INTRODUCTION
The United States Census Bureau (US Census) reports that in 2016 the estimated number of people 65 and older was 49.2 million. It is projected that by the year 2060 that number will reach 98 million.1 Older adults are living longer. Nonetheless, this population also experiences higher incidences of chronic diseases, such as diabetes, cancer, cardiovascular disease and stroke.2
Interesting to note is that older adults who are low-income or are receiving Medicaid benefits have higher incidences of chronic disease. This conundrum contributes to the financial burden on Medicaid. For example, the cost of prediabetes and diabetes in the United States is an estimated $245 billion each year. Moreover, projected expenditures for people with diabetes on Medicaid was $13, 490 per capita.3
Another issue worth consideration is the impact of social isolation among older adults and risk of declining physical and psychological health. The literature states that the prevalence of social isolation among adults 65 and older is 7-24% in comparison to the general population at 7%.4
To address the concern of chronic disease, social isolation and its impact on the health and well-being of older adults 65 years of age and older, Healthy Shalom, a Christian ministry will provide a platform for this targeted population to interact, share and access resources that help them to age with dignity and self-efficacy. Moreover, up-to-date evidence-based resources and educational materials as well as positive health messaging will be employed and readily available.
This intervention will target primarily African American and Latinx older adults at risk or living with a chronic disease. Elements such as culturally competent and linguistically appropriate standards will align with the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS).5
The goal of Healthy Shalom is to help reduce the prevalence of chronic disease and social isolation among the targeted audience through an interactive online vehicle that is user-friendly, current, and provides a social network that is both engaging and sustainable. Moreover, the health communication strategy will promote the nexus between healthy eating and physical activity as an intervention for reducing risk and increasing self-management of chronic disease.
The formative research for this health communication strategy begins with a review of the current literature. The literature is organized in three parts. The first will discuss behavior change theory and its application to the promotion of physical activity and healthy eating. The research will continue with an investigation of perceived self-efficacy, one of the constructs of social cognitive theory (SCT) as it relates to health communication strategies. This is most important as the construct of self-efficacy within SCT is very responsive to intervention efforts.6
The second portion of this review is to examine the current literature on similar interventions and health communication strategies that have been effective and can serve as a model for other strategies specific to the utilization of and the engagement with social media. Further, an analysis of the strengths and weaknesses of these interventions will be performed to learn best practices and sustainability.
The final portion of this review will be to identify barriers to participating in the social media arena. Determinants such as equity and access will be explicated through the current literature. A conclusion of the review will provide a summary of the current literature and provide supporting evidence for a health communication strategy such as Healthy Shalom and address some of the methodologies utilized in the studies.
The criteria for selecting the literature are that it addresses the target population of older adults at risk or with a chronic disease. Further, it should speak to the theoretical underpinnings of health behavior, and that there is discussion of a social media platform and its impact on healthy aging. Lastly the literature should address issues of social isolation and barriers for African American and Latinx older adults. The references selected meet that criteria.
BODY OF EVIDENCE
Behavior Change Theory
Perceived self-efficacy is one of the key constructs in social cognitive theory. The theory presents methods to change behavior that inimitably integrate a mechanism to facilitate behavior change. Moreover, for successful behavior change to occur moderators such as levels of self-efficacy, reciprocal relationships between the environment and the individual and the presence of social influences must occur.7
Sell, et al provide an integrative review of the use of social construct theory in chronic disease self-management among older adults. The highlight of the integrative review was the usage of key concepts from social cognitive theory that included psychological determinants of behavior change such as self-efficacy, a belief in one’s ability to change behavior and outcome expectations, a belief that individuals will engage in healthy behaviors if they perceive a benefit and the outcome is achievable.7
Another key concept is that of role modeling or observational learning. In persuasive communication, role modeling is considered to influence individuals’ decision-making. Bosone, et al discovered that many studies demonstrate the positive impact of “idealized individuals” that leads others to compare themselves with those individuals and thus increase their aspiration to improve their lives by adopting healthy behaviors.8
Concepts such as environmental determinants address the reciprocal influence the environment has on individual attitudes and the effect the individual may have on the environment. Self- regulation is also a concept of social cognitive theory. Self-monitoring ones’ behavior change helps with achieving one’s goals. Finally, moral disengagement assesses the reasoning an individual might have to change or continue harmful behaviors.7
Current Research
Internet usage has increased significantly. It has been reported that gathering health information from the Internet has empowered individuals which can lead to improved treatment and increased levels of patient satisfaction. Moreover, it allows individuals to have control of the amount of learning they acquire, thus preventing information overload.Laugesen, et al examined the role of Internet usage, specifically patients and individuals gathering health information data for their personal use and knowledge.9
Interesting to note, is their findings which suggest individuals who have accessed quality, relevant information regarding their condition are better able to communicate with their health care provider.The other component of this study examined issues of compliance and adherence to medication regime and health provider visits. Overall the findings discovered that although many patients use the Internet to gather health information comparatively, physician quality had the greatest impact on their patients.9
Another study of note is the McMaster optimal aging portal which provides evidence-based summaries and blog posts to older adults highlighting the best available research. This usability study examined older adult’s perception’ regarding the usability of this optimal aging portal. Some key findings included that the participants found the information valuable. The intended was influenced by information regarding their own health or health of a loved one. The challenges were the perception that the evidence-based summaries and blog were for health professionals, rather than them. Further, this perception demonstrates the need for the providers of the information to be even more conscious of the language and keeping it to a level that the general public understands.10
Barriers
Barriers to improving a healthy lifestyle need to be considered when examining the targeted population of older adults with chronic disease. Moreover, stressing the importance of physical activity and getting the adults engaged in performing the physical activity can have challenges. A study conducted by Mehra, et al examined the concept of an auxiliary home-based exercise program that utilizes mobile devices with the goal of encouraging seniors to exercise more in the privacy of their home. This intervention rooted in self-regulation, a construct of social cognitive theory.
There were many challenges in this study, there was a limited number of participants in the study and although there was an increase in motivation, there was not much difference in observed physical functioning.11
Garoon, et al conducted a study in the City of Baltimore that examined issues of trust and social engagement among lower-income seniors. The premise of the study was that lack of social interaction and trust contributed to declining health among the target population of low-income seniors, thus providing a barrier. The authors conducted this as qualitative study through interview transcripts and emergent findings. The study found that many of the older adults desired to stay in their communities and age in place.12
Conclusion
The literature addressing healthy aging and social media is varied. Nonetheless, there are studies that support the need for more interactive, user-friendly social media for older adults living with chronic disease. The McMaster optimal aging portal study has merit. Providing evidence-based health information to the lay community. Although, there were challenges in the language and understanding there is potential to revise the language into more understandable content. An iteration of this aging portal can be a useful resource for the community of Healthy Shalom.
Empowerment was a key theme in some of the interventions that have been developed. Gathering science-based health information on the Internet can help to bridge the relationship between doctor and patient. Nonetheless, the challenge is ensuring that health information from the Internet is credible.
It is my hope that this formative research will begin to lay the groundwork for building a health communication strategy plan that is effective, culturally competent and linguistically appropriate to the African American and Latinx older adults I want to serve.
Reference Page https://1drv.ms/w/s!ArohzPu9VMBpk0fnTORqWMjbByI8
Albert Whitaker 