The objective of this article is to identify determinants of quality of life (QoL) and investigate their association with individual- and community-level social capital among older people in rural Bangladesh. A cross-sectional study of 1,135 elderly persons (aged >/= 60 years) was conducted in a rural district in Bangladesh. Independent variables included age, sex, education, economic status of the elderly person, and individual- and community-level social capital. Self-rated QoL was the dependent variable. Descriptive analyses were done to show group differences in QoL and logistic regression analyses to identify determinants of QoL. Advanced age, poor household economic status, and low social capital at individual and community levels were significant determinants of poor QoL among the elderly. This population-based study provided empirical evidence that social capital both at individual and community levels was directly associated with the QoL of elderly people in rural Bangladesh.
SUMMARYThis study examines the change in health-related quality of life (HRQoL) among (60 years) elderly persons as a result of health education intervention. A communitybased intervention study was performed in eight randomly selected villages (Intervention: n ¼ 4; Control: n ¼ 4) in rural Bangladesh. A total of 1135 elderly persons was selected for this study. The analyses include 839 participants (Intervention: n ¼ 425; Control: n ¼ 414) who participated in both baseline and post-intervention surveys. Participants in the intervention area were further stratified into compliant (n ¼ 315) and non-compliant (n ¼ 110) groups based on the reported compliance to the intervention activities. The intervention includes, for example, 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 elderly persons at home and the community, including information about elderly persons' health and health care. The intervention activities were provided to the elderly persons, caregivers, household members and community people for 15 months. The HRQoL was assessed using a multi-dimensional generic instrument designed for elderly persons. Multivariate analyses revealed that in the noncompliant group the probabilities of increased scores were less likely in overall HRQoL (OR 0.52, 95% CI 0.32-0.82). Among the Control group, increased scores were less likely in the physical (OR 73, social (OR 0.37, spiritual (OR 0.60,, environment (OR 0.36, 95% CI 0.26-0.49) dimensions and overall HRQoL (OR 0.44, 95% CI 0.32-0.59) (adjusted for age, sex, literacy, marital status and economic status). This study concludes that provision of community-based health education intervention might be a potential public health initiative to enhance the HRQoL in old age.
Background In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. Methods A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. Results Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. Conclusion KPs’ willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.
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