Original article

FACTORS INFLUENCING HEALTH BEHAVIORS OF ELDERS IN MUEANG DISTRICT, PROVINCE, THAILAND Siriwat Chaihanit*, Prathurng Hongsranagon and Piyalamporn Havanond College of mtblic Health Sciences, University, 10330, Thailand

ABSTRACT: The objectives of this research were to study health behaviors of the elderly in Mueang District, Roi Et province, concerning exercise, diet, self-care during illnesses and stress management; to describe each personal attribution factor, such as, gender, age, educational background, marital status, income, income sufficiency, main source of income and personal illness; and to determine factors influencing the mentioned health behaviors. It was a cross-sectional study with a systematic sampling of 430 samples. Data collection was in December 2009. A face to face interview was used and descriptive statistics was employed (frequency, percentage, mean, standard deviation) while Chi-Square test was used to find out the factors associated with their health behaviors. The results found that majority of the samples was female (58.6%), aged between 60-65 years old (40.5%) ,finished primary school (79.8%),married (63.7%) , with monthly household income less than 5,000 baht (47.9%), had sufficient income but not enough for saving (41.9%), earned their own incomes (96.3%),had personal illnesses (57.2%) such as diabetes (46.1%), with consistent follow-up of their chronic disease (99.3%). In regards to their health behaviors, the result revealed that diet behavior was on good level(x=2.68, S.D.=0.25);exercisebehavior was on fair level(X=2.13, S.D.=0.60); self care behavior was on good level (x=2.69, S.D.=0.39) and stress management behavior was on good level(X=2.37, S.D.=0.41). Factors positively associated with health behaviors of elderly were as follows: age and personal illnesses with diet behavior at the statistical significance level of 0.05 dp=0.048, 0.008 respectively); gender, educational background and income sufficiency with exercise behavior at the statistical significance level of 0.05 (p=0.002, 0.0 16, <0.001 respectively); marital status with self care behavior at the statistical significance level of 0.05@=0.032); gender, educational background and income sufficiency with stress management behavior at the statistical significance levelof 0.05 (p=0.045,0.024,0.001 respectively).This study made aware of behavioral health and factors influencing health behaviors of elderly, to guide the operation of the elderly health promotion in Mueang District, Roi Et Province, such as screening at least once a year. The objective is to reduce sickness and risky activities; provide accurate information and conduct continuous health promotion behavior among elders and their families. The information should include positive diet, exercise, self care during illness and stress management behavior and improve questions regarding exercise in the questionnaire for interviewing elders to be more suitable for them. KEYWORDS: Heath behavior/ Elderd Mueang District, Roi Et Province, Thailand.

INTRODUCTION: In 1970, the proportion of of the total population by 2020 and 20252). the elderly to the total Thai population was The number of Thai elderly has rapidly been five percent which ranked the country as on the rise when one compares with the same the seventh with the highest proportion of occurrence in developed countries in the past. the elderly in the South East Asia Region. The time taken for the proportion of the Currently, that proportion becomes doubled elderly, above 60 years old, to the total or ten percent1), thus Thdand possesses the population in those developed countries highest number of the elderly, second only to grew from 7% to14% within the period of 107 Singapore'). According to the projection of years, while Thailand used only 30 years in Thai population between 2000-2030, it duration3)14). According to the United Nations' reveals that in 2010, the elderly population criteria, an ageing society refers to a society rises to 7.6 million or an equivalent of 11.4% where 10 percent or more of its population of the total population. The figure is expected ages over 60, or over 7 percent of its to increase to 11.3 million or 16.1% and19.8Oh population is older than 655). The changing in

*To whom correspondence should be addressed E-mail:[email protected].

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Thai population pyramid structure at each aged 60 years and above, both male and interval changes from the wide-base pyramid female, who were living in Mueang District, (the shape of pagoda) in 1970 to the high Roi Et Province. The sampled population was shape vessel in 1995 and is expected to 430 through a systematic sampling9),,arrange become a vase shape in 2025 6). This list of elders according from 15 sub - district continuously increasing trend of Thai elderly calculate the interval and select the sample will bring along their health risks and health until attain the calculated sample size. Data problems, especially their chronic disease due collection was a face - to - face interview, the to the deterioration in physical, emotional, face - to - face interviews were pre - test the economic and social aspects of the elderly. corrected and improved questionnaire with The information generated by Roi Et Province 30 elderly people, each scale's reliability was found that during year 2007-2009, the elderly food consumption Cronbach' s Alpha = 0.678; population were 131,689,134,7 18 and 141,651 exercise Cronbach' s Alpha = 0.923; illness respectively. The independent percentage was and sick-role Cronbach' s Alpha = 0.768 and 15.6 and the trend of average life expectancy stress management Cronbach' s Alpha = was accelerating. Male and female elderly had 0.82, interpretation of health behavior by an average life expectancy of 69.97 and 74.31 aspect could be classified into ranges of score years respectivelyq. Mueang District possesses value. Descriptive statistics was employed a total population of 150,145, out of which (frequency, percentage, mean, standard 17,720 or 11.8% are the elderlys). Roi Et deviation) and Chi - Square test was used to Province is considered as one of the provinces find out the factors associated with their with an increasing number of its elderly health behaviors. population which in an alignment with is RESULTS : From the data analysis of the statistical projection of Thai population. personal attribution of the elderly, it was The increase in elderly population will affect found that majority of the samples was female Roi Et socially and economically so much (58.6%), aged between 60-65 years old that there is a necessity to provide continuous (40.5%), finished primary school (79.8%), health resources in the long run. This study married (63.7%), with monthly household thus aimed to (1) study the elderly' s health income less than 5,000 baht (47.9%), had behaviors concerning exercise, diet, self care sufficient income but not enough for saving during dlnesses and stress management, (2) to (41.9%), earned their own income (96.3%), describe each personal attribution factor, had personal illnesses(57.2%) such as such as, gender, age, educational background, diabetes (46.1%)) with consistent follow - up marital status, income, income sufficiency, on their chronic disease (99.3%). In regards main source of income and personal illness, to their health behaviors, the result revealed and (3) to determine factors associated with a good level for diet, exercise, self care health behaviors of the elderly. practice and stress management behaviors. MATERIAL AND METHODS: a cross-sectional Factors associated with h&th behaviors of study was used to explore factors that the elderly were demonstrated in the following influenced the health behaviors of the elderly. tables: The targeted population was those elderly

Table 1 Factors associated with diet behavior Variation Level of diet behavior Poor-Fair Good Total p - value XI Age (years) 60 - 80 71- 80 Above 80 Personal illnesses Do not have personal illness 25(13.6%) 159(86.4%) 184(100%) 6.998 0.008* Have personal illnesses 15(6.1%) 231(93.9%) 246(100%) * Statistical significance at the level of 0.05

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Table 2 Factors associated with exercise behavior

Variation Level of Exercise Behavior Poor-Fair Good Total x2 -R- value Gender Male 101(56.7%) 77(43.3%) 178(100%) 9.937 0.002* Female 180(71.4%) 72(28.6%) 252(100%) Educational Background No education 10(76.9%) 3(23.1%) 13(100%) 10.345 0.016* Primary school 234(68.2%) 109(31.8%) 343(100%) Secondary school/ 24(47.1%) 27(52.9%) 51(100%) vocational education Bachelor's degree 13(56.5%) 10(43.5%) 23(100%) Higher than bachelor's degree Income sufficiency Insufficient 129(73.7%) 46(26.3%) 175(100%) 16.978 <0.001* Sufficient but not 117(65.0%) 63(35.0%) 180(100%) enough for saving Sufficient and have 35(46.7%) 40(53.3%) 75(100%) some left for saving

* Statistical significance at the level of 0.05

Table 3 Factors associated with self care behavior during illness

Variation Level of self care behavior during illness Poor-Fair Good Total X' p value

Marital status Single 2(13.3%) 13(86.7%) 15(100%) 6.908 0.032* Married 42(15.3%) 232(84.7%) 274(100%) Widow, Divorce/ separation 9( 6.4%) 132(93.6%) 141(100%) * Statistical significance at the level of 0.05

Table 4 Factors associated with stress management behavior

Variation Level of stress management behavior Poor-Fair Good Total X' p value

Gender Male 62(34.8%) 116(65.2%) 178(100%) 4.001 0.045* Female 112(44.4%) 140(55.6%) 252(100%) Educational Background No education 9(69.2%) 4(30.8%) 13(100%) 9.443 0.024* Primary school 143(41.7%) 200(58.3%) 343(100%) Secondary school/ 13(25.5%) 38(74.5%) 51(1OO0h) vocational education Bachelor's degree 9(39.1%) 14(60.9%) 23(100%) Higher than bachelor's degree Income sufficiency Insufficient 83(47.4%) 92(52.6%) 175(100%) 13.416 0.001* Sufficient but not 74(41.1%) 106(58.9%) 180(100%) enough for saving Sufficient and have 17(22.7%) 58(77.3%) 75(100%) some left for saving

* Statistical significance at the level of 0.05

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DISCUSSION: As the elderly are valuable standard index of exercise might not be and respectful human resources in Thai strictly adhered to by the elderly (for culture and tradition, the current research on " instance, stretching out or exercising for at Factors influencing health behaviors of least 30 minutes daily).lo) The lesson learnt elders in Mueang District, Roi Et Province, is that an evaluation on exercise habits of Thailand " had the objectives to study their the elderly in Roi Et Province needs an health behaviors concerning diet, exercise, adaptation for measurement to match with self-care during illnesses and stress management; the reality. In terms of self-care behavior to learn about each different personal during illness, the sample put a great attribution factor (such as gender, age, importance on the issue. However, their educational background, marital status, practice of purchasing medication at their income, income sufficiency, main source of own judgment is the topic of attention by income and personal illness or the eight health personnelll). For whatever reasons factors); and to find out factors associated they may have, this practice may indicate with health behaviors of these elderly. that there is a trend of self-reliance for Regarding eight personal attribution factors, primary care (through the use of pharmacy as an overall, it found that females between services) talung place among the elderly in 60-65 years old with primary school Mueang District, Roi Et Province. The last education lived with their spouses and had aspect concerns stress management behaviors an income of less than 5,000 baht per by the samples. Through the Thailand month. About 42% of the samples had northeast ancient tradtion of "Hit Seepsong, sufficient income but not enough for saving. Klong Seepsii", these religious-oriented Almost 97% of the samples earned their activities preoccupy the time of the elderly. own income. However, about 58% of them Being backed up with frequent interaction had personal illnesses, particularly diabetes among their neighbors, elderly in Mueang mellitus (DM) where almost all had consistent District could rely on natural peer-assistance to follow-up on their chronic disease (99.3%). relieve their tension. Employing Chi-Square Other personal illnesses included high test to find out the relationship between blood pressure (98.9%) and osteoarthritis independent and dependent variables of the (90.3%).For the four aspects of the elderly's study, it was found, with the statistical health behaviors, it was found that for diet significance at the level of 0.05, that age and part, the elderly in Mueang District, had personal illnesses had positive association good, suitable and positive diet behaviors with diet behavior of the elders. Economic caused by proper nutritious consumption. necessity and self-reliant effort might explain The credit should be given to the team of this phenomenon. Gender, educational background public health personnel in the province and income sufficiency positively associated comprises of multidisciplinary workforce who with exercise behavior of the elderly. The keep on providing health education at result revealed that male elderly would have different health facilities to the patients. higher exercise behavior than female due to This task of action is well supported by the differences in their physicalityl2).It is known Thai government aiming at the establishment that males tend to be stronger than females. of "healthy ageing" at each locality. Since Although they are confronted with body 77.9% of the elderly in Roi Et province still deterioration but due to the reduction in attentively work in farming@, therefore, their social responsibilities, they tend to taking a look into their exercise behavior, place an emphasis on their physical health they could naturally have strong physical by doing regular exercise. Education is an activities while they are working. Consequently, important source of self-improvement which

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stimulates a change in health behavior in those with lower educational background. the aspect of knowledge, attitude and Moreover, sufficient income and enough for actionl3). The fact that a person needs to saving would have better stress management18) possess accurate knowledge and right because income is an important factor for attitude in order to carry out correct health one's living as money is used to procure behavior practice, therefore, the elderly with things that can satisfy one's basic needs. higher educational background would Consequently, the elderly with sufficient perhaps have a better chance to learn and income and enough for saving would not access to the source of knowledge about have to struggle to earn their living after exercise than those with lower educational their retirement which would enable them background. In addition, those with sufficient to look for health service conveniently income and enough for saving tend to have without worrying about extra expenses. In better exercise behavior than those with fact, they can spend more time looking after sufficient income but not enough for themselves. On the contrary, the elderly saving141 because the first would have stable who have insufficient income still needed to financial status with financial power to work to support their family and to make inquire factors that can benefit their health ends meet for their household expenses. and enable them to live a happy life. On the RECOMMENDATIONS: For the application other hand, marital status had a positive of research 1.) Screening is carried out by association with self- care behaviors perhaps the public health officers at Primary Care due to spouse existencel51. Finally, gender, Unit at least once a year. The objective is to educational background and income sufficiency reduce sickness and risky activities; determine had positive association with stress management illness at early period; and provide accurate behavior of the elderly. Male elderly would health knowledge. 2.) Prwide accurate information have better stress management behavior and conduct continuous health promotion than female ones because, by nature, men behavior among elders and their families. would tend to have a leading role in his 3.) Encourage all family members to involve family, possess power to make decision, in elderly care so as to enable the elders to have opportunity to meet with other people experience warm and happy family atmosphere and participate in the social events more during their retirement. often than womenl61. These factors enable 4.) Promote mental healthcare for elders by men to perceive him self with higher self allowing more elders to participate in activities esteem. Meanwhile, women's main responsibilities initiated by elderly clubs or other groups. 5.) are to look after the family, do house Improve questions regarding exercise in the chores, and lack an opportunity to engage questionnaire and for interviewing elders to in outside-home activities. As a result, be more suitable. The exercise standard for women tend to feel stressful easier than normal person which is doing exercise at men. Samples with higher educational least 3 times a week for at least 30 minutes background tend to cope up with their per session is not applicable to elders' stress better than those with lower educational physical condition. For future research 1 .) background17 because education is the important A study on health behavior of elders in source of knowledge and potential development qualitative approach should be conducted factor which helps to create positive attitude so as to be guideline to improve health toward self-care behavior. Therefore, people behavior of elders according to environmental with higher educational background would condition and traditions of the community. have better access to sources of information 2.) A study on other factors that have that can be used for decision making than association with health behavior of elders,

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such as social support, environment, family, 10. Ministry of Public Health, Department psychology etc, should be conducted as of Health. 2010. Division of exercise for well. 3.) The sampled group for this study health. [On line]. Available from: http: / / www. consisted only of elders who were living in anamai.moph.go. th/ download/ download/ Mueang District, Roi Et Province. In order check/07.doc [2010,March 121. to widen the working scope, a similar study 11. Mallika Mattiko and team. 1997. Report should be conducted on elders in all area of on hygiene and self care behavior regarding Roi Et Province or in other provinces. The hygiene of elders in the Northern part of Thdand, information gathered should be compared to Social Sciences Department, Faculty of Social determine difference of factors association with Sciences and Humanities Mah~dolUniversity. health behavior elders. 12. Wandee Yamchanchai. 1995. Correlation ACKNOWLEDGEMENT: I would like to express between Self-Efficacy, Self-perceived Health my sincere gratitude and appreciation to my and Health Promotion Behavior of Elders in thesis advisor, Dr.Prathurng Hongsranagon, as . Master's Thesis, well as Ajam Ryalampom Havanond, Assistant Nursing in Adult Program Faculty of Graduate Professor Ratana Sarnrongthong and Ajarn Studies Mahidol University. Wongwat Liuluck, M.D. for their guidance, 13. Wannipa Assawachaisuvikrom. 2002. invaluable advice, kindness, and encouragement Research on Factors influencing Exercise throughout the period of my study. Behavior of Elders who were living in Tambol REFFERENCES: Saensuk, Chonbuti province. Faculty of 1. National Institute of Aging. 2006. A Survey and Nursing Burapha University. Study of Healthcare Condition of Elders in 4 14. Khemika Yamarat. 1984 . Old Age Life Satisfaction: A case of Retired Government Regions. Bangkok: National Institute of Aging. officials of the Ministry of Agriculture and 2. The National Economic and Social Development Cooperatives. Master's Thesis, Sociology Board, Office. 2007. Projection of Thailand's Graduate School Thammasat University. Population 2000 - 2030. Bangkok: Office of the 15. Niranard Witthayachokkitti. 199 1. Self National Economic and Social Development Board. Care Ability and Health Condition of Elders. 3. Jitapunkul S, Bannag S. 1998. Aging in Master's Thesis, Nursing Program Graduate Thailand 1997. Bangkok: Thai Society of School Mahidol University. Gerontology and Geriatric Medicine. 16. Chitkanya Boonya. 996. Mental Health 4. The National Commission on the elderly. 2006. of Elders in Elderly Club in Pichit Province: Situation of the Thai elderly 2005. Bangkok: the A case study on Elderly Club in Tambol National Buddhism office's Publisher. Tapanhin. Master's Thesis, Major: Psychology 5. United Nation. 1956. The aging of populations advice Naresuan University. and its economic and social~implications 17. Chonthicha Wangvivek. 1994. Relationship (population studies No). New York: United Nation. between Physical Condition, Social Support and Self Care Behavior of Elders: A case 6. United Nations. 1996 . Population aging study on Elders in Thammasat University in Asia and the Pacific. New York: United Nation. Hospital. Master's Thesis, Major: Family 7. Roi Et Public Health Office.2009. Information Health Graduate School Mahidol University. Center on Strategy Development Group.Roi Et, 18. Maitree Tiyarathanakoon. 1993. Factors Thailand. that have Correlation with Mental Health of 8. Mueang District Public Health Office. Elders who were living in Bangkok Area: A case 2009. Database Hos xP PCU. Roi Et, Thailand. study elders who were members of Elderly 9. Kalaya Vanijbancha. 2006 . Statistics for Clubs in Bangkok. Master's Thesis, Major: Research Work. 2d ed. Bangkok: Chulalongkorn Population and Social Study Graduate School University Press, pp. 15-16. Mahidol University.

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