Towards Salutogenic Health Promotion Organizing Healthy Ageing Programs at the Local Level
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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Wageningen University & Research Publications Towards salutogenic health promotion Organizing healthy ageing programs at the local level Jeanette Lezwijn Thesis committee Thesis supervisor Prof.dr. C.M.J. van Woerkum Professor of Communication Strategies Wageningen University Thesis co-supervisors Dr.ir. H.W. Vaandrager Associate professor, Health and Society Wageningen University Dr.ir. M.A.E. Wagemakers Assistant professor, Health and Society Wageningen University Other members Prof.dr. B. Lindström, Folkhälsan Research Centre, Helsinki, Finland Prof.dr.ir. E.J.M. Feskens, Wageningen University, Wageningen, The Netherlands Prof.dr. A.J. Schuit, VU University, Amsterdam, The Netherlands Prof.dr. K. Horstman, Maastricht University, Maastricht, The Netherlands This research was conducted under the auspices of the Wageningen School of Social Sciences (WASS). Towards salutogenic health promotion Organizing healthy ageing programs at the local level Jeanette Lezwijn Thesis submitted in fulfilment of the requirements for the degree of doctor at Wageningen University by the authority of the Rector Magnificus Prof.dr. M.J. Kropff, in the presence of the Thesis Committee appointed by the Academic Board to be defended in public on Tuesday 20 September 2011 at 1.30 p.m. in the Aula Jeanette Lezwijn Towards salutogenic health promotion Organizing healthy ageing programs at the local level 200 pages Thesis, Wageningen University, Wageningen, The Netherlands (2011) With references, with summaries in Dutch and English ISBN 978-90-8585-986-4 Abstract Introduction The increase in the ageing population in the Netherlands is having an impact on national as well as on local level. As people are now living longer, the importance of preventing unnecessary disability, maintaining physical functioning and preventing complications from chronic diseases and adding life to years rather than years to live has become increasingly important. Local governments therefore face challenges to improve healthy ageing for their ageing population. Aim In municipalities all kind of facilities and activities to improve healthy ageing are already developed. However the reach of these facilities and activities is often low. Especially among the more vulnerable older people. More insights and new methods are therefore needed to reach these older people or to develop facilities and activities that better fit the wishes and desires of older people themselves. This study aims to contribute to the knowledge base of health promotion professionals about how to develop, implement and evaluate local healthy ageing programs. Methods Since in this study, the researcher is at the same time a health promotion professional developing, implementing and evaluating a healthy ageing program in three municipalities in the eastern part of the Netherlands, mainly an action research approach is used. Thereby, action research fits well within the complex setting of a municipality. It aims to analyse the situation and its problems, to find solutions to address the problems, and to look for opportunities to put these solutions into practice. In this thesis multiple methods, such as interviews and participant observation, and different sources of data, such as the ageing population, local organizations and policymakers, were used. Results Because intersectoral collaboration and participation of the community, which are essential for developing a new healthy ageing program (coordinated action for health), were not self- generating processes, the HP 2.0 framework is developed. The framework is based on the principles of health promotion and on salutogenesis and exist out of the concepts ‘sense of coherence (SOC)’, ‘resources for health’ and ‘health’. When ‘resources for health’ are adapted to the SOC, older people are more likely to identify those resources and make use of it. The HP 2.0 framework is developed to contribute to the discussion concerning the content of a health promotion program. Other issues contributing to coordinated action for health are prerequisites such as time and money. Thereby, in each municipality the extent to which coordinated action is built and sustained was different, which influenced the processes in the municipalities when developing a healthy ageing program. Four different planning approaches were identified, namely the classical, evolutionary, processual and the systemic approach to planning. In the process of achieving and sustaining coordinated action for health, both context-free – such as epidemiological data and scientific literature – and context-sensitive evidence – stemming from interviews with older people, organizations and local policymakers – were combined. This resulted in a new healthy ageing program, called Neighbors Connected. Conclusion Three conclusions can be drawn from this study. The first conclusion is that the HP 2.0 framework contributed to the development, implementation and evaluation of healthy ageing strategies. The framework visualizes the salutogenic relationship between resources for health and SOC, which is not made explicit elsewhere. This means that although a health promotion program in itself has the potential to contribute to health, the framework adds that a program also needs to be perceived as comprehensible, manageable and meaningful. The second conclusion is that coordinated action starts from the moment stakeholders meet and share ideas, and thus before the actual health promotion programs starts. Such a preliminary phase influences local planning processes to develop and implement health promotion programs in the municipality, since in this phase relevant stakeholders have to be found and discussions with stakeholders have to take place about aims and objectives. Therefore, this preliminary phase should be part of the evaluation of the health promotion program as well, next to the evaluation of the impact of the program on (determinants of) health. The third conclusion is that within this study the HP 2.0 framework and the achieved coordinated action for health made it possible to combine different forms of evidence. Combining different forms of evidence, context-free and context-sensitive, contributed to the sharing of knowledge, to the co-creation of a salutogenic health promotion program and to more sustainable changes. Contents Chapter 1 Introduction; 9 Health promotion and healthy ageing in complex contexts Chapter 2 HP 2.0 framework; 31 Building a theoretical framework for developing a healthy ageing strategy in the complex context of a municipality Chapter 3 Coordinated action; 47 Context, dynamics and prerequisites of healthy ageing strategies in three Dutch municipalities Chapter 4 Coordinated action checklist; 67 A tool to facilitate and evaluate coordinated action for healthy ageing Chapter 5 Neighbors Connected; 85 The effect of using inter-disciplinary evidence Chapter 6 Neighbors Connected; 91 A strategy to recruit older people to participate at local activities Chapter 7 Looking back; 107 The quality assurance of Neighbors Connected Chapter 8 Looking back; 125 Project panning for healthy ageing in local health promotion practice Chapter 9 Discussion; 143 Main conclusions and future directions Appendix I Newspaper clippings as used in Chapter 3 161 Appendix II Interactive sessions within the municipalities 173 Summary 179 Samenvatting (Summary in Dutch) 185 Dankwoord (Acknowledgements) 191 About the author 195 1 Introduction; Health promotion and healthy ageing in complex contexts Chapter 1 Health promotion and healthy ageing in complex contexts Introduction In the Netherlands, increased life expectancy and decreased fertility rates in the last century have resulted in a sharp rise and growing share of older people in the population (Boluijt et al. 2010; Van der Lucht and Polder 2010). As people are now living longer, the importance of preventing unnecessary disability, maintaining physical functioning, preventing complications from chronic diseases and adding life to years rather than adding years to life has become increasingly apparent (Minkler, Schauffler & Clements-Nolle 2000). Governments therefore face challenges about how to improve healthy ageing for their ageing population. On the local level, all kinds of facilities and activities for especially the more vulnerable older people have already been developed. Examples include: special public transport for older people, meals on wheels, an activity program with workshops, activities to meet other people and discussion groups, courses for people who have lost their partner, a counselor who supports older people to make use of existing facilities and an internet site or a regular newsletter with practical information about local facilities and activities for older people. The reach of some of these facilities and activities is low. This does not mean that the facilities and activities in themselves do not contribute to healthy ageing, but rather that some of the older population have difficulty accessing these facilities and activities. More insight and new methods are therefore needed to reach these older people or to develop facilities and activities that better fit the wishes and desires of older people themselves. This study aims to contribute to the knowledge base of health promotion professionals about how to develop, implement and evaluate local healthy ageing programs. In this chapter, the background and the current views concerning health and