Strategies to improve engagement of ‘hard to reach’ older people in research on health promotion: a systematic review

Abstract

Background: This systematic review aimed to identify facilitators, barriers and strategies for engaging 'hard to reach' older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. Methods: Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people. Results: Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions. Conclusions: This review identified facilitators, barriers and strategies for engaging 'hard to reach' older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.

Social Relations, Community Engagement and Potentials: A Qualitative Study Exploring Resident Engagement in a Community-Based Health Promotion Intervention in a Deprived Social Housing Area

“…Our findings, in accordance with other studies, demonstrate that the social relation aspect is an important motive for engagement in community-based health promotion interventions [21,37,38]. In investigating the motivation for residents of deprived areas of social housing to engage in health promotion interventions, a systematic review of strategies to improve engagement of hard-to-reach older adults emphasized that participants preferred group-based health promotion interventions compared to individual sessions because of their social element [21]. The establishment of new relations to fellow residents and the enhancement of existing relations among residents in our study are health promoting, since positive social relations are favorable for both the physical and mental health and overall wellbeing of individuals [7,8].…”

“…Engagement in the intervention was driven by a desire to establish and enhance social relations. Our findings, in accordance with other studies, demonstrate that the social relation aspect is an important motive for engagement in community-based health promotion interventions [21,37,38]. In investigating the motivation for residents of deprived areas of social housing to engage in health promotion interventions, a systematic review of strategies to improve engagement of hard-to-reach older adults emphasized that participants preferred group-based health promotion interventions compared to individual sessions because of their social element [21].…”

“…Deprived population groups may be disempowered and unable to engage in traditional health promotion interventions, since these encourage individuals to exert control over their own health, often through a focus on advancing knowledge of risk factors [19,20]. Nevertheless, studies concerning recruitment approaches attempting to reach deprived population groups have found that working with residents of deprived social housing areas can enhance the acceptance of and engagement in health promotion interventions [3,9,15,[21][22][23]. This entails that residents, in collaboration with formal and informal organizations in the deprived social housing areas, are involved in the design and implementation of the health promotion intervention [3,16,[22][23][24].…”

What older adults want from their health care providers

“…Barriers to engagement for more fragile and harder to reach individuals were also addressed by reaching out to the most populous multi-unit retirement residences. 51 Patient Experience Journal, Volume 5, Issue 3 -2018 Study participants included persons who were living independently. Persons who are residing in assisted living facilities have more functional decline and require more support and resources.…”

Older south Asian women sharing their perceptions of health and social care services and support: A participatory inquiry

“…From within groups of older people from BAME communities, the authors found that both convening social group sessions and strengthening community connections facilitated health promotion activities. However, together with language and cultural differences, barriers included members not having the confidence or motivation to get involved …”