Older Adults RecallOlder Adults Recall Key Fall Prevention ......PiPreventing fllfalls by taking a...
Transcript of Older Adults RecallOlder Adults Recall Key Fall Prevention ......PiPreventing fllfalls by taking a...
Older Adults RecallOlder Adults Recall Key Fall Prevention Messages
after Social Marketing to Promote Balance Classesto Promote Balance Classes
through Churches
Carolyn DiGuiseppi, MD, PhDColorado School of Public HealthColorado School of Public Health
CollaboratorsCollaborators Colorado Department of Public Health and Environmentp
Sallie Thoreson, MS University of Utah
Lauren Clark, RN, PhD Worldways Social Marketing
Mark Marosits MS Mark Marosits, MS Colorado School of Public Health, University of Colorado
Denver & Colorado Injury Control Research Center j y Cynthia Goss, MA Dustin Currie
D i L tt PhD Dennis Lezotte, PhD
Few older adults take b l i lbalance exercise classes
Belief that falls in old age are inevitable
Fear of falling Discomfort with Discomfort with
group exercise classesclasses
Lack of available and accessible classesaccessible classes
Social MarketingSocial Marketing
Uses persuasion to motivate the voluntary Uses persuasion to motivate the voluntary behavior of target audiences
Offers products that target market Offers products that target market members perceive to be in their own best interestinterest
Shown to increase preventive health b h i i ld d ltbehaviors in older adults
Could be effective for persuading older adults to take balance classes
Study ObjectivesStudy Objectives
Examine awareness and recall of social Examine awareness and recall of social marketing messages about balance classes among older adults exposedclasses among older adults exposed through their churches
Two western Colorado counties (pop. 177,415)Two western Colorado counties (pop. 177,415)One city, few small towns, otherwise ruralOne city, few small towns, otherwise rural
Study Design: Cluster RandomizedCluster Randomized
Controlled Trial
Enrolled Churches
Intervention (Social Marketing)
Churches
ControlChurchesRand.
Churches
Older Adult Members
Older Adult Members
Social Marketing ProgramSocial Marketing Program
“Prevent future falls by attending the N’Balance class”
“Keep your independence with a better senseKeep your independence with a better sense of BALANCE”
-Authoritative endorsement-Pulpit announcements-Church bulletins
-Peer marketing-Trained ‘Church Messengers’
-Newsletter articles-Newsletter articles-Marketing messages-Schedules, locations
Social Marketing Programg gImplementation
Implemented by health department staff Each church received on average four Each church received on average four
month-long marketing ‘waves’Brochures posters pulpit announcements and Brochures, posters, pulpit announcements and informal conversations >90% of churches
Bulletins newsletters >75% of churches Bulletins, newsletters >75% of churches
OutcomesOutcomes
Awareness of messages Awareness of messages “Have you heard or seen any information about
balance classes falls or exercise to preventbalance classes, falls or exercise to prevent falls at your church or from its members?”
Recall of specific messages and Recall of specific messages and communication channels “What information about have you heard or What information about …. have you heard or
seen …?” “How did you hear or see information about ?” How did you hear or see information about ...?
Data CollectionData CollectionData CollectionData Collection
In each church mail survey of ~6% random In each church, mail survey of 6% random sample of older adult church members ~one year after enrollmentyear after enrollment Multiple mailings, $2 incentive
Mail survey included: Mail survey included: Awareness and recall of information
F f d h h Frequency of attendance at church Fall history, fear of falling Health status, demographics
Data analysisData analysisData analysisData analysis
Compared message awareness and recall Compared message awareness and recall between study groups using logistic regression modelsregression models
All models included random effect for church to account for intra clusterchurch to account for intra-cluster correlationM lti i t d l d t dj t f Multivariate models used to adjust for confounding
Results: RecruitmentResults: Recruitment
51 Enrolled Churches
26 Social Marketing 25 ControlR d26 Social MarketingProgram Churches
25 ControlChurchesRand.
3580 Older Adult Members
3521 Older Adult Members MembersMembers
Churches: Baseline CharacteristicsChurches: Baseline CharacteristicsSocial ControlSocial
MarketingControl
Mean total membership 484 620
Mean % of congregation aged 60+(range 5% - 90%)
45% 48%
Mean number of services per week 3.0 2.7
% Protestant 77% 88%% Protestant 77% 88%
% Rural Location 39% 40%
Church leader’s willingness to market* 3.4 3.4
Church leader’s perceived effectiveness of 3 2 3 1Church leader s perceived effectiveness of balance classes for fall prevention*
3.2 3.1
*(1=not at all, 5 = extremely)
Mail SurveyMail SurveyMail SurveyMail Survey
281 Congregants aged 60 and older 281 Congregants aged 60 and older Estimated response rate = 62%
64% Female, 96% White Age: mean 72.5 years Education: mean 14.8 years No sociodemographic differences No sociodemographic differences
between study groups
SocialMarketingChurch
ControlChurch
Respondent Characteristics
Church Members (n=149)
Members (n=131)
Attends church at least weekly 70% 82%
Fell at least once in past year 46% 38%
High concern about falling 35% 38%
Very good or excellent health 56% 53%
S i fi d i fi d i h lif 94% 92%Satisfied or very satisfied with life 94% 92%
Awareness of MessagesAwareness of MessagesHave you heard or seen any information about Have you heard or seen any information about
balance classes, falls or balance classes, falls or exercise to prevent falls…??
60%Social Marketing Control
40%
50%
20%
30%
40%
10%
20%
0%
At church / from members
Awareness of MessagesAwareness of MessagesHave you heard or seen any information about Have you heard or seen any information about
balance classes, falls or balance classes, falls or exercise to prevent falls…??
60%Social Marketing Control
40%
50%
20%
30%
40%
0%
10%
20%
0%
At church / from members From other sources
Awareness of MessagesAwareness of MessagesAwareness of MessagesAwareness of MessagesHeard or seen any information about balance l f ll f ll ?classes, falls or exercise to prevent falls?
Adjusted Odds Ratio* (95% CI)(95% CI)
At church or from church b 7.7 (3.1, 18.7)members 7.7 (3.1, 18.7)
From any other sources 0.8 (0.5, 1.4)(e.g., TV, MD) 0.8 (0.5, 1.4)
*Adjusted for clustering by church, frequency of church attendance
Recall of MessagesRecall of MessagesWhat information … heard or seen about balance classes, falls or exercise to prevent falls at church or from church members?
35%Social Marketing Control
20%25%30%
10%15%20%
0%5%10%
Prevent falls w/ balance class
Balance classes available
Falls/ fall injuries serious
Recall of MessagesRecall of MessagesggWhat information have you heard or seen about balance classes falls or exercise to prevent falls at
Adjusted Odds Ratio*
balance classes, falls or exercise to prevent falls at church or from church members?
Adjusted Odds Ratio(95% CI)
P i f ll b ki b l l 6 2 (2 6 14 8)Preventing falls by taking a balance class 6.2 (2.6, 14.8)
Availability of balance classes in the 7 7 (2 6 22 9)community 7.7 (2.6, 22.9)
Seriousness of falls or fall injuries in ld d l 1.2 (0.4, 3.3)older adults 1.2 (0.4, 3.3)
*Adjusted for clustering by church, frequency of church attendance
Recall of Communication Channels:Recall of Communication Channels:“How did you hear or see information about ...?”How did you hear or see information about ...?
(Intervention Church Members)
Church bulletin or newsletter
Conversation w/ church members
Pulpit announcement
B h
Poster
Presentation during services
Brochure
0% 10% 20% 30% 40% 50% 60% 70%
Limitations & StrengthsLimitations & StrengthsLimitations & StrengthsLimitations & Strengths
Survey response rate 62%Survey response rate 62% Survey response rate 62%Survey response rate 62% Generalizability of results to minorities, other Generalizability of results to minorities, other faithfaith based congregations highly urbanizedbased congregations highly urbanizedfaithfaith‐‐based congregations, highly urbanized based congregations, highly urbanized areasareas
Randomized controlled designRandomized controlled design Characteristics of respondents similar between Characteristics of respondents similar between groupsgroupsg pg p
Conclusions & ImplicationsConclusions & Implicationspp
Church based social marketing programs can effectively Church‐based social marketing programs can effectively reach older adults with messages about preventing falls through balance classesg
Such programs should take advantage of trusted communication channels such as church newsletters, bulletins, pulpit announcements Messages via other modalities (e.g., posters, brochures
li d b ) l ff isupplied by program) appear less effective Further research should examine whether findings can be generalized to other populations and settingsgeneralized to other populations and settings
AcknowledgmentsAcknowledgments
The churches, their leaders and congregants whoThe churches, their leaders and congregants whoThe churches, their leaders and congregants who The churches, their leaders and congregants who participated in this studyparticipated in this study
Research assistants: Sarah Morehouse, Vedavani Research assistants: Sarah Morehouse, Vedavani ,,TiruveedhulaTiruveedhula
This project This project was supported was supported by Colorado Injury Control by Colorado Injury Control Research Center Research Center Grant Number R49/CCR811509 from Grant Number R49/CCR811509 from the Centers for Disease Control and Prevention.the Centers for Disease Control and Prevention. Its Its
l l h ibili f h h dl l h ibili f h h dcontents are solely the responsibility of the authors and contents are solely the responsibility of the authors and do not necessarily represent do not necessarily represent official official views of the CDCviews of the CDC..
Questions?Questions?Questions?Questions?
Awareness and R llRecall
93% f b l l ti i t f 93% of balance class participants from intervention churches reported that they heard about the class through theirheard about the class through their church.
What kind of information did h t h h?you hear or see at church?
Availability of balance
B l l t f ll
Availability of balance classes
Falls and fall injuries are
Balance classes prevent falls
Other ways to prevent falls
jserious
Other message
Other ways to prevent falls
0% 20% 40% 60% 80%
Other message
How did you receive this How did you receive this information at your church?information at your church?information at your church?information at your church?
Church bulletin / newsletter
Conversation with church member
Pulpit announcement
Brochure
Conversation with church member
Presentations at services or events
Poster
Oth
Letter or email
0% 10% 20% 30% 40% 50% 60%
Other ways
Previous findings f thi t dfrom this study
Demonstrated that a social marketingDemonstrated that a social marketing program, implemented in churches, increased participation in balance classes p pby older adult church members
Number of Older Adults Enrolled in Number of Older Adults Enrolled in N’BalanceN’Balance Classes (total n=269)Classes (total n=269)
200
160180200
100120140
406080
02040
Intervention Control Churches Non Study or NoIntervention Churches
Control Churches Non-Study or No Church
Mean Proportion of Older Adult Congregants Mean Proportion of Older Adult Congregants Who Enrolled in Balance ClassWho Enrolled in Balance ClassWho Enrolled in Balance ClassWho Enrolled in Balance Class
12.0%
10.0%
6.0%
8.0% Z=-4.47, p<.001
4.0%
6.0%
2.0%
0.0%Intervention Churches Control Churches
Product: N’BalanceProduct: N Balance
Individualized Individualized balance, strength, sensory, gaitsensory, gait training
10 students/class Meets biweekly for
8 weeks (16 class (sessions)
158 Churches Assessed for
Results:R it t EligibilityRecruitment
29% Not Eligible (size, location)71% Eligible
51 Enrolled(46%)
61 Refused / Did Not Respond (54%)
26 Social Marketing Ch h ( 1%)
25 Control Ch h (49%) Churches (51%)
3521 OA MembersChurches (49%)
3580 OA Members