 132.7.WorldHealthOrganization.Aging and workingcapacity:ReportofaWHOstudygroup.Geneva:WorldHealthOrganization,1993.8. StollerEP, PollowR.Factors affecting thefrequencyof health enhancingbehaviorsbytheelderly.JPubHReports1994;109: 37789.9.NikpourS,SolaAH,SeiedoshohadaeiM,HaghaniH,HadjikazemiE.Healthpromotionbehaviorsamong elderly in westareaof TehranIran.MiddleEastJAgeAging2006;3: 106.10.KimHJ,KimLH,ParkYH.Factorsinfluencinghealth promotingbehavioroftheelderly.Available at http://www.koreamed.org/SearchBasic.php.AccessedonJune22,2009.11.KyeongYS,SueS,HyeAY.Healthpromotingbehaviors of elderlyKoreanimmigrants in theUnitedStates.JPub HNurs 2002;19: 294300.12.Statistical Office,Buriram Province,Reportofcensuspopulationsurveyin2005.Unpublished,2006.13.Buriram Provincial Health Office,Ministry ofPublicHealth.Annualreportsontheelderlysituationsurvey,2003.Unpublished,2005.14.PenderNJ.Healthpromotioninnursingpractice,2ndedition.Norwalk:Appleton & Lange,1987.15.GreenLW,KreuterMW.Healthpromotingplaning:An educational and ecologicalapproach,3rdedition.California:MayfieldPubCom,1999.16.WalkerSN,SechristKR,PenderNJ.ThehealthPromoting lifestyles profile:Development andpsychometriccharacteristics.JNurs Resh1987;36:7681.17.Tardy CH.Social support measurement.Am JComPsy1985;13: 187202.18.SeoHM.andHahYS.AStudyof FactorsInfluencingon Health Promoting Lifestyleintheelderly:ApplicationofPender’sHealthPromotionModel,Availableathttp://www.ncbi.nlm.nih.gov/pubmed/.AccessedonJanuary4,2009.19.AniseManSW,CatherineST,TimothyChiYK.Physical and psychosocial factors associatedwithhealth promotingbehaviorsamongelderlywithtypesdiabetes.JH Psy2004;9: 73140.20.Lee TW,KoIS,LeeKJ,Kang KH.Health status,health perceptionand health promotionbehaviorsof low incomecommunitydwellingelderly. Available at http://www.ncbi.nlm.gov/.pubmed.AccessedonJune22,2009.21.KattikaT,KusolS.Family relationsandhealthpromoting behavioramongolderpeopleinNanprovince.JMedAssocThai2008;91: 11028.22.KemmJandCloseA,Healthpromotion:Theoryandpractice.London:Macmillan,1995.23.HuangLH,ChenSW,YuYP,ChenPR,LinYC.Theeffectivenessof healthpromotioneducationprograms for community elderly. J Nurs Res2002; 10: 26170.24.CoulsonI,MarinoR,MinichielloV.Olderpeople’sknowledgeandpracticeaboutlifestylebehaviorsthatmaypreventvasculardementia.GerontandGeriatJ2001;33:27385. . AsiaJournalofPublic Health, JanuaryJune2010 Vol.1No.115 Factors Influencing Health Promoting Behaviors among the Elderly Under the Universal Coverage Program, Buriram Province, Thailand KanitthaChamroonsawasdi*SukanyaPhoolphoklang**SuthamNanthamongkolchai*ChokchaiMunsawaengsub**DepartmentofFamily Health, FacultyofPublic Health, MahidolUniversity,Bangkok ,Thailand **DepartmentofCommunity. andpain13.Tohelp the elderly inBurirumprovincetomaintain good health status under the universal coverage,  the health promoting behaviors and its influencing

— Xem thêm —

Xem thêm: Factors Influencing Health Promoting Behaviors among the Elderly Under the Universal Coverage Program, Buriram Province, Thailand ppt, Factors Influencing Health Promoting Behaviors among the Elderly Under the Universal Coverage Program, Buriram Province, Thailand ppt, Factors Influencing Health Promoting Behaviors among the Elderly Under the Universal Coverage Program, Buriram Province, Thailand ppt

Lên đầu trang

Tài liệu liên quan

Từ khóa liên quan

Đăng ký

Generate time = 0.140871047974 s. Memory usage = 13.93 MB