Health-promoting education needs of middle-aged people in a community within Taiwan
Chen-ying Su, Merilyn Annells, Beverley Wood
School of Nursing and Midwifery, La Trobe University
Cysu2004@hotmail.com
The 20th Century was noteworthy for remarkable advances in life expectancy in countries around the world, including Taiwan. In the year 2005, life expectancy in Taiwan was 79 years for females and 74 years for males.1 Despite these positive developments, chronic disease is still widespread in many countries. WHO declares that: 'The rapid rise of chronic noncommunicable diseases represents one of the major health challenges to global development'. 2 This is a serious issue because these diseases are a major cause of death, burden health systems and reduce quality of life. Some health care analysts suggest the need for a particular focus on health promotion during middle-aged years as this is a common turning point toward health deterioration. 3,4,5,6 However, globally, middle-aged people have not been a primary focus for health promoting education. This is a report of an aspect of the first phase within a project that is an innovative initiative to address such a deficit in part of Taiwan, pioneering and hopefully leading a new emphasis with this focus in that nation, and with potential implications across nations, including Australia.
Purpose
To identify the health-promoting education needs of middle-aged people in a rural community of Taiwan.
Design
Descriptive Survey
Setting
A rural community in the South-West of Taiwan
Sample
A representative sample of middle-aged people (40- 64 years old) living in the community was required. A randomised sample of 1,100 potential respondents was mailed a survey questionnaire with a response rate of 29.7%. The achieved respondent size was 327, providing a confidence interval of ±5.33.
Methods
The questionnaire was a unique 'needs analysis' tool developed by the researchers. Data were analysed using descriptive and inferential statistics. The questionnaire included four sections:
- Profile of respondents - questions about demographic characteristics, socio-economic factors and certain health variables.
- General health status measurement using SF- 12v2 (Chinese version).
- Questions about lifestyle factors relevant to the population.
- Questions regarding interest in various education topics appropriate to the middle-aged era in a life span.
Findings
Section 1:
Characteristics of the respondents were: 53.3% female, mean age 52.4 years, mostly married (84%), most commonly from the Ha-ka ethnic group (53.1%), 33.8% had completed primary school (most common level of education), most had two or three children, 40.8% had an income of less than AUD 833 monthly, 41.8% were full-time employed - commonly as a labourer or as a farmer. Health-wise, 47.4% were overweight with chronic diseases already being experienced by 46.2% (top three being hypertension, osteoporosis and high cholesterol). However, 61.55% of respondents had regular medical checkups.
Section 2:
SF-12v2's reliability was good for this study (Cronbach's alpha 0.86). The Physical Component Scores (PCS) and Mental Component Scores (MCS) were below the USA norm. Significant differences were identified between gender groups and with/without chronic diseases.
- Women reported better physical health condition than men - men reported better mental health.
- Respondents without chronic diseases had significantly better mental health than repondents with a chronic disease.
Section 3:
Less than half the respondents (44.2%) exercised frequently. Alcohol consumption was reported by only 28.2% of respondents, whilst 19% smoked, and 7.3% chewed beetle nut. The majority of respondents had satisfactory sleeping patterns, and used seat belts in cars and safety helmets when on a motorcycle. The majority also consumed fruit and vegetables frequently and used stir frying, boiling or steaming as the main cooking methods rather than deep frying.
Lifestyle factors were examined in relation to the respondents' PCS and MCS. Independent student ttests revealed significant differences among respondents according to their sleeping patterns. These who had difficulty falling asleep were more likely to have a lower MCS score (t=-5.017, p=0.000 ??0.001) as were these who experienced difficulty staying asleep (t=-4.610, p=0.000??0.001). These results indicate sleep disturbances affect the mental health of respondents.
Section 4:
Participants ranked their interest in 25 health education topics. The five highest ranked topics were:
- Healthy diet
- Family communication
- Relating to adult children
- Fitness and exercise
- Cancer prevention.
Factor analysis of the 25 topics using principal components analysis and varimax rotation extracted four groups of factors reflecting four sub-scales (Table 1); these were then labelled:
- Dealing with normal healthy ageing
- Pscho/social health
- Managing life changes
- Maintaining/ promoting health.
Cronbach's alpha was 0.92, 0.83, 0.83 and 0.85 respectively for the four sub-scales, indicating high internal consistency reliability in each group.
| Item No. | Item | Percentage of Variance | Factor Loading |
|---|---|---|---|
| Factor 1 | Dealing with normal healthy ageing | 21.8% | |
| 24 | Healthy Diet | .774 | |
| 9 | Family communication | .769 | |
| 10 | Fitness and exercise | .726 | |
| 17 | Medication management | .725 | |
| 5 | Caring for a family member | .703 | |
| 14 | Leisure opportunities | .687 | |
| 18 | Menopause and hormones | .677 | |
| 19 | Relating to adult children | .633 | |
| 15 | Living wills | .524 | |
| 25 | Cancer prevention | .521 | |
| Factor 2 | Psycho/social health | 15.1% | |
| 7 | Elder abuse | .789 | |
| 12 | Suicide prevention | .686 | |
| 6 | Depression | .670 | |
| 11 | Grieving and losses | .580 | |
| Factor 3 | Managing life changes | 14.4% | |
| 20 | Retirement planning | .697 | |
| 21 | Sexual dysfunction | .696 | |
| 23 | Adjusting to death of parents or a partner | .605 | |
| 22 | Strengthening and enriching marriage | .586 | |
| 8 | Estate planning | .472 | |
| Factor 4 | Maintaining/promoting health | 12.6% | |
| 4 | Dementia | .747 | |
| 1 | Chronic illness prevention | .735 | |
| 2 | Positive aspects of aging | .716 | |
| 3 | Smoking cessation | .706 |
Conclusion
The results provide foci for a health-promoting education program relevant to this target group. In addition, other needs may be considered such as 'normative needs' - perhaps ascertained by interviewing local health care professionals or by analysing available epidemiological data. Following this survey, these additional steps have been planned; however, it was imperative to gain and privilege 'felt needs' rendered into 'expressed needs', as achieved by this survey.
The value of the study to other communities in Taiwan, and possibly elsewhere with some cultural context adjustment, is that a questionnaire has been designed that can be used as a needs analysis tool when planning a health-promoting education program for middle aged people.
References
- Department of Health in Taiwan. (DOH). Life expectancy at birth. 2004. Available from URL: http://www.doh.gov.tw/statistic/data/supplement/2004/3.doc. Accessed 28 February 2006.
- WHO. Chronic diseases and health promotion. 2006.
- Lee S, Lu YC, Yen WJ, Lin SC. Adult health problems and coping at life turning points. Journal of Nursing (Taiwan) 2004; 51(1): 14-19.
- Tseng Y. Middle-aged health behaviors. Journal of Nursing (Taiwan) 2004; 51(1): 20-24.
- Swanson EA, Tripp-Reimer T, Buckwalter K. Health promotion and disease prevention in the prevention in the older adult: Interventions and recommendations. New York: Springer, 2001.
- Yin ZQ. Public Health Nursing (Taiwan). Taipei: Yong-Dai; 2000.