Case study: community development Neighbors Connected: the interactive use of multi-method and interdisciplinary evidence in the development and implementation of neighbors connected Jeanette Lezwijn1,2, Jenneken Naaldenberg1,2, Lenneke Vaandrager2 and Cees van Woerkum3 Abstract: Neighbors Connected is a community-based intervention in the Netherlands. It helps the active older people to organize social activities for their less active older neighbors, facilitated by practical and financial support from the Community Health Service. The intervention is the outcome of a combination of semi-structured interviews with the older people, with organizations for older people and with local policy-makers, epidemiological data and interactive discussions, all of which support the notion that engaging in social activities is a way to enhance healthy ageing within the community. The use of different sources of evidence resulted in a comprehensive picture and action- able local knowledge. (Global Health Promotion, 2011; 18(1): pp. 27–30) Keywords: aged, evidence-based practice, health promotion, organizational case studies, public health Introduction themselves participate in the development and implementation of Neighbors Connected. Within As people grow older, biological changes influence Neighbors Connected, active older people are their mental, physical and social state, including invited to organize an activity and invite less active their social networks. This can have a huge impact older people in their neighborhood. Examples of on their quality of life and their health. Healthy such activities include: starting a club for people ageing is a complex issue on which stakeholders with mobility scooters and making Christmas each have their own views that must be included in cards. The initiators are responsible for inviting par- the development of interventions in order to create ticipants. The collaborating partners of Neighbors effective programs. To include relevant stakeholders Connected facilitate these activities by practical and their opinions, the Gelre-IJssel community support, such as advertising for the event. Financial health service closely collaborates with two munici- support can be provided up to an amount of 500€ palities in the eastern part of the Netherlands. per initiative. For one year it was possible to finance Within these municipalities, local organizations for 20 activities within two municipalities. The organi- older people, welfare organizations and older people zational support was funded by a community health 1. GGD Gelre-IJssel (Community Health Service), Appledorn, the Netherlands. 2. Wageningen University, Department of Social Sciences, Health and Society Group, Wageningen, the Netherlands. 3. Wageningen University, Communications and Innovation Studies, Wageningen, the Netherlands. Correspondence to: Jeanette Lezwijn, GGD Gelre-IJssel (Community Health Service), AGORA Academic Collaborative, Deventerstraat 43, 7311 LV Apeldoorn, the Netherlands. Email: [email protected] (This manuscript was submitted on November 30, 2009. Following blind peer review, it was accepted for publication on October 5, 2010.) Global Health Promotion 1757-9759; Vol 18(1): 27–30; 393167 Copyright © The Author(s) 2011, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975910393167 http://ghp.sagepub.com Downloaded from ped.sagepub.com at Wageningen UR Library on October 20, 2016 28 J. Lezwijn et al. service. The aim of the intervention is to improve much appreciated resources for all kind of and sustain social participation and engagement of chores. Interviews with local organizations older people. Another goal is to build an infrastructure underline the importance of control. that facilitates older people to be active in the com- 2. Epidemiological analysis of data from a health munity and creates greater awareness of health- monitor among older people was used to deter- promoting resources for the older people within mine risk factors of ageing and indicators con- their municipality. tributing to healthy ageing. Cluster analyses of the monitor data revealed different groups. The The evidence clusters in which older people were less socially engaged scored lower on perceived health than Neighbors Connected is part of an academic col- the clusters of older people who were more laboration between Wageningen University, Gelre- socially engaged in the form of leisure or work IJssel Community Health Service and municipalities (also voluntary work) (3). This quantitative within its region to bridge the gap between research, result supports the findings from the interviews policy and practice. This academic collaborative that revealed the importance of social support (AGORA) is funded by the Netherlands Organization and social capital. Neighbors in particular were for Health Research and Development. AGORA found to contribute to well-being. aims to develop, implement and evaluate methods to 3. The results from points 1 and 2 were discussed promote healthy ageing within municipalities. with relevant stakeholders in order to validate AGORA’s interdisciplinary and intersectoral way of findings, set priorities and think about which working provides opportunities to integrate evidence steps to take next. In these discussions, the from different perspectives and practical, policy and problem of hard-to-reach groups, such as the scientific approaches into a coherent evidence base lonely older people, played a central role. for healthy ageing (1). Disciplines collaborating together include, for example, researchers, health On the basis of this evidence it can be concluded promotion professionals, epidemiologists and policy- that social participation, reduction of loneliness makers, from different sectors such as policy, research, among the older people and perceived feeling of welfare and health. control are determinants of healthy ageing. Factors To develop a healthy ageing program, evidence was contributing to this feeling of control are: (i) a posi- collected in three different ways: first, interviews with tive approach to healthy ageing; (ii) a supportive main stakeholders including target groups; second, an environment in which neighbors play an active role; extended analysis of quantitative monitor data; and (iii) clear communication and visibility of facilities; third, interactive sessions with stakeholders. and (iv) the active involvement of older people in their own situation (2). 1. Relevant stakeholders and older inhabitants were approached to participate in interviews How the evidence was used that explored differences in perceptions and goals with respect to healthy ageing. These inter- Evidence was used and valued at different levels. views showed that older people do not approach First, close collaboration between epidemiologists health and ageing as separate from their daily and social scientists resulted in mutual learning and lives (2). Furthermore, older people with serious synthesizing of approaches. Questions that arose in physical problems can be very capable of func- interpreting quantitative data were added to the tioning up to a satisfactory level. This indicates interviews, and the results from these interviews that physical health status alone does not explain were strengthened by investigating them quantita- the way older people experience health, but that tively. Difficulties with this interdisciplinary a feeling of control plays an essential role (2). To approach concerned the interpretation of concepts feel in control, respondents indicated that being and validity of results. The close interpersonal col- able to use facilities by themselves is important, laboration between the disciplines created mutual especially local resources. Neighbors are very trust in which these differences could be overcome IUHPE – Global Health Promotion Vol. 18, No. 1 2011 Downloaded from ped.sagepub.com at Wageningen UR Library on October 20, 2016 Case study: community development 29 (4). Second, the interactive discussions among stake- removes obstacles that might prevent the less socially holders encouraged learning from each other’s per- active older people from participating. These older spectives, familiarity with other organizations within people are invited by their neighbors to participate in the municipality, and input for researchers on how to nearby activities that are meaningful for them. present their findings in a way that local organiza- tions and policy-makers could put them into practice. Conclusion Difficulties encountered concerned the time it took to come to shared goals and objectives. Planning health- The development and implementation of the promoting programs often requires pre-defined goals Neighbors Connected intervention form a process in and evaluation methods. This resulted in uncertainty, which different kinds of evidence from research con- and an alternative approach to planning had to be ducted in AGORA were used. The academic collabo- adapted to overcome this. Third, the interactive rative setting facilitates these processes because it session with both stakeholders and target groups simplifies the creation of opportunities to share revolved around several issues such as: (i) the impor- knowledge and create social learning among the dif- tance of issues such as health, happiness, pleasure and ferent disciplines and policy, science and practice (1). convenience as motivations to be socially participa- Another factor that facilitated the use