Effects of a dietary self‐management programme for community‐dwelling older adults: a quasi‐experimental design

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The population of older adults (≥65 years old) in Taiwan was 11.73% in 2014, nearly doubling from 6.2% in 1990 1. One factor that plays a crucial role in determining successful ageing and is closely linked with health is nutrition 2. Unfortunately, malnutrition is a major problem often overlooked in older adults 3. For example, older adults in Taiwan have insufficient dietary intake and inadequate nutritional status 4. Nutritional status may also differ by living area. Indeed, people living in rural areas may have nutritional problems due to poorer health status than those in urban areas and more barriers accessing health care 6. This situation is highlighted in Taiwan by recent findings that older adults living in rural areas had significantly poorer self‐rated healthy eating, lower nutritional self‐efficacy and poorer nutritional outcomes than their urban counterparts 7.
An important strategy in health care, particularly for people with chronic or behavioural issues such as poor nutrition or dietary behaviours, is self‐management 8. Self‐management refers to a person's ‘ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes’ associated with having a chronic condition and to monitor one's condition, thus establishing a process of self‐regulation (10, p. 178). Self‐management differs from traditional strategies used in intervention programmes since it incorporates problem‐solving, continuously monitors behaviours/outcomes and can use action plans to achieve better health outcomes 8. From the patient's perspective, self‐management involves learning important knowledge, practising skills, developing the confidence to solve problems and modifying health behaviours 11.
A central concept in self‐management is self‐efficacy 12, which provides a theoretical basis for successfully managing health 9. Indeed, participants in self‐management programmes are taught to practise skills such as problem‐solving and goal‐setting to enhance their self‐efficacy 11, thus promoting their ability to follow recommended behaviours such as changing their diet 14. Another factor influencing people's health‐related behaviours such as nutrition and diet is health locus of control (HLC), i.e. beliefs about the control of one's health. HLC theory 15 posits that people with a strong internal health locus of control believe that they control their own health and are thus most likely to engage in healthy behaviours, whereas persons with an external locus of control believe that their health is controlled by powerful others or by chance. These latter people are less likely to engage in healthy behaviours.
Although nutritional health has been emphasised for the older adult population, most studies on this topic examined disease‐specific dietary needs 16 or addressed specific intervention components within specific disease conditions 17. Since the vast majority of older people live in their own homes, we searched for studies on dietary programmes for community‐dwelling older adults. Given the health challenges for people living in rural areas 6, we also searched for studies on urban–rural differences in dietary programmes. After excluding studies using nonexperimental designs, focusing on single nutrients (e.g. calcium, vitamin B12), only on rural or urban areas and noncommunity‐based intervention, we found three articles published since 2004 on nutrition interventions for community‐dwelling older adults 19. Among these four studies, two combined nutrition and physical activity interventions 19, one used a dietary intervention only in the control group 21, and all conducted in Western countries 19. None of these studies focused on nutrition, was conducted in Chinese society or addressed urban–rural differences in the effects of nutritional interventions. Thus, no evidence is available to develop programmes or establish policies to enhance the nutritional health of Chinese older adults living in urban and rural communities. Therefore, we designed a dietary self‐management programme for older adults living in rural and urban communities of Taiwan.
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