The relationship among social support, spiritual well-being, commitment and health-promoting behaviors in older adults

The purpose of this study was to examine relationships among personal factors, social support, spiritual well-being, commitment and health-promoting behaviors in three age groups of older adults. The elderly are a vulnerable, high-risk group and elder care accounts for a large portion of the national health budget. The challenges issued by Healthy People 2000. while addressing health promotion, protection, and preventive needs for all ages, contain numerous objectives specific to the older adult. Prominent objectives are those to increase functional independence, reduce risk through promotion of healthy behaviors, and increase accessibility and services, such as health promotion programs. At a midpoint review those goals had not been met. To successfully meet these challenges and mandates, it is important to understand factors that enhance commitment by older adults to practice healthy behaviors.

Pender’s revised Health Promotion Model (Pender, 1996) guided development of a theoretical model for this correlational study using a non-probability sampling method. Criteria for inclusion were(a)adults aged 65 and older who are(b)self caring, (c) community dwellers, (d) English speaking, and (e) without known cognitive impairment. The sample of 595 seniors was divided into three age groups: 65-74, 75-84, and 85 and older. Data collection sites included senior centers, senior residences, social and civic groups and religious congregations in communities of four geographic areas: Southeast Missouri, East Tennessee, East Texas and Southwest West Virginia. For data collection, a demographic data form and four self-report scaled questionnaires were used: the Physical Activity, Nutrition, Stress Management, and Health Responsibility Subscales of the Health-Promoting Lifestyle Profile 11; the Commitment Subscale ofthe Health-Related Hardiness Scale; the Personal Resource Questionnaire 85, Part 2; and the JAREL Spiritual Well-Being Scale. Data analysis, using SPSS-PC, included measures of central tendency, Pearson correlation, analysis of variance (ANOVA), post hoc Scheffe’ tests and Levene Tests for Homogeneity of Variance. Structural equation modeling with Amos software was conducted. Cronbach’s Alpha coefficient analysis was employed to establish reliability of instruments used in this sample.

Findings supported the relationships hypothesized by Pender’s Health Promotion Model and that older adults are not a homogeneous group. ANOVA analysis revealed differences among the age groups in levels of commitment and physical activity. SEM analysis supported the theoretical model in each age group. An interaction effect between Social Support(SS)and Spiritual Well-Being (SWB) was supported, with each concept having both direct and indirect effects on Commitment and indirect effects on Health-Promoting Behaviors(HPB). A surprising and new finding was that SS and SWB only influenced HPB through Commitment and not directly. The relationship between Commitment and HPB was significant (p j< .0000) in age groups I and II, but not significant in age group III. A Personal Factors concept was not supported. Rather, individual personal factors had direct, as well as indirect, effects on specific health-promoting behaviors in all age groups, suggesting that specific personal factors are more relevant to performance of one behavior than to that of another. These findings suggest that Health-Promoting Behaviors may be important as a conceptual category, but not as a latent concept in older adults, and that Commitment to healthy behaviors may no longer be an important issue for those aged 85 and older. The importance of Source of Spirituality and SWB to Commitment and individual outcome behaviors is especially noteworthy, supporting the addition of each concept to Pender’s Health Promotion Model.

Implications were primarily for the efficacy ofthe Health Promotion Model for planning, providing and evaluating health promotion programs for older adults.