Qualitative Studies In Community Health: A Systematic Review In The Elderly Population

Problem Statement

According to WHO (2011) maintain independence and active life, strengthen health prevention

and promotion policies for elderly people, and maintain and/or improve the quality of life in aging, are the

main challenges for public health.

Therefore, it is an area of intervention with a strong component of epidemiology, but with the

participation of multiple areas of knowledge (medicine, statistics, law, social sciences ...) in intervention

planning. The social work intervention in health, particularly socio-educational intervention, constitutes a

privileged field of action, in empowering individuals for social life, fostering autonomy, responsibility,

understanding and involvement/participation in the surrounding environment, as well as the change of

behaviours, in order to improve their living conditions (Carvalho & Baptista, 2004). Community health

research with the elderly population has become increasingly important (Lima-Costa & Veras, 2003),

reinforced by the fact that population aging is considered one of the greatest challenges of contemporary

public health (WHO, 2011). In this context, quantitative and qualitative studies increase, highlighting the

latter by the possibility of identifying specific and contextual needs that become fundamental for local

intervention, enhancing results. Hence, it’s important to know the contributes of the qualitative research

in this field in order to improve the socio-educational intervention.

Research Questions

Given the problem statement, we formulated the following research questions: what’s the

relevance of qualitative methodology in the community health with elderly population? What are the

main themes and the main socio-educational practice implications in this field?

Purpose of the Study

The purpose of this systematic review paper is to identify and appraise the importance of the

qualitative methodology in the study of elderly in community health. It seeks to identify areas of existing

research, describe findings and analyse implications emerged for socio-educational intervention to inform

practice and further research.

Research Methods

This is a systematic review and the relevant literature was identified through two electronic

databases: MEDLINE and PubMed (2010-2015). The search terms were qualitative research AND

community health AND elderly and the inclusion criteria were: published qualitative or mixed-method if

the qualitative methods could be considered as a separate section of the study; with elderly samples (≥65

years); and studies in community health. Following we excluded duplicates and 226 citations were

retrieved for possible inclusion in the present review. With full text available (free access) we found only

119 articles. The study selection criteria were applied by one author in consultation with at least one

other, by reading titles and abstracts, and if the source was suitable for inclusion, the full article was read.

Each study was rated for seven quality using pre-defined assessment criteria (Table 1 ), by two of the

authors independently.

69

The final result of agreement between encoders was 94%, and discrepancies were discussed as a

panel with a third author to reach consensus. In the quality assessment were awarded grades ranging from

one (very poor) to four (good), providing a maximum score of 28, and only were accepted studies with

≥21 score. Finally, there were 48 articles included in the study, whose information extracted was

tabulated. Figure 1 details the study selection process and the number of papers retrieved and excluded at

See Full Size >

Findings

The majority (20) of analysed studies came from Europe and 11 from North America, especially

from EUA, but we found studies in all Continents (Asia 7, Australia 5, South America 4 and Sub-Saharan

Africa 1). Study respondents were health professionals, informal carers, patients, community members

and relatives. According to the techniques of collecting dates, predominate semi structured interviews

(34) and focus group (16). Questionnaires, observation, workshops, inventories and document analysis,

all of them, only appear eleven times.

According to the themes, most (13) of the articles are focused on health care network, six on end-

of-life care and six on quality of life and successful aging. The others refer to multiples themes (Table 2 ),

each of them with a frequency between one (7 references) and three (two references).

1.Legend: Courtney et al. (2010); 2. Heravi-Karimooi, Anoosheh, Foroughan, Sheykhi, & Hajizadeh (2010); 3. Mullen, Nicolson, & Cotton (2010); 4. Chan & Pang (2011); 5. Gysels, Pell, Straus, & Pool (2011); 6. Hansen, Bi, Nitschke, Pisaniello, Newbury, & Kitson (2011); 7. Kennedy, Harbison, Mahoney, Jarvis, & Veitch (2011); 8. Klymko, Artinian, Price, Abele, & Washington (2011); 9. Medbo, Melbye, & Rudebeck (2011); 10. Motta, Aguiar, & Caldas (2011); 11. Stewart, Goddard, Schiff, & Hall (2011); 12. Uchoa, Firmo, Lima-Costa, & Corin (2011); 13. van Uffelen, Heesch, Hill, & Brown (2011); 14. Yamada, Vass, Hvas, Igarashi, Hendriksen, & Avlund (2011); 15. Antonsson, Korjonen, & Rosengren (2012); 16. Huong, Hai Ha le, Quynh Chi, Hill, & Walton (2012); 17. Tsai, Wong, Ku, & Liu (2012); 18. Tynkkynen, Lehto, & Miettinen (2012); 19. Aase, Laugaland, Dyrstad, & Storm (2013); 20. Breitholtz, Snellman, & Fagerberg (2013); 21. Garcia, Espinoza, Lichtenstein, & Hazuda (2013); 22. Horder, Frandin, & Larsson (2013); 23. Muller-Mundt, Bleidorn, Geiger, Klindtworth, Pleschberger, Hummers-Pradier, & Schneider (2013); 24. Romo, Wallhagen, Yourman, Yeung, Eng, Micco, . . . Smith (2013); 25. Thai, Walter, Eng, & Smith (2013); 26. Turjamaa, Hartikainen, & Pietila (2013); 27. Zayas, Wisniewski, & Kennedy (2013); 28. Au, Wong, McMillan, Bridges, & McGrath (2014); 29. Cheung, Geisler, & Sunneberg (2014); 30. Corvol, Balard, Moutel, & Somme (2014); 31. Countouris, Gilmore, & Yonas (2014); 32. Ferretti, Gris, Mattiello, Paz Arruda Teo, & De Sa. (2014); 33. Gilmartin, Marriott, & Hussainy (2014); 34. Goth & Smaland (2014); 35. Heppenstall, Keeling, Hanger, & Wilkinson (2014); 36. Resnick, Michael, Griffith, Klinedinst, & Galik (2014); 37. Riva, Monti, Iannello, Pravettoni, Schulz, & Antonietti (2014); 38. Wiig, Guise, Anderson, Storm, Lunde Husebo, Testad, . . . Moltu (2014); 39. Andreasen, Lund, Aadahl, Gobbens, & Sorensen (2015); 40. Bindels, Cox, Abma, van Schayck, & Widdershoven (2015); 41. Geisler & Cheung (2015); 42. Holloway, Toye, McConigley, Tieman, Currow, & Hegarty (2015); 43. Karki, Bhatta, & Aryal (2015); 44. Ligthart, van den Eerenbeemt, Pols, van Bussel, Richard, & Moll van Charante (2015); 45. McCloskey, Jarrett, & Stewart (2015); 46. Pereira, Giacomin, & Firmo (2015); 47. Philippi, Luderer, & Altenhoner (2015); 48. van Erning, Janssen-Heijnen, Creemers, Pruijt, Maas, & Lemmens (2015)

About the healthcare network for the elderly, the main conclusions are: a) elderly-related health

and social policies and national guidelines related on what is best for the local people rather than related

to the benefits of the governmental or municipality, contrary to what is most frequent; this has a potential

to compromise the affordability of the services and undermining the principles of the welfare state; b) the

needs of hierarchically organized services and levels of care that provide support for the healthcare teams'

work; d) a good relationship between participating organizations and professionals is required for

successful by identifying barriers concerning institutional collaboration.

We also found that: e) structural funding and the need of education programs for teams, that

facilitate the development of professional and personal skills, including project leadership are also key

elements; f) the psychological and social resources should be valued as well as the economical resource;

g) It is fundamental to identify needs, including instrumental activities of daily living, from the elderly,

families and caregivers, to support programs and services that emphasize person-centered approach; h)

community involvement to promote supportive social networks including the participation of the elderly.

Concerning the end-of-life care planning, stands out: a) the identification of decision-making

processes for the elderly and caregivers, and the development of strategies to involve them (self-

determination), adopting a person-centered approach; b) understanding sociocultural specificity in

choices; c) find methods of overcoming the barriers\ perceived by the elderly; d) adjust care throughout

the aging process in terms of clinical, psychosocial and information needs. Promote quality of life (QoL)

and successful aging, it is important, according to the elaborated synthesis: a) to measure QoL as a

support for the intervention; b) respect the elderly (interests and values); c) understand the elderly's

perception about successful enrichment, to improve communication with the technicians and the

intervention; d) involve the elderly in volunteering activities with peers; e) stop and prevent resignation of

the elderly. Different conclusions, given the diversity of themes, can be drawn from the remaining

articles. However, all refer the possibility of using the results in terms of developing socio-educational

actions. Indeed, in general, all results point out changeable behavioral aspects, as well as providing,

identifying and respecting individual and collective specificities in the intervention to promote successful

aging.

Conclusion

Qualitative research in elderly community health can help researchers to gain a more complete

understanding or interpret the results of quantitative data more completely, as well as show local

specificities. Europe and North America stand out with the greatest focus (33 out of 48 studies) in the

review. Generally, there is an investment in the network of care, end-of-life care planning and quality of

life and active aging.

In terms of conclusions, emphasis is placed on the need to value the interests and needs of the

elderly and caregivers, focusing on less economic approaches, favoring psychological, personal and social

aspects, as well as people-centered interventions. It is also noted the concern to capture the perceptions of

all involved in the aging process: health professionals, informal carers, patients, community members and

relatives.

We observed an increase in the qualitative studies, in multiple themes, that support a socio-

educational intervention respecting the individual, local and regional specificities, in order to value and

imply the individual in the modification of behaviors that promote an aging with quality. Professionals in

this area can and should collaborate intensively in multidisciplinary teams that also involve health

professionals. We emphasize a limitation due to the inclusion of free access texts, hence the need to revise all the

texts resulting from the research and the inclusion criteria referring to the nature and characteristics of the

works. We believe that the search for research in other electronic databases and other time periods is

relevant. It is important to use these and other results of similar work as support for programs and socio-

educational practices.

Acknowledgments

To the Centre for Studies in Education, Technologies and Health (CI&DETS) at the Polytechnic

Institute of Viseu, Portugal.

References

1. Araújo, P., Martins, E., Fernandes, R., & Mendes, F. (2016). O método das histórias de vida na investigação qualitativa em psicologia. In A. Costa, P. Castro, S. Sá, J. Carvalho, F. Souza, & D.
2. Souza (Eds.), Atas do 5º Congresso Ibero-Americano em Investigação Qualitativa - Investigação Qualitativa na Educação (pp. 588-595). Porto: Ludomedia.
3. Barbosa, L., Motta, A., & Resck, Z. (2015). Os paradigmas da modernidade e pós-modernidade e o processo de cuidar na enfermagem. Enfermería Global, 37, 342-349.
4. Bogdan, R., & Bilken, S. (1998). Qualitative research for education: An introduction for theory and methods. Boston: Allyn and Bacon.
5. Britten, N. (2005). Making sense of qualitative research: A new series. Med Educ, 39(1), 5-6.
6. Carvalho, A., & Baptista, I. (2004). Educação Social. Fundamentos e estratégias. Porto: Porto Editora. Countouris, M., Gilmore, S., & Yonas, M. (2014). Exploring the impact of a community hospital closure on older adults: a focus group study. Health Place, 26, 143-148.
7. doi:10.1016/j.healthplace.2013.11.008 Courtney, K. L., Lingler, J. H., Mecca, L. P., Garlock, L. A., Schulz, R., Dick, A. W., & Olshansky, E.
8. (2010). Older adults' and case managers' initial impressions of community-based telehealth kiosks. Research in gerontological nursing, 3(4), 235-239.
9. Coutinho, C. (2011). Metodologia de investigação em ciências sociais e humanas: Teoria e prática. Coimbra: Edições Almedina.
10. Ferretti, F., Gris, A., Mattiello, D., Paz Arruda Teo, C. R., & De Sa, C. (2014). [Impact of a health education program on the elderly's knowledge about cardiovascular diseases]. Impacto de programa de educacao em saude no conhecimento de idosos sobre doencas cardiovasculares. Revista de salud publica (Bogota, Colombia), 16(6), 807-820.
11. Garcia, C. H., Espinoza, S. E., Lichtenstein, M., & Hazuda, H. P. (2013). Health literacy associations between Hispanic elderly patients and their caregivers. J Health Commun, 18 Suppl 1, 256-272.
12. doi:10.1080/10810730.2013.829135 Geisler, C. C., & Cheung, C. K. (2015). Complementary/alternative therapies use in older women with arthritis: Information sources and factors influencing dialog with health care providers. Geriatr Nurs, 36(1), 15-20. doi:10.1016/j.gerinurse.2014.08.013 Gilmartin, J. F., Marriott, J. L., & Hussainy, S. Y. (2014). Exploring factors that contribute to dose administration aid incidents and identifying quality improvement strategies: the views of pharmacy and nursing staff. Int J Pharm Pract, 22(6), 407-414. doi:10.1111/ijpp.12091 Goth, U. S., & Smaland, E. (2014). The role of civic engagement for men's health and well being in Norway-a contribution to public health. Int J Environ Res Public Health, 11(6), 6375-6387.
13. doi:10.3390/ijerph110606375 Gysels, M., Pell, C., Straus, L., & Pool, R. (2011). End of life care in sub-Saharan Africa: a systematic review of the qualitative literature. BMC Palliat Care, 10, 6. doi:10.1186/1472-684X-10-6
14. Hansen, A., Bi, P., Nitschke, M., Pisaniello, D., Newbury, J., & Kitson, A. (2011). Perceptions of heat-susceptibility in older persons: barriers to adaptation. Int J Environ Res Public Health, 8(12), 4714-4728. doi:10.3390/ijerph8124714 Heppenstall, C. P., Keeling, S., Hanger, H. C., & Wilkinson, T. J. (2014). Perceived factors which shape decision-making around the time of residential care admission in older adults: a qualitative study.
15. Australas J Ageing, 33(1), 9-13. doi:10.1111/j.1741-6612.2012.00644.x Heravi-Karimooi, M., Anoosheh, M., Foroughan, M., Sheykhi, M. T., & Hajizadeh, E. (2010).
16. Understanding loneliness in the lived experiences of Iranian elders. Scand J Caring Sci, 24(2), 274-280. doi:10.1111/j.1471-6712.2009.00717.x Holloway, K., Toye, C., McConigley, R., Tieman, J., Currow, D., & Hegarty, M. (2015). National consultation informing development of guidelines for a palliative approach for aged care in the community setting. Australas J Ageing, 34(1), 21-26. doi:10.1111/ajag.12083 Horder, H. M., Frandin, K., & Larsson, M. E. (2013). Self-respect through ability to keep fear of frailty at a distance: successful ageing from the perspective of community-dwelling older people. Int J Qual Stud Health Well-being, 8, 20194. doi:10.3402/qhw.v8i0.20194 Huong, N. T., Hai Ha le, T., Quynh Chi, N. T., Hill, P. S., & Walton, T. (2012). Exploring quality of life among the elderly in Hai Duong province, Vietnam: a rural-urban dialogue. Glob Health Action, 5, 1-12. doi:10.3402/gha.v5i0.18874 Karki, S., Bhatta, D. N., & Aryal, U. R. (2015). Older people's perspectives on an elderly-friendly hospital environment: an exploratory study. Risk Manag Healthc Policy, 8, 81-89.
17. doi:10.2147/RMHP.S83008 Kennedy, C., Harbison, J., Mahoney, C., Jarvis, A., & Veitch, L. (2011). Investigating the contribution of community nurses to anticipatory care: a qualitative exploratory study. Journal of advanced nursing, 67(7), 1558-1567.
18. Klymko, K. W., Artinian, N. T., Price, J. E., Abele, C., & Washington, O. G. (2011). Self-care production experiences in elderly African Americans with hypertension and cognitive difficulty. J Am Acad Nurse Pract, 23(4), 200-208. doi:10.1111/j.1745-7599.2011.00605.x Ligthart, S. A., van den Eerenbeemt, K. D., Pols, J., van Bussel, E. F., Richard, E., & Moll van Charante, E. P. (2015). Perspectives of older people engaging in nurse-led cardiovascular prevention programmes: a qualitative study in primary care in the Netherlands. Br J Gen Pract, 65(630), e41-48. doi:10.3399/bjgp15X683149 McCloskey, R., Jarrett, P., & Stewart, C. (2015). The Untold Story of Being Designated an Alternate Level of Care Patient. Healthcare policy = Politiques de sante, 11(1), 76-89.
19. Medbo, A., Melbye, H., & Rudebeck, C. E. (2011). "I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly. BMC Fam Pract, 12, 42. doi:10.1186/1471-2296-12-42 Motta, L. B., Aguiar, A. C., & Caldas, C. P. (2011). [The Family Health Strategy and healthcare for the elderly: experiences in three Brazilian cities]. Cad Saude Publica, 27(4), 779-786.
20. Mullen, K., Nicolson, M., & Cotton, P. (2010). Improving medical students' attitudes towards the chronic sick: a role for social science research. BMC medical education, 10, 84.
21. Muller-Mundt, G., Bleidorn, J., Geiger, K., Klindtworth, K., Pleschberger, S., Hummers-Pradier, E., & Schneider, N. (2013). End of life care for frail older patients in family practice (ELFOP)--protocol of a longitudinal qualitative study on needs, appropriateness and utilisation of services. BMC Fam Pract, 14, 52. doi:10.1186/1471-2296-14-52 Pereira, J. K., Giacomin, K. C., & Firmo, J. O. (2015). [Functionality and disability in old age: to stay still or not to stay still]. Cad Saude Publica, 31(7), 1451-1459. doi:10.1590/0102-311X00046014 Philippi, M., Luderer, C., & Altenhoner, T. (2015). ["So I would have been sitting at home and moping...": How do older single people in need of support experience companionship by volunteers after discharge from hospital?].
22. Resnick, B., Michael, K., Griffith, K., Klinedinst, J., & Galik, E. (2014). The impact of PRAISEDD on adherence and initiation of heart health behaviors in senior housing. Public Health Nurs, 31(4), 309-316. doi:10.1111/phn.12080
23. Riva, S., Monti, M., Iannello, P., Pravettoni, G., Schulz, P. J., & Antonietti, A. (2014). A preliminary mixed-method investigation of trust and hidden signals in medical consultations. PLoS One, 9(3), e90941. doi:10.1371/journal.pone.0090941 Romo, R. D., Wallhagen, M. I., Yourman, L., Yeung, C. C., Eng, C., Micco, G., . . . Smith, A. K. (2013).
24. Perceptions of successful aging among diverse elders with late-life disability. Gerontologist, 53(6), 939-949. doi:10.1093/geront/gns160 Santos, Q., Azevedo, D., Costa, R., & Medeiros, F. (2011). A crise de paradigmas na ciência e as novas perspectivas para a enfermagem. Escola Anna Nery Rev. Enferm.,15(4), 833-837.
25. Stewart, F., Goddard, C., Schiff, R., & Hall, S. (2011). Advanced care planning in care homes for older people: a qualitative study of the views of care staff and families. Age Ageing, 40(3), 330-335.
26. doi:10.1093/ageing/afr006 Thai, J. N., Walter, L. C., Eng, C., & Smith, A. K. (2013). Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc, 61(2), 264-269. doi:10.1111/jgs.12098 Tsai, Y. F., Wong, T. K., Ku, Y. C., & Liu, W. C. (2012). Reasons for living among older male Chinese residents of veterans' homes. J Adv Nurs, 68(9), 1978-1987. doi:10.1111/j.1365-2648.2011.05884.x Turato, E. (2005). Qualitative and quantitative methods in health: Definitions, differences and research subjects. 39(3), 1-8.
27. Turjamaa, R., Hartikainen, S., & Pietila, A. M. (2013). Forgotten resources of older home care clients: focus group study in Finland. Nurs Health Sci, 15(3), 333-339. doi:10.1111/nhs.12037 Tynkkynen, L. K., Lehto, J., & Miettinen, S. (2012). Framing the decision to contract out elderly care and primary health care services - perspectives of local level politicians and civil servants in Finland.
28. BMC Health Serv Res, 12, 201. doi:10.1186/1472-6963-12-201 Uchoa, E., Firmo, J. O. A., Lima-Costa, M. F., & Corin, E. (2011). An anthropologic study on strategies for addressing health problems among the elderly in Bambui, Minas Gerais State, Brazil. Cadernos de saude publica, 27 Suppl 3, S370-377.
29. van Erning, F. N., Janssen-Heijnen, M. L., Creemers, G. J., Pruijt, H. F., Maas, H. A., & Lemmens, V. E.
30. (2015). Deciding on adjuvant chemotherapy for elderly patients with stage III colon cancer: a qualitative insight into the perspectives of surgeons and medical oncologists. J Geriatr Oncol, 6(3), 219-224. doi:10.1016/j.jgo.2015.02.001 van Uffelen, J. G., Heesch, K. C., Hill, R. L., & Brown, W. J. (2011). A qualitative study of older adults' responses to sitting-time questions: do we get the information we want? BMC Public Health, 11, 458. doi:10.1186/1471-2458-11-458 Wiig, S., Guise, V., Anderson, J., Storm, M., Lunde Husebo, A. M., Testad, I., . . . Moltu, K. L. (2014).
31. Safer@home-Simulation and training: the study protocol of a qualitative action research design.
32. BMJ Open, 4(7), e004995. doi:10.1136/bmjopen-2014-004995 World Health Organization (2011). Global Health and Aging. Obtido de http://www.who.int/ageing/publications/global_health.pdf Yamada, Y., Vass, M., Hvas, L., Igarashi, A., Hendriksen, C., & Avlund, K. (2011). Collaborative relationship in preventive home visits to older people. Int J Older People Nurs, 6(1), 33-40.
33. doi:10.1111/j.1748-3743.2010.00213.x Zayas, L. E., Wisniewski, A. M., & Kennedy, T. (2013). Instrumental activity of daily living limitations and supports in a clinic population of low-income Puerto Rican elderly adults with chronic diseases. J Am Geriatr Soc, 61(10), 1789-1795. doi:10.1111/jgs.12461