Engaging Men and Boys in Maternal Health: Results from a Participatory Film Project in Maputo Province.

BACKGROUND: Research has demonstrated that men often play a critical role in increasing access to and use of maternal health services. Improving male involvement in maternal health can contribute to better health outcomes for the mother, the newborn, and the father. OBJECTIVES: Assess barriers and facilitators for male involvement in maternal health in a local community in Mozambique and analyze perceived benefits and challenges of using a participatory approach. METHODS: Participants engaged in a participatory video project involving different components: a workshop around gender norms, a video workshop, a filming phase, a feedback screening, and a dissemination phase of the final film. Qualitative data were gathered throughout the participatory process and analyzed thematically by an inductive approach. In addition, the participatory video framework was used to analyze the participatory process. RESULTS: Our research project showed that participants faced several barriers for their involvement in maternal health, including strong patriarchal gender norms in the community, unwelcoming health care facilities, and economic challenges. Facilitators for their engagement included a strong sense of responsibility for taking care of the family, the willingness to generate change among the younger generation and the valorization of women as equal partners. Our findings suggest that the project empowered the participants to take up a more active and supporting role in maternal health and inspire other men's involvement. CONCLUSIONS: The participatory approach used in our study helped to identify and tackle barriers for male involvement in maternal health at community level, and dissemination of findings. Community campaigns should consider both barriers and facilitators for more male involvement in maternal health. In addition, governments and program planners should invest on male-friendliness of health facilities and to minimize the incidence of bribery and other illegal practices for health services.

Exploring college students' attitudes toward older adults: A description of methods used by the gerontological literacy network.

Recognizing the pervasiveness of negative societal attitudes toward aging and older adults is critical, as research indicates how older adults are viewed subsequently influences how they are treated. The Gerontological Literacy Network (GLN) is a multi-university collaboration established to address ingrained beliefs that underlie ageism and gerontophobia. The GLN developed a data-gathering protocol that uses drawing as a foundation to assess the gerontological literacy of college students. The protocol includes drawing what aging means, writing a paragraph describing the drawing, indicating the age at which someone is "old," and writing words associated with "old person" and "grandma/grandpa." Results from 1,609 protocols confirm that college students have negative views of aging as depicted in drawings of negative emotional states, illness, physical decline, and death. The presence of positive representations of aging (e.g., smiling) reveals the heterogeneity of perceptions and suggests the potential to achieve more accurate perceptions through educational interventions. This article provides an overview of the protocols and suggestions for future efforts related to gerontophobia and ageism.

A mixed-methods investigation of successful aging among older women engaged in sports-based versus exercise-based leisure time physical activities.

This mixed-methods study compares active older women in different physically based leisure activities and explores the difference in subjective ratings of successful aging and quantifiable predictors of success. A survey was administered to 256 women, 60-92 years of age, engaged in a sports- or exercise-based activity. Quantitative data were analyzed through ANOVA and multiple regression. Qualitative data (n = 79) was analyzed using the approach associated with means-end theory. While participants quantitatively appeared similar in terms of successful aging, qualitative interviews revealed differences in activity motivation. Women involved in sports highlighted social/psychological benefits, while those involved in exercise-based activities stressed fitness outcomes.

Early career reflections of three female gerontologists: Motivations, perceptions, and the life course.

As the number of individuals age 65 and older increases, so does the need for those prepared to work with this population. Doctoral-level preparation in the field of gerontology creates a uniquely prepared contingent who advocate, conduct research, instruct future generations, and serve the older adult population directly. Women are especially likely to pursue gerontology doctoral degrees, yet little is understood about the unique challenges and opportunities they face. The purpose of this reflection was to examine the experiences of three women who pursued doctoral-level gerontology education and faculty positions at different life stages to explore their challenges and opportunities through their educational process and early career experiences.

Cross-cultural comparison of long-term care in the United States and Finland: Research done through a short-term study-abroad experience.

In May 2014, a short-term study-abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term-care settings in the United States and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults who require care in the United States . Those participating in the course visited a series of long-term-care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semistructured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the United States and Finland were identified and are described here.

Beyond Assessment: Conducting Theoretically Grounded Research on Service-Learning in Gerontology Courses.

Service-learning is a useful pedagogical tool and high-impact practice, providing multiple benefits. Gerontology (and other) courses frequently include service-learning activities but lack theory-based, intentional research on outcomes. Here, the authors define service-learning and contextualize it in higher education, provide an overview of research and assessment in service-learning and gerontology courses, demonstrate the shortcomings of program evaluations, and offer suggestions for future research to advance and generate theory.

The nature and meaning of identity in retired professional women.

Through this study we sought to understand the complex experience of retirement and the meaning of identity for women who recently retired from a professional career. Through the use of qualitative methods, including photo elicitation, journaling, and a series of two in-depth interviews with each of six women, a fluid description of the meaning of identity among a small, homogenous sample of retired professional women was constructed. Salient themes included consistency of significant identity components from work to retirement, importance of social connectedness, engagement in continued learning; involvement in aspects of former work roles, and the importance of helping others.

Intergenerational Efforts to Develop a Healthy Environment for Everyone: Sustainability as a Human Rights Issue.

As climate change proceeds at an unprecedented rate, concern for the natural environment has increased. The world's population aging also continues to rise at an unprecedented rate, giving greater attention to the implications of an older population. The two trends are linked through the fact that changes to the environment affect older adults, and older adults affect the environment. Sustainability is, therefore, an intergenerational phenomenon, and protecting resources today leaves a positive legacy and enhances quality of life for future generations. Older adults have much to share with younger generations about behaviors that promote sustainable living, yet few sustainability efforts are intergenerational in nature. As large numbers of people currently subsist without secure access to basic needs, ensuring equitable resource consumption for all generations is urgent and aligns with the Universal Declaration of Human Rights. Through exploring linkages between aging and sustainability, we identify intergenerational strategies to protect the environment and promote human rights and quality of life for older adults.

Appalachian women's perspectives on breast and cervical cancer screening.

INTRODUCTION: Although breast and cervical cancer screening rates have been increasing over the three past decades, many Appalachian women in the USA do not receive screening, leading to disproportionate mortality rates. The aims of this study were to: (1) better understand barriers to and facilitators of breast and cervical cancer screening among Appalachian women; and (2) identify strategies to increase cancer screening. METHODS: Eight focus groups and 19 key informant interviews were conducted with 79 participants. Tape-recorded session were transcribed and content analyzed. RESULTS: Findings consistent with screening determinants research include: inadequate personal and community resources, attitudinal and knowledge barriers, and competing demands. Less commonly described factors include family cancer history, personal health habits, and the multiple influences of healthcare providers. CONCLUSIONS: Interpreting findings in terms of consumer information processing theory, healthcare providers and supports play a key role in educating and influencing the screening uptake among Appalachian Kentucky women. These findings have the potential to inform innovative and culturally consonant intervention approaches capable of increasing screening and decreasing mortality rates.

Alcohol effects on cognitive change in middle-aged and older adults.

OBJECTIVES: This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups. METHODS: Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities). RESULTS: Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status. DISCUSSION: In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Mental health and aging initiative: intervention component effects.

INTRODUCTION: The objective of this investigation is to evaluate the Mental Healthiness and Aging Initiative (MHAI) intervention. The MHAI was created to promote awareness and knowledge about mental health/substance (MH/SA) use and aging issues in rural Kentucky, USA, due to limitations in formal and informal mental health care and treatment resources as a result of multilevel barriers in rural regions and effects on health, wellbeing and quality of life. METHODS: This investigation took place between 2010 and 2011 in two rural counties in Kentucky. Participants from two counties were recruited through an email solicitation sent to Kentucky cooperative extension agents (university-affiliated community liaisons). Individuals participated in a two-hour intervention session covering facts and information, application exercises, and community tools for addressing late-life mental health and substance abuse. Effectiveness was evaluated by examining changes in attitudes and knowledge about MH/SA and aging from pre-test to post-test and again 3 months and 6 months later. The evaluation survey examined mental health and substance abuse awareness (six questions) and knowledge (13 questions) and was previously piloted and designed for the current study ensuring face validity. Seven individual linear mixed models were analyzed using each of the six awareness questions and an additional model using an aggregate score across the knowledge questions representing the total percent correct for knowledge questions. RESULTS: The participating sample (n=55) was 65.35 years of age on average, with the majority being female (85%), white (100%), married (69%), living with a spouse/partner only (68%), high school educated (57%) and having a total household income averaging US$44,199. The findings indicated sustained improvement in awareness and knowledge about MH/SA and aging. Results also indicated that there is a need to improve maintenance of knowledge regarding older adult alcohol consumption risk, clinical provider communication about mental health, identifying/recognizing mental health problems, and older adult retention of their mental abilities based on long-term retention rates. These indicators had below 90% correctness at 6 months, despite having 90%+ accuracy at post-assessment, immediately after the intervention administration. CONCLUSIONS: This study demonstrates that community interventions for MH/SA awareness and knowledge are effective within majority rural regions. As currently designed, implementing the MHAI intervention program is feasible. Evidence from the current study indicates that community residents (including rural individuals) can be recruited to participate in a program about MH/SA and aging, and as an outcome have increased awareness and knowledge about MH/SA and aging. Future research will need to explore how to utilize MHAI-type intervention programs to a point where the mental health of rural adults can be improved. Specifically, further investigation is needed to examine whether community mental health awareness interventions, such as the MHAI intervention program, can lead to earlier detection of MH/SA issues among older adults and increase treatment rates. If so, community mental health workers and facilities can expect such interventions to increase local residents' awareness of their services and likelihood of utilizing mental health services. Future research needs to enhance generalizability and ensure that improved knowledge and awareness translates into improved mental health in rural regions.

Perceptions of smoking cessation programs in rural Appalachia.

OBJECTIVES: To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. METHODS: Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. RESULTS: Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. CONCLUSIONS: To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.

Formative research conducted in rural Appalachia to inform a community physical activity intervention.

PURPOSE: Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians. DESIGN: Eight focus groups and seven group key informant interviews were conducted. SETTING: This study was conducted in eastern Kentucky, in central Appalachia. SUBJECTS: One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated. MEASURES: Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked. ANALYSIS: Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%. RESULTS: In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agriculture's Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities. CONCLUSIONS: When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.

Evaluation of the Mental Healthiness Aging Initiative: community program to promote awareness about mental health and aging issues.

The objective of this study is to evaluate the Mental Healthiness Aging Initiative, designed to promote community awareness and knowledge about mental health and aging issues. This study occurred during 2007-2009 in 67 of 120 counties in Kentucky. A rural region (11 counties) received the intervention, consisting of focus groups, Extension Agent training, and television-based social marketing campaign. Partial-intervention counties (29 counties) received only the television-based social marketing campaign. The control counties (27 counties) received no intervention activities. Results indicated that the intervention counties agreed more with being able to assist elder adults with a potential mental illness. Also, the intervention counties understood the risk of consuming alcohol and medications better, but had a poorer recognition of drinking problems in elder adults. These findings need to be considered within study limitations, such as measurement error, degree of intervention exposure, and regional differences across intervention groups. The study demonstrates that community interventions on mental health awareness and knowledge are feasible within majority rural regions, with Extension Agents being gatekeepers, for promoting positive messages about mental health and aging issues.

Massage therapy usage and reported health in older adults experiencing persistent pain.

BACKGROUND: Persistent pain is a frequent complaint among older adults and can greatly decrease quality of life while also contributing to other negative outcomes such as poor health, increased pharmaceutical medication usage, increased rates of depression, and cognitive decline. OBJECTIVE: The current study (N = 69) examines the potential impact of massage therapy (MT) in older adults (60+ years) with persistent pain, by comparing self-reported health outcome scores among those who have and have not utilized massage therapy in the past year. DESIGN: The current study was derived from a larger study that collected data as part of a one-time, self-report, mail-in survey. PARTICIPANTS: Lexington, Kentucky area adults, 60 and older who reported persistent pain were eligible to participate in the study. OUTCOME MEASURES: The RAND 36-Item Health Survey was used to determine participant health-related quality of life. RESULTS: The current study demonstrated that for older adults experiencing persistent pain, massage is associated with self-report of less limitation due to physical or emotional issues, better emotional health, more energy/less fatigue, better social functioning, and better overall health. Age, education, cumulative morbidities, number of areas in which participants reported experiencing persistent pain, and number of complementary and alternative medicine options in addition to MT utilized in the past year did not affect the association between receipt of massage and better self-reports in those domains. CONCLUSIONS: While many causes of pain for older adults elude cure, further study is warranted that examines MT as an intervention to improve coping in older adults with persistent pain.

Health behavior risk factors across age as predictors of cardiovascular disease diagnosis.

OBJECTIVE: The current study examines the prevalence of health risk behaviors and their cumulative effects on cardiovascular disease (CVD) among a sample of adults. Age cohort is also examined to determine the role of age in predicting CVD and risky health behaviors. METHOD: Medical records of a sample of adults from the Seattle Longitudinal Study categorized into one of four age-group cohorts were examined. Data regarding participants' health risk behaviors were examined individually and cumulatively for predicting later CVD diagnosis. RESULTS: The prevalence of CVD increases with age, obesity, and risky medical checkups. Female risky sleepers are more likely to receive a CVD diagnosis than men who report risky sleep patterns (p < .05). DISCUSSION: A high risk of CVD appears to exist for adults across the life span, and several risky health behaviors also seem to place individuals more at risk for being diagnosed with CVD.