Empowering Community-Dwelling Older Adults to Become Self-Advocates for Health Care Services

Abstract

Health care systems are shifting to patient-centered models of care, requiring individuals to be active participants in health care interactions. Health self-advocacy is the ability to state one’s needs and take action to meet these needs, through activities such as communicating with health care providers, making health care decisions, and obtaining relevant information. Older adults in Newfoundland and Labrador have high rates of chronic disease and frailty, but as frequent consumers of health care services, there is limited understanding of how they self-advocate in health care settings. This purpose of this research study was to understand the perspectives of older adults in Newfoundland and Labrador about the health care system and self-advocacy. From this information, a health self-advocacy workshop for community-dwelling older adults was developed, implemented, and evaluated. This study used an exploratory sequential mixed methods design. In phase one, eighteen older adults across Newfoundland and Labrador participated in interviews and focus groups to provide detailed perspectives about health self-advocacy. Nine components of health self-advocacy for older adults were identified, including knowledge of rights, communication, informed decision-making, persistence, self-management, health literacy, computer literacy, obtaining relevant information, and connected strength. In phase two, synthesis of the data collected, and existing self-advocacy frameworks and learning theories lead to the development of a self-advocacy workshop for older adults. In phase three, the workshop was implemented and evaluated, using a single-group, pretest-posttest design. Fourteen older adults in an urban Newfoundland community participated. The evaluation indicated positive changes in self-reporting of self-advocacy skills, with the greatest change in scores found in finding health information and accessing community groups to support health care. Future directions for the workshop include exploring applicability to virtual, rural, and more diverse populations of older adults. The findings from phases 1 and 2 led to the development of a new self-advocacy framework, the Health Self-Advocacy Framework for Older Adults. The framework describes how previous experiences and specific components support older adults in self-advocacy. Further research is required to develop the framework and understand the relationship of the identified components in supporting self-advocacy.