Building a self-sustaining community system of health support for the elderly, determinants of individual participation in voluntary community action

Abstract

Ongoing funding constraints and decreasing resources in the Canadian health care system have led to major changes in the delivery of health care services. These changes include community collaboration around health issues, and in particular an emphasis on self-help models of community development. The purpose of this thesis was to examine the factors in elderly people's lives which influence their involvement in the planning and provision of their own health services. Study participants consisted of residents living in a high-density apartment complex within the city of London, Ontario. The apartment complex has a high concentration of elderly and is an area of high health service utilization. It consists of 13 apartment buildings with 2325 units and 64 businesses under a single management group, the ESAM Corporation. The study consisted of two phases and utilized cross-sectional survey methodology. Phase I (n=1231) involved a secondary analysis of a 1997 Community Survey which was used to identify predictors of health and health service utilization in the Cherryhill population. Bi-variate correlational analyses were used to identify the predictors of health. Predictors of health included well-being, functional ability and age. Univariate analyses, cross-tabs analyses with chi-square tests and t-tests were used to examine the predictors of health service utilization. Predictors of health service utilization included health, functional ability, age and getting satisfactory answers to health questions. Phase II of this study (n=181) examined predictors of health voluntarism and volunteer leadership and specifically examined the factors in people's lives that are receptive to change which have an impact on health-related volunteer behaviour; those factors over which individuals, health professionals and community planners can have some influence. The moderating effects of non-modifiable variables such as age, socio-demographic and personality variables on the relationship between modifiable variables and health voluntarism and volunteer leadership were also examined. Bi-variate and multi-variate analyses were used to determine predictors of health voluntarism and volunteer leadership. It was found that individuals who were younger, more active, and received fewer health services, experienced fewer limitations in their day-to-day functioning, and those with higher levels of affective (short-term) well-being were more predisposed to volunteering. Likewise, it was found that individuals whose personality characteristics included being extroverted, open to change and agreeable were more likely to volunteer. The majority of elderly volunteers reported they would not take on positions requiring leadership. A series of hierarchical multiple regression analyses were used to determine if non-modifiable characteristics of study participants (e.g., age; personality; socioeconomic status; etc.) masked the influence of modifiable factors on health voluntarism and volunteer leadership. Several interactions were found. For example, the extent to which a person volunteered in the past moderated the influence of health/function on health voluntarism. Likewise a person's age moderated the influence of health/function on health voluntarism. Likewise a person's age moderated the influence of health service utilization on volunteer leadership. These findings have implications for practice in community development and health settings. Further research is required to fully examine factors receptive to change such as functional ability, psychosocial and environmental factors, and subsequent strategies that may be employed to maximize the involvement of elderly individuals in the planning and provision of their own health services.