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An experimental study of factors related to participation in health awareness with seniors between ages… St. Onge, Anna Marie Antoinette 1990

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AN EXPERIMENTAL STUDY OF FACTORS RELATED TO PARTICIPATION IN HEALTH AWARENESS WITH SENIORS BETWEEN AGES OF 60 TO 75 by ANNA MARIE ANTOINETTE ST.ONGE B.A., University of B r i t i s h Columbia, 1986 B.S.W., University of B r i t i s h Columbia, 1986 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES School of Soc i a l Work We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1990 © A n n a Marie Antoinette St.Onge, 1990 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis f o r scholarly purposes may be granted by the head of my department or by his or her representatives. It i s understood that copying or publication of t h i s thesis f o r f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of Social Work The University of B r i t i s h Columbia Vancouver, Canada Date • 7 0 • Qt- ) b DE-6 (2/88) ABSTRACT Society's dramatically mounting population of Seniors i s creating a demand to increase our knowledge of senior health program p a r t i c i p a t i o n and of what promotes 'Healthy Aging'. This thesis i s concerned with factors that a f f e c t seniors' p a r t i c i p a t i o n i n health promoting programs. There are two d i s t i n c t aspects to t h i s study, one i s an experiment and the other i s a survey. The experiment component of the thesis predicts that pot e n t i a l program parti c i p a n t s ' giving advice on a projected program topic, more than giving information w i l l increase s e l f -esteem, in t e r n a l locus of control and thus program p a r t i c i p a t i o n . The survey aspect of the t h e s i s i s designed to discover other factors which a f f e c t p a r t i c i p a t i o n and health concerns. The project deals with psychological constructs such as locus of control, self-esteem and l i f e s a t i s f a c t i o n put to the use of s o c i a l work concerns such as increasing program p a r t i c i p a t i o n , health awareness and resource use. One hundred and twenty persons aged 60-75 were randomly selected from the f i l e s of Matsqui-Abbotsford Community Services and randomly assigned to 3 groups of 4-0 persons each. Group 1 & 2 were administered Ulallston & Wallston & DeVallis' Multidimensional Health Locus of Control Scales and Rosenbergs"Self-Esteem Scale before and a f t e r the two i i experimental i n t e r v e n t i o n s of g i v i n g a d v i c e or i n f o r m a t i o n on the same h e a l t h t o p i c s . Both groups a l s o responded t o Diener & Emmons & Larsen & G r i f f i n ' s L i f e S a t i s f a c t i o n S c a l e , Chapin's O r g a n i z a t i o n a l P a r t i c i p a t i o n S c a l e and some q u e s t i o n s about f a m i l y , f r i e n d s , smoking, h e a l t h and demographics. Group 3, the c o n t r o l group, was not i n t e r v i e w e d . A f t e r r e g u l a r i n t e r v a l s a l l groups were i n v i t e d t o p a r t i c i p a t e i n t h r e e p r o g r e s s i v e l y i n v o l v i n g 'Healthy Aging' p u r s u i t s . S t a t i s t i c a l a n a l y s i s does not support the h y p o t h e s i s that g i v i n g a d v i c e i n c r e a s e s s e l f - e s t e e m , l i f e s a t i s f a c t i o n , p a r t i c i p a t i o n or ' i n t e r n a l i t y ' of h e a l t h l o c u s of c o n t r o l . P a r t i c i p a t i o n i n formal o r g a n i z a t i o n s c o r r e l a t e s with o t h e r forms of s o c i a b i l i t y and knowledge about p r e v e n t i o n , while smoking co-r e l a t e s p o s i t i v e l y with s o c i a l i s o l a t i o n . H e a l t h i n t e r n a l i t y i s a s s o c i a t e d with g r e a t e r s e l f - r e p o r t e d h e a l t h , l i f e s a t i s f a c t i o n , more c o n t a c t with f a m i l y and not a s s o c i a t e d with s o c i a b i l i t y o u t s i d e of the home. i i i TABLE OF CONTENTS Page ABSTRACT i i TABLE OF CONTENTS i v LIST OF TABLES v i i ACKNOWLEDGEMENTS x INTRODUCTION 1 CHAPTER 1. BACKGROUND LITERATURE REVIEW 5 D e f i n i t i o n of Terms and Concepts 5 P a r t i c i p a t i o n and the Elder l y 9 Why i s P a r t i c i p a t i o n Important? 10 Old Age and Locus of Control 13 Posit i v e Correlates of In t e r n a l i t y 15 Implications of Increased I n t e r n a l i t y 16 2. DEVELOPMENT OF THE HYPOTHESES 19 Underlying Theories 19 Kuypers and Bengston's So c i a l Reconstruction Model 19 Arnstein's Theory of Degrees of Pa r t i c i p a t i o n 21 Objectives of the Study 23 Hypotheses 24 Synopsis of Theory Reformulated into Hypotheses 24 Consequent Hypotheses 25 3. RESEARCH PROCEDURES 29 Source of Data 30 Research Design 30 Flow Chart of Experiment-Survey Events and Interventions 31 Measurement Tools 32 Measurement of P a r t i c i p a t i o n 39 Sampling Procedures 40 Steps of Research Procedure 43 Analysis Design 44 Implementation of Research Plan and Suggestions for Improvements 45 i v 4. FREQUENCY DISTRIBUTIONS 48 Demographic Indicators 48 Pa r t i c i p a t i o n Indicators 50 Health Indicators 52 Summary 53 5. HYPOTHESES RESULTS 54 Findings f o r Hypothesis 1 54 Findings f o r Hypothesis 2 60 Findings f o r Hypothesis 3 63 Findings f o r Hypothesis 4 66 Findings f o r Hypothesis 5 69 Findings f o r Hypothesis 6 70 Findings f o r Hypothesis 7 70 Summary 73 6. GROUP 1 CHARACTERISTICS RELATED TO RECOMMENDATIONS 75 Group 1 Ch a r a c t e r i s t i c s 76 Group 1 Recommendations and Correlated C h a r a c t e r i s t i c s 83 Summary 88 Conclusions 89 7. GROUP 2 CHARACTERISTICS AND RESOURCE CITINGS 90 Group 2 Ch a r a c t e r i s t i c s 91 Group 2 Resource Cit i n g s and Ch a r a c t e r i s t i c s 97 Summary 104 8. KEY VARIABLE RELATIONSHIPS IN BOTH GROUPS 105 Pa r t i c i p a t i o n Correlates 105 Health Correlates 112 Int e r n a l i t y Correlates 115 Summary 116 9. SUMMARIES, CONCLUSIONS AND RECOMMENDATIONS 120 Survey Components of the Project 120 Experimental Components of the Project 127 Relationships between the Key Variables 129 REFERENCES 132 APPENDIX 1 - U.B.C. Ethics Committee C e r t i f i c a t e of Approval 138 APPENDIX 11 - Agency Letter of Introduction of Researcher 140 v APPENDIX 111 - Multidimensional Health Locus of Control Scale - F i r s t Half 142 APPENDIX IV - Multidimensional Health Locus of Control Scale - Second Half 144 APPENDIX V - Rosenberg's Self-Esteem Scale 146 APPENDIX VI - Group 1 Advice-Asking Questionnaire 148 APPENDIX V l l - Group 2 Information-Asking Questionnaire. 152 APPENDIX V l l l - S a t i s f a c t i o n with L i f e Scale 158 APPENDIX IX - Organization Questionnaire 159 APPENDIX X - Demographics Questionnaire 161 APPENDIX XI - Consent Form 163 APPENDIX X l l - Letter tt 1 -Invitation to Part i c i p a t e tt 1 166 APPENDIX X l l l -Letter # 2 -Invi t a t i o n to Part i c i p a t e tt 2 168 APPENDIX XIV - Letter tt 3 -Invitation to Pa r t i c i p a t e tt 3 170 APPENDIX XV - Correlation Matrix of P a r t i c i p a t i o n , Health and Other Indicators Corresponding to Tables 172 v i LIST OF TABLES Table Page 1. Arnstein's Ladder of P a r t i c i p a t i o n 22 2. Predicted Rates of P a r t i c i p a t i o n Following the Interview 25 3. Predicted Outcome of Averages of Self-Esteem Scale 26 4. Predicted Outcome of Averages of MHLC 27 5. Demographic Indicators f o r the 80 Respondents... 49 6. P a r t i c i p a t i o n Indicators f o r 80 Respondents by Gender 51 7. Health Indicators f o r the 80 Respondents 52 8. Expected P a r t i c i p a t i o n Rates 54 9. P a r t i c i p a t i o n Rates by Group i n Project Invitations 55 10. Independent Samples t - t e s t on P a r t i c i p a t i o n Totals Grouped by Group 1 (advice-giving) and Group 2 (information-giving) 56 11. Group 1 (advice-giving) and Group 2 (information-giving) on Health Orientation, Smoking and Health 58 12. Independent Samples t - t e s t on P a r t i c i p a t i o n Grouped by Group 2 (information-giving)and Group 3 (control) 59 v i i 13. Independent Samples t - t e s t on P a r t i c i p a t i o n Grouped by Group 1 (advice-giving) and Group 3 (control) 59 14. Predicted Outcomes of Averages of Self-Esteem Scale 60 15. Actual Results of Averages of Self-Esteem Scale. 61 16. Paired Samples t - t e s t f o r Self-Esteem Scale Before and After Treatment f o r Group 1 and Group 2 61 17. Paired Samples t - t e s t on Self-Esteem f o r Those who were Familiar with Concept of Prevention 63 18. Predicted Outcomes of Averages f o r MHLC 64 19. Actual Averages f o r MHLC Before and After Treatment 64 20. Paired Samples t - t e s t s on MHLC Before and After the Two Types of Treatment, with Group 1 (Advice-Giving) and Group 2 (Information-Giving) 65 21. Paired Samples t - t e s t s on MHLC Before and After the Two Treatments i n Group 1 and Group 2 by Prevention Oriented 66 22. Predicted Outcome of Averages of "S a t i s f a c t i o n with L i f e Scale (SWLS)" 67 23. Results Comparing Averages of Group 1 (Advice Giving) and Group 2 (Information-Giving) i n the "S a t i s f a c t i o n with L i f e Scale" a f t e r two Treatments 67 24. Results Comparing Prevention Oriented Persons i n Group 1 (Advice-Giving) and Group 2 (Information-Giving) on SWLS 68 v i i i 25. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between P a r t i c i p a t i o n i n Organizations and Other Variables 107 26. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Church-Going A c t i v i t i e s and Other Variables 108 27. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between More Frequent Contact with Friends and Other Variables 110 28. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Smoking and Other Variables I l l 29. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Reported Health and Other Variables 113 30. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between L i f e S a t i s f a c t i o n and Other Variables 114. 31. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Prevention Oriented Persons and other Variables 115 32. S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Health I n t e r n a l i t y and other Variables 116 ix ACKNOWLEDGEMENTS I appreciate the kindly support of my two advisors, Dr. Ross McClelland and Dr. John Crane who both encouraged and advised me through the many questions I had surrounding t h i s thesis. Walter Paetkau, the Director of Matsqui-Abbotsford Community Services not only provided ideas but he also gave free access to the f i l e s and s e c r e t a r i a l resources of the center f o r t h i s work to be completed. He was supportive and interested at precisely the times t h i s was required. I also thank Christ i n e Ragneborg who generously l e t me work i n her environment and with her c l i e n t s . To these I owe the greatest debt of gratitude to f o r t h e i r patience and co-operation. Many thanks to my spouse and companion, Conrad Hadland who listened, provided insight, encouragement and computers so that I could complete t h i s work. Thanks to my daughter Mara fo r her love and support and to my f r i e n d Anne Lindsay who assisted me with the e d i t i n g of t h i s work. Gratitude i s also extended to an e a r l i e r proof-reader-typist, Laurent Dube. Most of a l l I f e e l thankful to the Seniors who so graciously waded through the many pages of t h i s survey with both patience and humour. x INTRODUCTION The aged i n our society are increasing i n proportion to other segments of the population. The "Greying" of Canada i s a genuine phenomenon substantiated by the most recent s t a t i s t i c s on the e l d e r l y i n Canada. According to Denton, Feaver and Spencer in Marshall's Aging i n Canada (1987), the proportion of those aged 65 and over w i l l r i s e to 13.6% of the population i n 2001 and to 29.1% of the population by 2051 (with decreasing f e r t i l i t y f i g u r e s ) . The r a t i o of e l d e r l y i n the Canadian population w i l l double i n the next 50 years. F e l l e g i , the Chief S t a t i s t i c i a n of Canada, i n the feature a r t i c l e "Can We Afford An Aging Society", October, 1988, Canadian  Economic Observer, maintains that dealing with the impact of t h i s increase i n the number of aged w i l l require far-reaching changes in a l l of society. These changes w i l l be r e l a t i v e l y expensive i n terms of the three major s o c i a l programs: health, education and pensions. With diminishing f e r t i l i t y rates the future productivity sector i s not growing quickly enough to support needed growth i n s o c i a l programs. Planning f o r an aging society might include strategies such as r a i s i n g immigration quotas and eliminating compulsory retirement at age 65. There are strong indications that people are not only l i v i n g longer, but are remaining healthy and h productive f a r longer (Stone and Fletcher, 1986). 1 F e l l e g i goes on to say that the e l d e r l y w i l l "undoubtedly carry an enhanced weight i n p o l i t i c s which might well r e s u l t i n more attention to those p o l i c i e s which are of interest to them" ( F e l l e g i , 1988, p. 4). F e l l e g i points out that because health care costs may increase substantially, the government must focus on prevention of i l l n e s s and indeed prevention has become a federal government p r i o r i t y . A preventative approach i s compatible with the desires of the e l d e r l y who, i n the main, wish to remain independent and healthy as long as possible, out of i n s t i t u t i o n s and within t h e i r own homes (Fiske, 1987). How can are we encourage such independence? Selby and Schechter (1982) point out that there i s a pressing need to consider s e l f - h e l p programs so that the e l d e r l y can p a r t i c i p a t e i n maintaining t h e i r own health. What are the current p a r t i c i p a t i o n patterns f o r seniors l i k e i n Canada f o r most group a c t i v i t i e s ? McPherson & Kozlik (1987) summarize the question: Nevertheless there are a few cross—sectional national studies that support the almost universal f i n d i n g that the reported frequency of involvement i s lower for older age groups i n most l e i s u r e a c t i v i t i e s , voluntary association involvement and attendance at c u l t u r a l events (McPherson & Kozlik, 1987, p. 211). 2 How can we promote s e l f - s t a r t e d health i n i t i a t i v e s i f current senior group p a r t i c i p a t i o n i s limited? Is the c u l t i v a t i o n of s e l f - h e l p groups a worthwhile use of scarce governmental resources? Could the r o l e of s o c i a l workers be expanded to champion these types of i n i t i a t i v e s ? A concern i n t h i s conservative era, i s that i f s o c i a l workers s h i f t t h e i r e f f o r t s to advancing service delivery through charity and s e l f - h e l p groups that there might be fewer persons reached than there would be by entrenched and i n s t i t u t i o n a l i z e d s o c i a l programs ( S c h i l l i n g , Schinke & Weatherly, 1988). It i s possible, however, that s o c i a l workers can define f o r themselves an additional valuable r o l e i n developing alternate workable service delivery strategies which s t r i v e to develop s e l f -determinism i n the e l d e r l y and a s s i s t them to act more on t h e i r own behalf as indiv i d u a l s and subsequently as groups, with such programs seen as an adjunct to more formal s o c i a l welfare programs rather than as a replacement. The problem may seem to be that we have a larger number of e l d e r l y persons than the rest of society, (with i t s declining resources) can adequately support. However, the main obstacle may be, rather, that seniors are currently a disadvantaged group in terms of power. The e l d e r l y have been deprived of autonomy and authority, by v i r t u e of the demands of an i n d u s t r i a l i z e d society which has relegated the old to the position of unemployed, ignored and dependent. 3 The elderly, i f allowed to remain i n the work force and/or achieve p o l i t i c a l clout, may soon be i n a position to assume role s of advisers and autonomous directors of t h e i r own circumstances, ultimately benefiting both the community and the i n d i v i d u a l e l d e r l y person. How do we propose to encourage and promote t h i s process? Mould giving seniors opportunities to express t h e i r views, communicate t h e i r opinions, suggestions and advice, empower them? Mould empowerment increase self-determination i n matters of personal health, self-education and group p a r t i c i p a t i o n ? As we w i l l see i n t h i s subsequent Abbot sford study, the concept of "empowerment" i s not a simple one. If a senior i s given the opportunity to give advice, does t h i s experience increase empowerment? Is there a need for advice givers to f e e l that the advice w i l l be heeded? Need they f e e l that they know t h e i r subject well and that they have made a valuable contribution with t h e i r advice? Does asking people to give advice upon topics they are unfamiliar with increase t h e i r c u r i o s i t y to learn more about the subject or w i l l they f e e l that the topic i s associated with embarrassment and not to be pursued? These questions are addressed i n the following study where the tool of giving advice i s evaluated for i t s e f f e c t on self-esteem, increasing locus of control and promoting participatory behaviors. 4 CHAPTER 1: BACKGROUND LITERATURE REVIEW In t h i s chapter we w i l l look at the factors which aff e c t formal group p a r t i c i p a t i o n , at why p a r t i c i p a t i o n and involvement i n the el d e r l y i s important, at the association of "locus of control" to p a r t i c i p a t i o n , at correlates of " i n t e r n a l i t y " and at the implications f o r p a r t i c i p a t i o n of increasing i n t e r n a l i t y of locus of control. Before discussing the concepts c r u c i a l to t h i s survey/experiment, the d e f i n i t i o n of the main terms and concepts are introduced i n the following section. D e f i n i t i o n of Terms and Concepts  P a r t i c i p a t i o n P a r t i c i p a t i o n can be defined as involvement and contribution i n one modality or another, with money, time, energy, s k i l l , knowledge, support or commitment. P a r t i c i p a t i o n i s characterized by input and can vary i n in t e n s i t y and frequency. In t h i s thesis p a r t i c i p a t i o n i s operationalized as follows: The respondents were in v i t e d to p a r t i c i p a t e i n three ways afte r they were interviewed. Two weeks af t e r the interview the interviewed persons and a randomly selected person from the pool of Group 3, (control group) were mailed an i n v i t a t i o n to return the bottom of a l e t t e r , to the Community Services i n order to receive a free booklet on Healthy Aging. Two weeks af t e r t h i s 5 the respondents were mailed a l e t t e r asking them to return the bottom of the page i f they wished to be put on the mailing l i s t of a Healthy Aging group. Again, two weeks af t e r t h i s they were mailed an i n v i t a t i o n to attend a Healthy Aging group meeting. These three i n v i t a t i o n s were considered to be incremental par t i c i p a t o r y steps and each step was given increasing weight. Ordering a free booklet was deemed to be worth 1 point f o r p a r t i c i p a t i o n . Choosing to be placed on a mailing l i s t was considered to earn a score of 2 i n p a r t i c i p a t i o n and attending a meeting was awarded a score of 3 f o r p a r t i c i p a t i o n . Cognitive Dissonance Festinger created a theory, which e s s e n t i a l l y maintains that people are uncomfortable with "cognitive dissonance" which i s a discrepancy between t h e i r d i f f e r e n t b e l i e f s , values or behavior. If people experience t h i s "dissonance" they w i l l attempt to correct the discrepancy by changing t h e i r behavior or b e l i e f s so that thought and action are congruent (Baron & Byrne, 1984). Locus of Control J. B. Rotter devised a scale f o r measuring a person's at t i t u d e i n r e l a t i o n to how his/her actions are perceived to r e l a t e to outcomes. Persons who believe that they have some control over t h e i r destinies are l a b e l l e d as "internals" and those who believe that they themselves do not control outcome as much as fate, luck, chance, powerful others and unpredictable forces, are deemed to be "externals". 6 Most research so f a r points to the fact that internals who demonstrate i n t e r n a l i t y , achieve t h e i r goals more s a t i s f a c t o r i l y , than do externals who seem handicapped by t h e i r b e l i e f s , (or who have developed t h e i r b e l i e f s because of the problems i n t h e i r l i v e s ) (Robinson & Shaver, 1973). This congruence between success and the b e l i e f system of inte r n a l s and less success and the b e l i e f system of the externals i s possibly an example of Festinger's theory of "cognitive dissonance" (Baron & Byrne, 1984). Those who imagine the power resides within themselves w i l l act accordingly and thus increase the chances of furthering s i t u a t i o n s to t h e i r advantage. Those who do not believe the power l i e s within themselves may give up before they can change a s i t u a t i o n . Thus both the b e l i e f s and actions of internals and externals and the way they f e e l the world works, would be consonant and not dissonant. Self-Esteem Rosenberg defined self-esteem as self-acceptance, s e l f -regard and a f e e l i n g of self-worth which i s the opposite of s e l f -abnegation. He developed the self-esteem scale used i n t h i s project. Empowerment Persons who are "empowered" f e e l that they have control over the p o s s i b i l i t y of furthering s i t u a t i o n s to t h e i r advantage. Soc i a l workers can empower people i n a great number of ways, but 7 the underlining p r i n c i p l e i s to approach t h e i r c l i e n t s , i n a manner which restores or maintains the c l i e n t s " self-respect and dignity and gives them a sense that they can control the events of t h e i r l i v e s . This approach also e n t a i l s handing over the reins of power, as described by Kuypers and Bengston, (as c i t e d i n Barrow & Smith, 1983) to "increase t h e i r involvement, t h e i r control, t h e i r power, and thus enable them to develop greater self-confidence" (p. 85). Advice-Giving and Consultation In the context of t h i s project, giving advice i s responding to the queries of the researcher, which are couched i n the form of "Could you give some suggestions, or advice about such and such a program". Hopefully, giving advice increases the sense of i n t e r n a l i t y of locus of control, as opposed to simply giving information. Because i n t e r n a l i t y of locus of control i s increased, p a r t i c i p a t i o n may be more l i k e l y . According to Arnstein (as c i t e d i n AIP Journal, 1969), giving advice i s closer to c i t i z e n control and p a r t i c i p a t i o n than merely giving information although the difference may not be a large one. 8 Giving Information In t h i s research project giving information r e f e r s to the type of questions the researcher uses with a participant i n the study upon a selected topic, such as "Who would you contact i f you had questions about healthy n u t r i t i o n ? " . Giving information i s to be d i f f e r e n t i a t e d i n t h i s study from giving advice where the researcher asks the respondent "What would you advise i s needed to ensure that seniors get healthy n u t r i t i o n that w i l l keep them well?" Prevention Oriented For the purposes of t h i s study, those who are prevention oriented are conversant with the topic of "prevention" and healthy aging. In the project i t s e l f , one of the ways the concept of prevention was operationalized was to ask the respondents i f they both recognized the concept of "wellness or prevention" and had noticed or bought the "Prevention" magazine s t r a t e g i c a l l y placed near several check-out counters i n large supermarkets. This was based on the assumption that those who are prevention oriented generally take a pro—active interest i n t h e i r personal health and seek out information about health promoting practices. P a r t i c i p a t i o n and the Eld e r l y The p r i n c i p a l factors c i t e d by McPherson & Kozlik (1987) which a f f e c t p a r t i c i p a t i o n i n the el d e r l y , as supported by studies on the subject are presented i n rank order: 9 For the younger cohort of el d e r l y residents (62-74), the most frequently c i t e d b a r r i e r s were: being too busy, health, expense and distance to the a c t i v i t y (Hoffman, 1985a:4) (cited i n McPherson & Kozlik, 1987 p. 224). On senior pa r t i c i p a t o r y behavior, from compiling the l i t e r a t u r e , we also know, that the type of dwelling, gender, culture, length of residency i n the area, education, past occupation, s o c i a l class, marital status, past participatory patterns, amount of recent personal loss, amount of family v i s i t i n g , neighborliness, sense of personal control, self-esteem, personality t r a i t s , r e l i g i o u s a f f i l i a t i o n and types of a c t i v i t i e s available, a l l exert varying degrees of influence on how frequently, with what type of in t e n s i t y and with what re s u l t s , e l d e r l y persons take an active part i n the programs and a c t i v i t i e s available to them (McPherson & Kozlik, 1987; Cutler, 1987) . It was necessary to focus on only s p e c i f i c variables f o r the purposes of t h i s limited study, but as many as possible of the above mentioned plethora of variables which exert diverse pressures on part i c i p a t o r y patterns were included i n the study i n regards to the topic on healthy aging. Why i s P a r t i c i p a t i o n Important? We may not have decisive proof that p a r t i c i p a t i o n i s generally b e n e f i c i a l , but we do know that s o c i a l i s o l a t i o n has a negative e f f e c t on some groups of the aged, notably on those who 10 are i n v o l u n t a r i l y i s o l a t e d : the recently widowed, (Bennett, 1980) the newly arrived, those who have gradually l o s t s o c i a l contacts because of the relocation of family, friends and colleagues and those with impaired health. The e f f e c t s of i s o l a t i o n f o r those who wish to be with others are multifold. Loneliness and consequent depression may impair the ind i v i d u a l ' s motivation to reach out. If the loneliness p e r s i s t s a f t e r a p r e c i p i t a t i n g event, the e f f e c t can lead to demoralization (Sherman, 1985) and eventual depression. Both loneliness and depression may have an adverse e f f e c t on physical health and also those e l d e r l y persons with mental health impairment do the worst i n or out of care. Furthermore, prolonged i s o l a t i o n atrophies the r e q u i s i t e s o c i a l s k i l l s f o r making friends and keeping them. Not only does the Isolated person become in s e n s i t i v e to c r u c i a l s o c i a l cues, he/she begins to l i v e i n an "out of date" world where new information i s not exchanged and conversation becomes s t i l t e d and r i g i d (Bennett, 1980). Bennett (1980) determines that c e r t a i n patterns of i s o l a t i o n are more deleterious than others, although any prolonged i s o l a t i o n from s o c i a l i n t e r a c t i o n i s found to be measurably negative f o r most ensuing interactions, e s p e c i a l l y i f the is o l a t e d person i s subsequently i n s t i t u t i o n a l i z e d , a s i t u a t i o n where i n t e r a c t i v e s k i l l s are mandatory f o r integration. 11 The i n v o l u n t a r i l y i s o l a t e d seem the most amenable to intervention i n terms of s o c i a l i z a t i o n according to Bennett. Those seniors who l i v e alone i n apartments tend to go out to s o c i a l i z e s i g n i f i c a n t l y more (Weaver, 1984), versus those who l i v e i n shared accommodations, s i g n i f y i n g a need fo r those who are more is o l a t e d to reach out. According to Norris (1987) not a l l s o c i a l p a r t i c i p a t i o n , e s p e c i a l l y i n non-intimate relationships i s deemed b e n e f i c i a l . Blunt (1982) reported i n a study on p a r t i c i p a t i o n and s o c i a l stress and health, that although health was p o s i t i v e l y associated with learning, p a r t i c i p a t i o n i n formal s o c i a l organization had "decremental e f f e c t s " upon health. Other studies done with el d e r l y p a r t i c i p a t i o n i n r e l i g i o u s a c t i v i t i e s , however have demonstrated wide-spread p o s i t i v e benefits (Cutler, 1987). If p a r t i c i p a t i n g i n organizations i s not always a s a t i s f a c t o r y experience It may be connected with the lack of leadership and control which some persons experience i n organized a c t i v i t i e s . Older persons do not often take leadership roles i n formal organizational settings and consequently may f i n d that although c e r t a i n s o c i a l needs are met, t h e i r sense of self-worth i s not increased. This i s an area i n which researchers f e e l there i s need fo r further study (Cutler, 1982). In non-i n d u s t r i a l i z e d s o c i e t i e s , the e l d e r l y p a r t i c i p a t e r e a d i l y and with p o s i t i v e e f f e c t s i n the l o c a l groups, because t h e i r power, position, contribution and s i g n i f i c a n c e i s assured and f e l t to be useful, conditions which s i g n i f y i n t e r n a l locus of control c r i t e r i a . C i c i r e l l i (1987), i n reviewing the studies done with aging and locus of control, (high i n t e r n a l locus of control i s associated with a strong f e e l i n g of having the power to e f f e c t change from within) associates s o c i a l p a r t i c i p a t i o n with i n t e r n a l i t y of control. Perceived control i n the community or neighborhood i s associated with neighborhood organizational p a r t i c i p a t i o n . According to a study done i n 1984, by Ainlay, perceived control was found to have more impact than attachment to the neighborhood, on the dependent variable of p a r t i c i p a t i o n . In f a c t , perceived control not only had d i r e c t e f f e c t s on p a r t i c i p a t i o n but also had a p o s i t i v e e f f e c t on a f f e c t i v e attachment to the neighborhood. If we can extrapolate t h i s to programming fo r seniors could we hope to assume that having seniors gain perceived control would increase not only t h e i r p a r t i c i p a t i o n , but t h e i r sense of community as well? Old Age and Locus of Control According to some studies, internal locus of control increases with age, at least up u n t i l the s i x t i e s (Knoop, 1981; Dolphin, 1986). Those who are from approximately the age of 50 13 to retirement age, often have a highly developed inte r n a l locus of control (Drobnies, 1984). This i s l i k e l y because inte r n a l locus of control i s p o s i t i v e l y associated with the male gender, better education, higher income, more self-esteem, more job involvement, more job s a t i s f a c t i o n and less job a l i e n a t i o n . Later middle age increases the opportunities f o r several of these parameters to become operable. On the other hand, i f the factors of jobs, gender and income af f e c t locus of control and there i s also evidence that locus of control can be manipulated with relevant variables (Hudson, 1983); Jackson, 1980; Reakes, 1979), than i t makes sense that those who are r e t i r e d (mostly women, with no jobs and lower income) would experience a decrease i n i n t e r n a l locus of control. Has t h i s r e l a t i o n s h i p of increasing in t e r n a l locus of control up u n t i l retirement been shown to revert s i g n i f i c a n t l y a f t e r retirement? Again the r e s u l t s are c o n f l i c t i n g and l i t t l e research has been done i n the area of locus of control and the aging. More research i s needed i n t h i s area. According to C i c i r e l l i (1987), i n h i s overview of the studies on age and locus of control, most of the studies cancel each other out, except f o r some possible indications of increased externality amongst the old-old. 14 P o s i t i v e Correlates of I n t e r n a l i t y Self-esteem and an in t e r n a l locus of control are commonly p o s i t i v e l y correlated i n the studies where the two are included. Where self—esteem increases, so too does inte r n a l locus of control (Aloia, 1973; DeCoster, 1987; Teitelman, 1983). Another study, (Jackson, 1980) done with the several groups of e l d e r l y i n North Carolina demonstrated that attending a course on " C i t i z e n P a r t i c i p a t i o n i n C i v i c A f f a i r s " s i g n i f i c a n t l y increased the l e v e l s of i n t e r n a l locus of control of the part i c i p a n t s as compared to control groups. This suggests that providing information and education can have an impact on " i n t e r n a l i t y " . Deutchman (1985), did a research project with a younger group of adults and determined that there was a l i n k between int e r n a l locus of control and p a r t i c i p a t i o n i n the p o l i t i c a l sphere. The l i n k was e s p e c i a l l y strong, with voting behavior. An important area f o r exploration i s the connection between sense of control and p o l i t i c a l involvement i n the e l d e r l y . The development of a p o l i t i c a l voice w i l l become important as the e l d e r l y population spurts i n growth r e l a t i v e to the other age populations. Implications of Increased I n t e r n a l i t y The implication of greater p a r t i c i p a t i o n evolving from consultation, speaks to the benefit of increasing the voice of 15 the s e n i o r s i n t h e i r own programs, l e a d i n g t o s u c c e s s f u l e n t e r p r i s e s . Selby and Schechter s t r e s s the r o l e of the e l d e r l y as a r e s o u r c e i n s t e a d of a burden t o s o c i e t y : The e x p e r t s see much of t h e i r c o u n t r i e s * e l d e r l y p o p u l a t i o n s as having p o s i t i v e c o n t r i b u t i o n s t o make (a) t o s o c i e t y at l a r g e , through v o l u n t e e r and f a m i l y r o l e s , through sma l l b u s i n e s s e s c r e a t e d by or f o r the e l d e r l y , and through a d v i s o r y o r p a r t - t i m e j o b s ; (b) t o t h e i r communities; and (c) t o o r g a n i z a t i o n s which serve other e l d e r l y persons. Some expe r t s urge t h a t the e l d e r l y p a r t i c i p a t e i n making o r g a n i z a t i o n a l d e c i s i o n s and i n c a r r y i n g them out. The e l d e r s can be mutually s u p p o r t i v e i f they have the mechanisms and encouragement t o perform i n t h i s way (Selby and Schechter, 1982, p. 23). I f s e n i o r s do not p a r t i c i p a t e because of an e x t e r n a l l o c u s of c o n t r o l , the i m p l i c a t i o n f o r f u t u r e program p l a n n i n g would be t o implement programs which i n c r e a s e t h i s sense of c o n t r o l . T r e l a (1978) notes i n h i s study with s e n i o r s t h a t membership i n v o l u n t a r y a s s o c i a t i o n s i n c r e a s e s the p r o b a b i l i t y of involvement i n p o l i t i c a l a s s o c i a t i o n s . He goes on t o e x p l a i n t h a t j u s t b e l o n g i n g t o s o c i a l o r g a n i z a t i o n s tends t o heighten p o l i t i c a l awareness. I f s o c i a l workers were t o i n t e r v e n e with t h i s goal i n mind, the r e s u l t might be more powerful than merely enhancing l i f e - s t y l e . T h i s i s the concept of "empowering", a s u b t l e p r o c e s s which e n t a i l s g r a d u a l l y handing over the decision-making c a p a c i t y t o those who need t o develop the co n f i d e n c e , i n t e r e s t or the d e s i r e t o take c o n t r o l . The process of i n c r e a s i n g p e r c e i v e d and r e a l c o n t r o l with s e n i o r s would most s u r e l y e n t a i l some education, (with both workers and s e n i o r s ) , t r u s t i n the process as w e l l as i n the 16 seniors themselves and accepting the r i s k of some degree of f a i l u r e . This speaks to the need fo r careful planning and forethought, as well as more knowledge, and thus continuing research i n the area. We can begin by looking at where seniors already exert control and how they presently use t h i s control to increase s e l f -esteem and p a r t i c i p a t i o n . According to those professionals who work with seniors, the most currently popular programs where seniors themselves take i n i t i a t i v e are those connected with l e i s u r e a c t i v i t i e s , s o c i a l i z i n g and t r a v e l l i n g . Can t h i s sphere be extended to take over more of the service and health prevention arenas? A l l the needs of the aging i n d i v i d u a l and those of society lead i n the d i r e c t i o n of seniors assuming a greater c o n t r o l l i n g voice i n t h e i r own destinies i n a l l the areas deeply relevant to t h e i r most basic needs. Kuypers and Bengston (cited i n Barrow & Smith, 1983), who developed the theory acknowledged i n the section on "Conceptual Framework", summarize the whole paradigm s h i f t : F a c i l i t a t e development of i n t e r n a l control i n the i n d i v i d u a l . Allow more self-determination by the e l d e r l y on p o l i c i e s and administration of programs that a f f e c t them. Increase t h e i r involvement, t h e i r control, t h e i r power, and thus enable them to develop greater self-confidence (Kuypers and Bengston c i t e d i n Barrow & Smith, 1983, p. 85). 17 B e l l adds to t h i s : F i n a l l y , we suggest that, to enable the development of an i n t e r n a l locus of control, those who envision themselves as serving the e l d e r l y must de-invest t h e i r own power and contr o l : self-determination by the e l d e r l y and individual control of policy and administration i s the foundation of competent aging ( B e l l , 1976, p. 87). The question then i s , how to increase an i n t e r n a l locus of control. To date, there have been no studies done with advice giving as a t r i g g e r f o r increasing self-esteem, i n t e r n a l i t y and subsequently p a r t i c i p a t i o n and involvement. This project seeks to determine what connection consultation has with these s o c i a l indicators. The topic chosen f o r the seniors to give advice about i s "Health and Prevention". This advice-giving group w i l l be compared to a group of seniors surveyed f o r information on the same topic and a control group who i s not interviewed at a l l . 18 CHAPTER 2: DEVELOPMENT OF THE HYPOTHESES The following chapter describes the the o r e t i c a l underpinnings of the research study. The objectives of the study are outlined and a bridge of the theory to the hypothetical constructs are described. From t h i s bridge emerge the seven consequent hypotheses. UNDERLYING THEORIES This thesis i s based on two underlying theories, Kuypers and Bengtson Social Reconstruction Model and Arnstein's Ladder of Pa r t i c i p a t i o n . Kuypers and Bengtson S o c i a l Reconstruction Model Kuypers and Bengston i n 1973 (cited i n Barrow & Smith, 1983) described a model which attempted to define the position of the aged i n our society. They b u i l t t h e i r theory on Zusman's model of " s o c i a l breakdown syndrome" which comprises four steps: (1) The f i r s t i s the s u s c e p t i b i l i t y of the in d i v i d u a l , which i s based on the "precondition" of the personality and previous experiences. If an older person doesn't have strong inner resources and personal guidelines, t h i s i n d i v i d u a l w i l l be vulnerable to negative l a b e l l i n g . 19 (2) The second i s the experience of negative l a b e l l i n g by others. This l a b e l l i n g i s society's view of the aged as being "redundant", "unproductive", "incompetent" and "useless". (3) The t h i r d i s the adjustment of b e l i e f s and behavior to f i t t h i s negative l a b e l l i n g . (4) The fourth i s the acceptance and resignation of one's self-concept to t h i s negative l a b e l l i n g . Kuypers and Bengston postulate that the el d e r l y become vulnerable to external negative l a b e l l i n g because of t h e i r loss of s i g n i f i c a n t roles, a productive place i n society, a support network and sometimes friends and partners. The el d e r l y consequently adopt unfavorable stereotyping as t h e i r own and become entrenched i n a negative cycle of low self-esteem and reduced'expectations of s e l f . Kuypers and Bengston put f o r t h intervention strategies which may a s s i s t the e l d e r l y to break out of t h i s cycle. The f i r s t i s to teach society to "eliminate the idea that work i s worth". The second i s to improve s o c i a l services, thereby improving health, housing and f i n a n c i a l status of the aged. The t h i r d , again by Kuypers and Bengston, which pertains d i r e c t l y to t h i s project, i s to: 20 . . . f a c i l i t a t e development of int e r n a l control i n the i n d i v i d u a l . Allow more self-determination by the e l d e r l y on p o l i c i e s and administration of programs that af f e c t them. Increase t h e i r involvement, t h e i r control, t h e i r power and thus enable them to develop greater self-confidence (Kuypers and Bengston, c i t e d i n Barrow and Smith, 1983, p. 85). Arnstein's Theory of Degrees of P a r t i c i p a t i o n Arnstein (as c i t e d i n AIP July Journal, 1969), also outlines a theory of increased p a r t i c i p a t i o n coupled with power towards c i t i z e n control, advocating f i r s t a voice and then active involvement i n change. Arnstein describes a ladder of p a r t i c i p a t i o n which also defines increasing l e v e l s of i n d i v i d u a l personal power towards the process of s o c i a l change (see Table 1). The thesis research project seeks to study the increase of locus of control and empowerment i n seniors by comparing the e f f e c t s of being asked for advice or being asked f o r information and the r e l a t i o n s h i p of these experimental variables to p a r t i c i p a t i o n , self-esteem and locus of control. The project integrates Zusman's model of s o c i a l breakdown with Kuypers and Bengtson intervention strategy of increasing locus of control and self-esteem. In the context of the t h e o r e t i c a l framework surrounding t h i s p a r t i c u l a r project, p a r t i c i p a t i o n as explained by Arnstein, (cited i n AIP Journal, 1969) can be described on a ladder of increasing power and control (see Table 1). 21 The bottom rungs of the ladder are (1) Manipulation and (2) Therapy. These two rungs describe l e v e l s of "non-p a r t i c i p a t i o n " that have been contrived by some to substitute for genuine p a r t i c i p a t i o n . Their r e a l objective i s not to enable people to p a r t i c i p a t e i n planning or conducting programs, but to enable power holders to "educate" or "cure" the participants. Rungs 3 (Informing) and 4 (Consultation) progress to l e v e l s of "tokenism" that allow the have-nots to hear and to have a voice: When they are proffered by powerholders as the t o t a l extent of p a r t i c i p a t i o n , c i t i z e n s may indeed hear and be heard... Further up the ladder are l e v e l s of c i t i z e n power with increasing degrees of decision making clout... there are s i g n i f i c a n t gradations of c i t i z e n p a r t i c i p a t i o n (Arnstein, 1969, p. 216). Table 1 Arnstein's Ladder of P a r t i c i p a t i o n 8. CITIZEN CONTROL ( f u l l managerial power) 7. DELEGATED POWER (more decision making power) 6. PARTNERSHIP (negotiate and make trade-offs) 5. PLACATION (non-powerful p a r t i c i p a t i o n ) 4. CONSULTATION ** (non-powerful p a r t i c i p a t i o n ) 3. INFORMING * (non-powerful p a r t i c i p a t i o n ) 2. THERAPY (non-part i c i pation) 1. MANIPULATION (non—part i c i p a t ion) * * This rung r e f e r s to Group 1 i n the research project gives the i n d i v i d u a l s opportunity to give advice on programming. * This rung r e f e r s to Group 2 i n the research project, which gives the i n d i v i d u a l s opportunity to give information on programming. 22 OBJECTIVES OF THE STUDY This research task was designed to meet both the needs of the catchment agency (survey element) and the larger research requirements of the academic community (experimental element). In order to service the population providing agency, t h i s project sought to gather information about the amount of knowledge of resources, which seniors have about t h e i r community. The study looked at whether the di f f e r e n t s o c i a l agencies have adequately promoted t h e i r programs, and even to which extent these programs are successful and popular. Thus the study examined what improvements the seniors suggested about programming and what new areas should be developed i n the realm of services to promote healthy aging. The project was fashioned to look at what types of attitudes, habits, strengths, problems, concerns and contacts the seniors have i n t h i s p a r t i c u l a r community i n such areas as s o c i a l p a r t i c i p a t i o n , smoking, housing and services. The study was also designed to ascertain how much seniors are aware of the concept of healthy aging and the promotion of prevention of i l l n e s s . The thesis experimental component explores several hypotheses based on the two theories outlined at the beginning of 23 t h i s chapter. These hypotheses are developed i n the following section. i Another element of the thesis attempts to support or refute existent l i t e r a t u r e on co-relationships between variables such as self-esteem and locus of control. HYPOTHESES Synopsis of Theory Reformulated into Hypotheses Input creates involvement. Giving advice or counsel encourages further p a r t i c i p a t i o n i n the area one gives advice about because i t : (1) increases a sense of powerfulness, control and status, (2) i s congruent to act upon what one t a l k s about (Festinger's theory of dissonance) as i n the act of giving advice. If one f e e l s comfortable about giving counsel, one i s more l i k e l y to f e e l comfortable with actions surrounding the area of advice. Self-esteem i s l i k e l y to be correlated with high int e r n a l locus of control because i f one f e e l s "power-full" than one i s more l i k e l y to respect and esteem oneself, since respect and esteem i s more given to the quality of control and power than to the opposite, ( i n our western cu l t u r e ) . Therefore, there should be a p o s i t i v e r e l a t i o n s h i p between the variables of self-esteem, in t e r n a l locus of control, giving counsel and p a r t i c i p a t i o n because these q u a l i t i e s and experiences are a l l congruent on a power and control dimension. 24 ADVICE GIVING INCREASED SELF-ESTEEM + INCREASED LIFE SATISFACTION INCREASED INTERNALITY INCREASED LOQUACITY INCREASED PARTICIPATION There should be less congruency between the variable of information-giving, self-esteem, int e r n a l locus of control, and p a r t i c i p a t i o n , because giving information may not be as powerful as giving counsel i n terms of increasing self-esteem. Consequent Hypotheses F i r s t Hypothesis The advice-giving Group 1 would p a r t i c i p a t e more i n the three p a r t i c i p a t i o n i n v i t a t i o n s than the information-giving Group 2 and both interviewed groups w i l l p a r t i c i p a t e more than the control group. The control group w i l l p a r t i c i p a t e less than the other two groups because t h i s group never gets the attention and education, or the opportunity to give advice or information and therefore has less input. Table 2 Predicted Rates of P a r t i c i p a t i o n Following the Interview Expected P a r t i c i p a t i o n Group 1 Group 2 Group 3 (Advice- (Information- (Control) Giving) Giving) H i g n e s t Middle Lowest 25 Second Hypothesis The advice-giving Group 1 should experience a greater s h i f t upward i n self-esteem a f t e r the advice-giving opportunity than the information-giving Group 2 who might not f i n d giving information as empowering and who might not consequently f e e l so knowledgeable as those who had the opportunity to give counsel (see Table 3). Table 3 Predicted Outcomes of Averages of Self-Esteem Scale Group Before Treatment After Treatment Average S h i f t Group 1 same as Group 2 + > than Group 2 + > Group 2 Group 2 same as Group 1 Lower than Group 1 No s h i f t Group 1 = Advice-giving Group 2 = Information-giving A 2 = .10 ES = .20 N = 40 Power = .23 Third Hypothesis If giving advice makes one f e e l s empowered, and i f empowerment i s seen as increased i n t e r n a l i t y than one should become more inter n a l a f t e r giving advice than a f t e r giving information. Thus Group 1 should experience a greater p o s i t i v e s h i f t i n i n t e r n a l i t y on the second half of the health locus of control scale than Group 2, the information-giving group, because the experience of giving counsel would be more congruent with an i n t e r n a l locus of control, a r e s u l t which should show up i n the second half of the locus of control scale (see Table 4). 26 Table 4 Predicted Outcome of Averages of MHLC Group Before Treatment After Treatment Average S h i f t Group 1 Same as Group 2 > than Group 2 Upward s h i f t Group 2 Same as Group 1 < than Group 1 No s h i f t Group 1 = Advice-giving Group 2 = Information-giving A 2 = .10 ES = .20 N = 40 Power = .23 Fourth Hypothesis Group 1, the advice-giving Group, should express greater l i f e s a t i s f a c t i o n than the information-giving Group 2 because those who have given counsel may f e e l greater self-esteem and consequently experience and report more l i f e s a t i s f a c t i o n . F i f t h Hypothesis Because high i n t e r n a l i t y i s associated with f e e l i n g powerful i t i s hypothesized that there w i l l be a large p o s i t i v e co-rel a t i o n s h i p between i n t e r n a l i t y of locus of control and s e l f -esteem. Sixth Hypothesis High self-esteem i s predicted to correlate p o s i t i v e l y with high l i f e s a t i s f a c t i o n , because both are related to self-concept and are often correlated p o s i t i v e l y i n previous research. Their p o s i t i v e co-relationship would also serve to p a r t i a l l y validate the measurement instruments i n t h i s study. 27 Seventh Hypothesis If those who have high i n t e r n a l i t y f e e l more i n charge of t h e i r own destinies, might they not also f e e l more confident, thus demonstrating t h i s confidence with increased loquacity? It i s predicted that there i s a po s i t i v e r e l a t i o n s h i p between i n t e r n a l i t y , loquacity, self-esteem, l i f e s a t i s f a c t i o n v and p a r t i c i p a t i o n i n organizations, positing that the common variable here would be greater self-confidence. 28 CHAPTER 3: RESEARCH PROCEDURES The following chapter reviews the source of the data f o r the study, the measurement tools and t h e i r sequencing. Sampling procedures, representativeness and sel e c t i o n of c r i t e r i a are b r i e f l y outlined, as well as a simple description of the steps of research and analysis design. This thesis i s primarily a quantitative analysis with an ov e r a l l twofold purpose of adding to the current l i t e r a t u r e on aging and serving the agency from which the respondents were selected. This means that the project i s both an experiment and a survey. Source of Data The research project respondents l i v e i n the Fraser Valley, just south-east of Vancouver i n B r i t i s h Columbia. A l l of the respondents reside i n an area described as Matsqui-Abbotsford, and t h e i r names were drawn from the f i l e s of Matsqui-Abbotsford Community Services. These respondents seek services from t h i s agency to a s s i s t them with t h e i r forms, income tax preparation, pension applications, f i n a n c i a l and housing concerns. They are thus i n the main, f a i r l y f a m i l i a r with the agency. Because t h i s agency i s the primary provider of t h i s p a r t i c u l a r type of service i n the catchment area of Matsqui-Abbotsford, the respondents are deemed to be f a i r l y representative of the seniors i n the region, 2 9 except f o r those groups mentioned under the heading "Representativeness" l a t e r i n t h i s chapter. Research Design This p a r t i c u l a r research design i s primarily quantitative, with a q u a l i t a t i v e component which can also be broken down and analyzed quantitatively. The 120 subjects were randomly selected and assigned to three groups of 40 each. Group 1 and 2 were personally interviewed and a l l three groups were given 3 graduated and increasingly weighted types of opportunities to p a r t i c i p a t e a f t e r the interviews were completed (see description of operationalization of P a r t i c i p a t i o n i n Chapter 2, under P a r t i c i p a t i o n i n " D e f i n i t i o n of Terms and Concepts"). The two interviewed groups received the same 5 measurement scales and demographic questions i n i d e n t i c a l order. The difference between the two interviewed groups lay primarily i n the manner i n which one of the questionnaires sandwiched between two halves of the health locus of control and self-esteem scales, was administered. Group 1 was given questions i n the form of asking f o r advice and.Group 2 was given the same questions i n the form of asking f o r information. Two of the measurement scales (health locus of control and self-esteem) were used before and a f t e r the d i f f e r e n t treatments 30 to determine i f the two types of intervention (advice-giving and information-giving) induced measurably d i s s i m i l a r e f f e c t s . Flow Chart of Experiment-Survey Events and Interventions Outlined below i s the sequence i n which a l l of the exchanges and interventions took place with, Group 1 (advice-giving), Group 2 (information-giving) and Group 3 (Control Group). Group 1 Group 2 Group 3 1. Letter of Introduct ion of survey Letter of Introduct ion of survey Letter of Introduction of survey 2. Telephone c a l l from researcher asking f o r Interview. Telephone c a l l from researcher asking f o r Interview. Telephone c a l l asking i f person s t i l l l i v i n g at same address. 3. Interview (1 to 3 hours -a l l scales read aloud to participants) Interview (1 to 3 hours -a l l scales read aloud to participants) No interview 3a. Read Consent Form Read Consent Form n/a 3b. MHLC f i r s t half 3c. Self-esteem done top-down MHLC f i r s t half Self-esteem done top-down n/a n/a 3d. Questionnaire on Health Awareness asking for advice done with lap top computer. Quest ionnaire on Health Awareness asking for information done with lap top computer. n/a 3e. MHLC second half MHLC second half n/a 31 3f. Self-esteem bottom to top Self-esteem bottom to top n/a 3g. L i f e S a t i s f a c t i o n Scale L i f e S a t i s f a c t i o n n/a Scale 3h. Organization P a r t i c i p a t i o n Quest ionnaire Organization P a r t i c i p a t i o n Questionnaire n/i 3 i . Demographic Quest ionnaire Demographic Questionnaire n/a 3j. Consent form Consent form 4. P a r t i c i p a t i o n 1 (Invitation to order booklet on healthy aging) P a r t i c i p a t i o n 1 (Invitation to order booklet on healthy aging) P a r t i c i p a t i o n 1 (Invitation to order booklet on healthy aging) 5. P a r t i c i p a t i o n 2 (Invitation to be on mailing l i s t of Health Awareness Group) P a r t i c i p a t i o n 2 (Invitation to be on mailing l i s t of Health Awareness Group) P a r t i c i p a t i o n 2 (Invitation to be on mailing l i s t of Health Awareness Group) 6. P a r t i c i p a t i o n 3 (Invitation to go to a meeting of Health Group) P a r t i c i p a t i o n 3 (Invitation to go to a meeting of Health Group) P a r t i c i p a t i o n 3 (Invitation to go to a meeting of Health Group) Measurement Tools A l l of the measurement tool s are included i n the Appendices. Four d i f f e r e n t r e l i a b l e measurement tool s were used i n t h i s research project: "Multi-Dimensional Health Locus of Control - Form A and Form B" scales (Wallston, wallston and DeVellis, 1978). 32 "Self-Esteem" scale by Rosenberg (1965) (cited i n Mangen & Peterson, eds. 1982). "Sa t i s f a c t i o n with L i f e Scale" by Ed Diener, Robert A. Emmons, Randy J. Larsen and Sharon G r i f f i n (1985). Extracts from "Social P a r t i c i p a t i o n Scale" by F. S. Chapin (1939) (as c i t e d i n M i l l e r , 1983). The Multi-Dimensional Health Locus of Control Scale The MHLC has two p a r a l l e l forms, Form A and Form B, which are e s s e n t i a l l y almost i d e n t i c a l , i n that they both have 3 sub-scales of 6 questions each that t e s t : whether an indi v i d u a l believes that he/she i s primarily accountable f o r his/her own health, i f chance, luck or fate i s responsible, or whether "powerful others" such as experts, doctors and nurses are the most i n f l u e n t i a l i n health matters. In t h i s p a r t i c u l a r study where d i f f e r e n t types of treatment are inserted between the two s p l i t halves (Form A and Form B) of the MHLC, i t i s of the utmost importance that there i s inter n a l r e l i a b i l i t y i n the scale i t s e l f . R e l i a b i l i t y , fortunately i s the MHLC's strongest feature. With Cronbach's alpha, the inter n a l consistency r e l i a b i l i t y extends between .67 to .77 f o r the di f f e r e n t sub-scales, the three dimensions and two p a r a l l e l forms. The alphas are between .83 and .86 when the two p a r a l l e l forms are combined. (Corcoran & Fischer, 1987). 33 In the Abbotsford project the int e r n a l consistency r e l i a b i l i t y between the sub-scales ranged between .68 to .74 using Pearson's product-moment c o r r e l a t i o n c o e f f i c i e n t . This scale had been vastly improved since the previous HLC scale which provided confusing r e s u l t s because i t f a i l e d to account f o r the three dimensions which are d i f f e r e n t i a t e d i n the MHLC. This measurement tool i s s t i l l being researched. These scales have, according to Corcoran & Fischer, (1987) " f a i r l y good c r i t e r i o n v a l i d i t y , c o r r e l a t i n g with subjects' state of health. The scales also correlate with other measures of locus of control, including the Multidimensional Locus of Control scales fo r P s y c h i a t r i c Patients" (p. 239) . In the Abbotsford study also, the " i n t e r n a l i t y " subscale correlated highly with the reported state of health (r = .401 p. <.ooi). According to the authors (Wallston & Wallston, 1981) i f the MHLC i s used as a dependent variable, the evidence for the v a l i d i t y of the measures appears greater, than when the construct i s used as a predictor of behavior. The hypotheses i n t h i s work do not pose the MHLC as either independent or dependent variable, but rather use i t s i n t e r n a l r e l i a b i l i t y to determine i f the two 34 types of treatments are d i f f e r e n t and as a scale to be correlated with others. Self-Esteem Scale The self-esteem scale consists of 10 f a i r l y unidimentional questions with a forced choice continuum between Strongly Agree to Strongly Disagree allowing f o r no neutral response. The brevity and administrative s i m p l i c i t y of t h i s instrument make i t an excellent t o o l f o r the el d e r l y person and t h i s scale i s continuing to be researched and developed f o r precisely t h i s type of application. Breytspraak and George (1982) i n t h e i r review of self-concept and self-esteem scales claim: "The Tennessee Self-Concept Scale and Rosenberg's scale probably represent the best of a l l the measures discussed because of the amount of work that has been done to e s t a b l i s h t h e i r v a l i d i t y and r e l i a b i l i t y , including t h e i r use on older populations (p. 249)." The Rosenberg scale has an alpha measure of internal consistency of .74 (Ward, 1977) and a t e s t - r e t e s t c o r r e l a t i o n of .85 within two weeks (Silber and Tibbett, 1965). In t h i s research Abbotsford project the Rosenberg scale was re-administered within half an hour, but from bottom to top, i n the second administration and had a Pearson's r of .834 p. <.000. 35 Correlations with Rosenberg's scale and other s i m i l a r types of measurement and c l i n i c a l ratings of depression range from .65 to .83 (Silber and Tippett, 1965; Rosenberg, 1965). This p a r t i c u l a r self-esteem scale was o r i g i n a l l y tested on adolescents and l a t e r used with adults and r e t i r e e s , quite successfully. However, d i f f e r e n t researchers have u t i l i z e d varying types of complex scoring ca l c u l a t i o n s which creates d i f f i c u l t i e s i n comparing r e s u l t s between researchers. There are suspicions that t h i s scale correlates with s o c i a l d e s i r a b i l i t y scales according to Breytspraak & George c i t e d i n Mangen and Peterson editors of Volume 1 Research Instruments i n  Social Gerontology: C l i n i c a l and S o c i a l Psychology (1982). There was some evidence of t h i s assessment i n the Abbotsford project, as the respondents' seemed to admit to less s o c i a l l y desirable c h a r a c t e r i s t i c s a f t e r they f e l t more at ease with the researcher when the scale was re-administered a f t e r a period of exchange. S a t i s f a c t i o n with L i f e Scale (SWLS) This scale was also developed f o r i t s brevity and easy administration. It consists only of f i v e key items, factor analyzed and extracted from 48 previous items. The SWLS measurement to o l has a convincing int e r n a l consistency with an alpha of .87. It has two month tes t - r e t e s t r e l i a b i l i t y with a c o r r e l a t i o n of .82 (Corcoran & Fischer, 1987). 36 The SWLS correlates i n the expected d i r e c t i o n with measures of self-esteem, a chec k l i s t of c l i n i c a l symptoms, neuroticism and emotionality. In the Abbotsford project the SWLS correlated highly with the self-esteem scale (r = .450 p. <.000). This instrument was developed on a sample of undergraduates but was used i n studies for adolescents, adults and elderly persons. The mean score was higher f o r the sample of elde r l y persons than f o r younger age groups (Corcoran & Fischer, 1987). In the Abbotsford study there was no change i n the SWLS over the age span of 60 to 75 years. Extracts from the Social P a r t i c i p a t i o n Scale This a c t i v i t y and community group p a r t i c i p a t i o n scale o r i g i n a l l y developed i n 1939, measures family involvement i n various types of associations; professional, c i v i c , r e l i g i o u s and s o c i a l . The instrument has the respondent name a l l of the a c t i v i t i e s and groups to which he/she belongs, including membership, attendance, contribution, committee membership and o f f i c e . These are then scored giving ascending weight to degrees of involvement. For the purpose of t h i s p a r t i c u l a r survey, the questions were aimed at the ind i v i d u a l and not the combined a c t i v i t i e s of the couple as i n the o r i g i n a l instrument. 37 Test-Retest r e l i a b i l i t y f o r one week was .89 and f o r several months was .88 (Mangen & Peterson, 1982). Quest ionnaires The two treatment questionnaires were designed to address the same topics (general health, exercise, n u t r i t i o n , safety, elder abuse, loneliness and prevention orientation) with the same number of questions. However the advice-giving questions ask what the seniors would advise or suggest should be done while the information-giving ask who the seniors would turn to f o r information about these topics. The advice-giving group was t o l d that t h e i r advice would be heeded by the Ministry of Health and the information group was t o l d that t h e i r information would be useful to determine what type of advertisement of programs was useful. The advice-giving questionnaire has the purpose of receiving suggestions about health and prevention issues while the second information-giving questionnaire i s designed to f i n d out where the seniors get t h e i r information or which resources in s t a n t l y come to mind. This data i s meant to a s s i s t i n planning f o r senior needs and information dispersal systems. The questionnaire on s o c i a l networks and demographics asks questions about frequency of contact with family and intimate friends, ethnic descent, state of health of s e l f and spouse, amount of time l i v e d i n the area, smoking habits, type of l i v i n g 38 accommodations and feel i n g s of comfort or usefulness with the survey. These questions were designed to shed extra l i g h t on the health attitude and p a r t i c i p a t i o n scales. Both questionnaires on advice gathering and information gathering were done on a lap-top computer so that the respondent could see h i s or her responses go d i r e c t l y on the screen and the respondent had at every moment, the opportunity to correct responses, add to them or delete them as the interview went along. This format complemented the format used f o r the other scales which were done with the respondent and researcher bent over the scale together. The researcher read a l l of the items and marked down the chosen response by the respondent. Thus a l l of the responses were seen by the respondent and complete openness was maintained throughout, about the content and responses, to ensure a sense of empowerment and p a r t i c i p a t i o n i n the respondent with the survey. Measurement of P a r t i c i p a t i o n Operationalization of the dependent variable of p a r t i c i p a t i o n i s described i n Chapter 2, under the heading of P a r t i c i p a t i o n i n the section of "De f i n i t i o n of Terms and Concepts". The actual instruments are included i n the appendices along with the other measurement instruments. 39 Sampling Procedures This p a r t i c u l a r project was designed to eventually service the needs of the e l d e r l y : (a) who are l i v i n g independently and not i n i n s t i t u t i o n s , (b) are between the ages of 60 to 75 (the young-old), thus are most l i k e l y to benefit from programs which promote independence and (c) who are not so wealthy or educated that they don't need the services of the Community center to a s s i s t with t h e i r finances. The wealthier population of seniors are not the seniors most seen to be i n need of enlightened programming, both because of t h e i r extra finances and t h e i r a b i l i t y to spend at least part of the year i n warmer climates away from consistent community involvement. Representativeness The f i l e s of Matsqui-Abbotsford Community Services are comprised of seniors i n the catchment area who are i n need of assistance with t h e i r finances at least once a year and t h i s community agency i s the primary and best known provider of such a service. Since t h i s service i s the only resource of i t s kind i n the v i c i n i t y the c l i e n t e l e represents a good cross-section of the seniors i n the area which the agency would l i k e to reach f o r healthy aging programming. These f i l e s however do not include a representative number of Indo-Canadians as t h i s p a r t i c u l a r population uses the services provided by the extended family or the s p e c i a l m u l t i - c u l t u r a l representative at the agency who keeps separate records. These 40 f i l e s also do not represent the i n s t i t u t i o n a l i z e d or wealthier seniors who have t h e i r finances taken care of by private accountants or public trustees. The f i n a l s e l e c t i o n did not include a representative sampling of the non-home-owning or renting e l d e r l y population, consisting primarily of transient males l i v i n g i n rooming houses or modest r u r a l dwellings with no telephone. Since the agency was a f a m i l i a r one f o r a l l of the part i c i p a n t s i n t h i s study t h i s f a m i l i a r i t y could elevate the rate of p a r t i c i p a t i o n of t h i s group compared to the rest of the population. The population sample used f o r the thesis was mainly representative of those whom most community services wish to reach i n t h i s age group, namely those who : (1) are independent i n the community, (2) are not so wealthy or sophisticated that they can handle t h e i r own income tax forms or h i r e someone else to do t h i s f o r them, (3) are not i n s t i t u t i o n a l i z e d or immobile consequently having t h e i r services provided on s i t e , (4) are not complete i s o l a t e s or transients, therefore possessing some capacity to reach out f o r assistance to an agency, even i f i t i s infrequently. This group i s representative of those who need, could and would use a community center. 41 Selection of the Participants The f i r s t s e l e c t i o n was made on the basis of: (1) the age of the c l i e n t , (between 60 and 75), (2) independent status (non-i n s t i t u t i o n a l i z e d ) , (3) the possession of a telephone number, (4) use of the agency within the l a s t three years. Judging by the response rate for the pretest of 20 persons i t was determined that about 360 persons would have to be selected i n order to assure a good response rate f o r the three groups. These 360 persons were assigned randomly to three groups. Each name was assigned a number which was put on paper. The numbers were mixed completely and randomly placed into three bowls. Subjects were selected randomly from these three groups. Approximately 32% refused, and about 35% could not be reached, because they were moved or simply not available. There was an acceptance rate of about 33%. Those who were selected at random from the control group were phoned by the agency, to e s t a b l i s h that they were indeed s t i l l residents at the same address and available, without being requested to be interviewed. Couples were assigned together to the d i f f e r e n t bowls under one number and those picked were alternated between husband and wife so that there was an equal balance of husband and wives being interviewed, rather than se t t i n g up a s i t u a t i o n where there might be an imbalance i n response between spouses (wives might be more comfortable i n responding since the researcher was a woman). 42 Steps of the Research Procedure A pre-test was undertaken where 60 randomly selected seniors were mailed a preliminary l e t t e r , explaining i n broad terms, the objectives of the project, who would be contacting them and pointing out t h e i r right to refuse to take part i n the research. Some of the l e t t e r s were returned, with either requests to not be included or because the address had changed. The remainder were telephoned and 20 accepted to be interviewed, lO having been randomly assigned to Group 1 and 10 to Group 2. These were interviewed and af t e r each interview the respondents were mailed an i n v i t a t i o n to pa r t i c i p a t e i n p a r t i c i p a t i o n option # 1. P a r t i c i p a t i o n # 1 was a l e t t e r which i n v i t e d the respondent to order a "Wellness Book" f o r free from the agency by either turning i n the bottom of the l e t t e r i n to the agency or mailing i t i n . A randomly selected member of Group 3 was mailed a p a r t i c i p a t i o n option #1 also, a f t e r being phoned at home to confirm residence and a v a i l a b i l i t y . After 2 weeks a second l e t t e r i n v i t e d them to mail i n a request to be on the mailing l i s t of an Advisory Group i n the area being formed f o r "Healthy Aging". After two weeks again, each was written an i n v i t a t i o n to actually attend a group meeting of the "Advisory Group fo r Healthy Aging", with a short explanation of i t s agenda. Few changes were made a f t e r the pre-test so the sample of 20 was added to the f i n a l number. These changes mainly comprised of additions, such as what type of dwelling the respondent l i v e d i n 43 and whether he or she smoked. If the modification was unclear the respondent was phoned f o r c l a r i f i c a t i o n . Analysis Design The scales were scored and keypunched into a Systat s t a t i s t i c a l analysis computer package data matrix with the variables plotted against the 80 cases of interviewed c l i e n t s . The variables consisted of the scores on the t e s t s and the various demographic and personal c h a r a c t e r i s t i c s transcribed into numbers. The f i r s t part of the analysis focussed on determining with the use of paired sample t - t e s t s i f there were s i g n i f i c a n t differences between scores on the tests before and a f t e r the d i f f e r e n t treatments. Independent t - t e s t s were used to determine i f there were differences i n the scores of the l i f e s a t i s f a c t i o n scales which were administered a f t e r the two treatments and i n the p a r t i c i p a t i o n scores. Key variables were correlated with others, using Pearson's' c o r r e l a t i o n c o e f f i c i e n t s to determine the extent of association between c r u c i a l concepts such as prevention orientation and p a r t i c i p a t i o n patterns or other c h a r a c t e r i s t i c s . The health-prevention advice and information-giving questionnaire responses were categorized and coded, quantified and p r i o r i z e d to determine what views the seniors most 44 consistently stated, which resources they quoted primarily, what concerns they expressed the most frequently and f i n a l l y with what other c h a r a c t e r i s t i c s these views and concerns were most often related. Implementation of Research Plan and Suggestions f o r Improvements During the pre-test i t was noted that some of the c l i e n t s were hesitant about being interviewed and had to be encouraged about the ease and safety of the process. Because of t h i s , i n the actual project many more introductory l e t t e r s were issued which gave the researcher more l a t i t u d e about r e f u s a l s and allowed f o r the constant reintroduction of the freedom f o r the respondent to refuse at various points i n the i n i t i a l telephone conversation. This meant that the respondents who did accept to be interviewed were more motivated and interested i n the topic and i n the pa r t i c i p a t o r y process than those who refused and those who possibly represent the average senior i n the general population. Unfortunately, because of e t h i c a l concerns, at present no obvious solution can be worked out to correct f o r t h i s bias f o r a future experiment. During the course of the pre-test i t became evident, by the types of responses which the seniors made i n t h e i r questionnaire on which resources they accessed, that the type of dwelling i n which they were l i v i n g affected almost a l l aspects of t h e i r l i v e s . Therefore the respondent's dwelling type was added to the demographic questionnaire. Smoking habits also seemed to affect 45 how the respondent viewed questions on health, thus a question about whether the respondent smoked was added. The self-esteem questionnaire was repeated before and aft e r the advice giving or information giving experience to determine i f the type of treatment affected self-esteem. The questions were given from the f i r s t to the l a s t , the f i r s t time and from the end to the beginning the second time, to prevent the respondent simply remembering what they had answered merely half an hour ago. Many of the respondents noted that the scale was f a m i l i a r and attempted to r e c a l l t h e i r answers, but were unable to because of the change i n sequence. An in t e r e s t i n g e f f e c t , however, materialized which affected the before and a f t e r r e s u l t s of the self-esteem questionnaire. While t a l k i n g about themselves and making disclosures about t h e i r health b e l i e f s and practices, sometimes the respondents f e l t increasingly comfortable, at ease and therefore more candid. During the second self-esteem questionnaire they would perhaps openly r e l i n q u i s h the s o c i a l l y desirable response and admit or acknowledge that they sometimes f e l t badly about themselves i n one way or another. It was d i f f i c u l t to e s t a b l i s h i f t h i s change i n response was triggered by the material i n the questionnaire or by the increased comfort with the s i t u a t i o n . There i s no l i t e r a t u r e that outlines what e f f e c t the re-administration of t h i s self-esteem (or any other self-esteem scale f o r that matter) i n such a short space of time, has on the scores. S t a t i s t i c a l l y , 4.6 there was no difference between the two groups i n the second self-esteem scale, and o v e r a l l there was a s l i g h t non-significant increase i n the scores. It was d i f f i c u l t to e s t a b l i s h however, just how contaminating s o c i a l d e s i r a b i l i t y , increased candidness and such an early r e p e t i t i o n of the measurement t o o l , had on the f i n a l r e s u l t s . It was frequently d i f f i c u l t to extract a signed consent from the respondents before the actual interview, as they were (not unreasonably) suspicious of having to sign a piece of paper which might commit them to some unknown consequence. After interviewing the f i r s t few c l i e n t s , I read the i n i t i a l part of the consent form and asked them to sign the paper only a f t e r the interview and only i f they f e l t absolutely comfortable doing so. A large number of them f e l t considerable apprehension about signing anything and a f t e r a time I requested i t only very l i g h t l y . Other than the changes introduced as mentioned above, the research plan was implemented without any impediments. The agency was very co-operative i n giving access to f i l e s , s e c r e t a r i a l assistance, copying and mailing services and provided encouragement and interest during the process. 47 CHAPTER 4: FREQUENCY DISTRIBUTIONS This chapter provides a b r i e f overview of the ch a r a c t e r i s t i c s of the two combined groups of studied respondents. Incorporated are demographic, p a r t i c i p a t i o n and health indicators, outlined to provide a context f o r better understanding of the findings. Some of the differences between men and women i n the three indicators are given consideration. Demographic Indicators In the general population i n Canada, within the age group of 60 to 75 there are about 80 men f o r every 100 women (Stone & Fletcher, 1986). This means that i n the general population i n t h i s age bracket, 44% of the population are men and 56% are women. In the Abbotsford pool of possible respondents 33% were men and 67% were women. Thus men were underrepresented by about 11% which can l i k e l y be explained by the tax service user pattern (referred to i n Chapter 3 when describing representativeness and sampling). The actual interview acceptance rate increased the difference i n representation between men and women further (men 29% and women 71%) so that men were actual underrepresented i n the study compared to the general population, by 15% due to a s l i g h t l y higher r e f u s a l rate. Fortuitously, the population available f o r study, i s precis e l y the target population about which the agency and the government need to acquire more information from, i n order to 48 provide greater relevant programming to promote independent l i v i n g and healthy aging. This i s underlined by the fact that women are increasingly becoming the survivors i n old age (Stone & Fletcher, 1986) and women enjoy less pension income, and spousal nursing care than t h e i r male counterparts. The mean age of the studied group was 68 years, and Table 5 outlines more demographic indica t o r s : gender, marital status, type of housing and ethnic o r i g i n . Table 5 Demographic Indicators f o r the 80 Respondents Demographic Indicators (ages 60—75) N (%) Men 23 29% Women 57 71% Widow/Widower 30 37% Married 38 48% Single or Divorced 12 15% Senior Complex Accommodation 36 45% Detached Housing Accommodation 44 55% B r i t i s h I s l e s Ethnic Descent 49 61% German/Dutch/other ethnic Descent 31 39% Most of the men were married (87% versus 32% of the women) and few of the men were actually single (13%, versus 68% of the women were s i n g l e ) . Almost a l l of the widowed were women. More of the married persons l i v e d i n detached housing (55%) rather 49 than i n a complex (39%). Therefore, men were more l i k e l y to be married, l i v e i n detached housing (65% to 51%) and were i n more frequent contact with t h e i r f a m i l i e s (65% to 58%), with a possible connection between increased family contact and l i v i n g i n the o r i g i n a l family dwelling. P a r t i c i p a t i o n Indicators P a r t i c i p a t i o n and s o c i a b i l i t y are key factors which influence the formulation and outcome of the hypotheses i n the project. Although on any one p a r t i c i p a t i o n indicator there were few massive differences between men and women, when several of the indicators were summated, men as a whole participated considerably less than women i n relationships outside of the home. Men had less frequent close contact with friends (37% le s s ) , went to church less by 26%, volunteered 23% less and participated less than women, i n formal organizations by about 15%. However, men reported having about 7% more contact with family than women did, perhaps because they tended to stay at home more, l i v e d i n t h e i r o r i g i n a l detached dwellings and were fa r less l i k e l y to be widowed. Stone and Fletcher (1986) also point out that there are strong indications of higher l e v e l s of s o c i a l i s o l a t i o n among older men. According to Stone and Fletcher's research, men tend to spend more of t h e i r l e i s u r e time alone, even i f they are married, but esp e c i a l l y i f they are single. 50 Table 6 Pa r t i c i p a t i o n Indicators f o r 8Q Respondents by Gender P a r t i c i p a t i o n Indicators (ages 60-75) N (%) M W Formal Organization P a r t i c i p a t i o n 59 73% 61% 76% Volunteer Work Community P a r t i c i p a t i o n 20 25% 9% 32% Church P a r t i c i p a t i o n 39 49% 30% 56% Close/frequent family contact 48 68% 65% 58% Frequent/close contact with friends 49 61% 35% 72% N = Number, % = % of Total 80, M = Men, W = Women Formal organization p a r t i c i p a t i o n , volunteer p a r t i c i p a t i o n , church p a r t i c i p a t i o n and frequent contact with friends were a l l s t a t i s t i c a l l y s i g n i f i c a n t l y d i f f e r e n t i n the genders, with women being more part i c i p a t o r y . There was also a cumulative percentage difference when a l l of the constructs i n Table 6 were added, of 94% difference between men and women f o r p a r t i c i p a t i o n i n di f f e r e n t contexts. Those who l i v e d i n senior complex housing did not d i f f e r d r a s t i c a l l y on indi v i d u a l indicators f or s o c i a l p a r t i c i p a t i o n , from persons who l i v e d i n detached housing. However, cumulatively, those who l i v e d i n detached housing tended to be somewhat less involved with others i n the community than those who l i v e d i n a senior complex. Persons l i v i n g i n detached housing participated about 17% less i n formal organizations, went to church about 17% less, volunteered about 20% less and had about 15% less frequent contact with friends. This i s i n spite of the fact that those who l i v e d i n a senior complex tended to be older and the older, according to McPherson and Kozlik. (1987) pa r t i c i p a t e somewhat less, generally i n formal groupings. P a r t i c i p a t i o n patterns i n the Abbotsford study, may have been affected by the actual larger numbers of married persons and men i n the sample who l i v e d i n detached housing. Both these groups tended to p a r t i c i p a t e less i n group a c t i v i t i e s . Health Indicators Some health indicators surveyed i n the project were: s e l f -reported l e v e l s of good health (ranging from poor through f a i r , good and excellent), smoking habits and i f a person was "prevention" oriented, that i s , conversant with ideas of health awareness and health management (see Table 7). If the respondents understood what the concepts of "prevention" and "wellness" were and had noticed or picked up the "Prevention" magazine exhibited on most of the large supermarket check-out counters, they were noted as prevention oriented. Table 7 Health Indicators f o r the 80 Respondents Health Indicators (ages 60-75) N (%) M W Health/Prevention oriented 20 25% 13% 30% Smoking 20 25% 39% 19% Poor to F a i r self --reported Health 29 36% 43% 33% Good to Excellent self-reported Health 51 64% 57% 67% N = Number, % = % of Total 80, M = Men, W = Women 52 Here again, some groupings such as gender, registered only small differences i n any one area, but these d i s t i n c t i o n s were cumulatively skewed i n one d i r e c t i o n upon d i f f e r e n t parameters, which then created a p r o f i l e of more widespread d i s s i m i l a r i t y . In t h i s project, women tended to be less l i k e l y to smoke than men by 20%, claimed better health, by 10% and were more prevention oriented by 17%. These differences are substantiated i n the national figures (Stone & Fletcher, 1986). Health indicators such as these, combined with higher s o c i a l p a r t i c i p a t i o n on several parameters by women present a p r o f i l e which demonstrate some possible p a r t i a l explanations f o r higher death rates of older men then older women. Summary Differences i n part i c i p a t o r y patterns seem to be connected to the single or married l i f e - s t y l e as well as to differences i n gender. Married persons, both male and female p a r t i c i p a t e less outside of the home, although single men tend to be more loners than single women. It becomes d i f f i c u l t to estimate causes i n various p a r t i c i p a t o r y patterns because of the weak effect of di f f e r e n t parameters, such as married status, type of dwelling, health and ethnic o r i g i n . Being a woman, German i n ethnic descent, l i v i n g i n a senior complex and single seem to increase pa r t i c i p a t o r y patterns and health awareness to a dif f e r e n t degree. 53 CHAPTER 5: HYPOTHESES RESULTS Project r e s u l t s were based on the seven hypotheses outlined i n Chapter 2, a f t e r scoring and s t a t i s t i c a l l y analyzing the Multi-Dimensional Health Locus of Control scales (wallston, Wallston & DeVellis, 1978), (MHLC), the Rosenberg Self-Esteem scales, (RSE) the S a t i s f a c t i o n with L i f e scales, (SWLS), (Diener et a l . , 1985) the P a r t i c i p a t i o n i n Organization scales (Chapin, 1955) and the three questionnaires asking demographic, health and p a r t i c i p a t i o n questions. Findings f o r Hypothesis 1 The o r i g i n a l hypothesis was that the 3 responses to the project i n v i t a t i o n s to p a r t i c i p a t e would be highest f o r Group 1, the "advice-giving" group. The next predicted highest r e s u l t s would be f o r Group 2, the "information-giving" group. The lowest response rate was predicted f o r the control group, Group 3, who had not been interviewed. Table 8 Expected P a r t i c i p a t i o n Rates Group 1 Group 2 Group 3 (Advice— (Information— (Control) Giving) Giving) Expected P a r t i c i p a t i o n Highest Middle Lowest A 0 = -lO ES = .20 N = 40 Power = .23 54 The numbers obtained were generally i n the expected d i r e c t i o n as outlined i n Table 9. Table 9 P a r t i c i p a t i o n Rates by Group i n Project Invitations Group Part.1 Part.2 Part.3 Group 1 (advice-giving) 41% 44% 69% Group 2 (information—giving) 37% 48% 31% Group 3 (control) 22% 8% 0% Total 100% 100% 100% Group 1 (N) = 4-0 Group 2 (N) = 40 Group 3 (N) = 40 The 2 main treatment groups, however did not demonstrate a large enough s t a t i s t i c a l l y s i g n i f i c a n t difference to f u l f i l l the predictions of the hypothesis, when t - t e s t s were applied, as demonstrated i n Table IO. The difference i n e f f e c t s i z e predicted was a small one, because of the small difference between the two variables advice-giving and information-giving, i n Arnstein's Ladder of P a r t i c i p a t i o n , referred to i n Chapter 2. According to Cohen's " S t a t i s t i c a l Power Analysis f o r the Behavioral Sciences" (1977), a small e f f e c t s i z e (d = .20) with 2 independent sample populations numbering 40 each and with an expected s o c i a l sciences s i g n i f i c a n c e l e v e l of .05, would y i e l d no better than 23% chance (given perfect instruments i n terms of r e l i a b i l i t y and v a l i d i t y ) of detecting a difference between the two groups. In 55 other words, given the numbers and ef f e c t s i z e , there was about an 80% chance that no difference would be detected. Group 1 Compared to Group 2 i n P a r t i c i p a t i o n Table lO Independent Samples t - t e s t on P a r t i c i p a t i o n Totals Grouped by  Group 1 (advice-giving) and Group 2 (information-giving) Group Mean Standard Deviation Group 1 (Advice) 1.150 1.626 Group 2 (Information) 1.125 1.265 Pooled variances t = .077 degrees of freedom = 78 pro b a b i l i t y = .939 A 2 = .10 ES = .20 N = 40 Power = .23 The treatment e f f e c t of having subjects give advice instead of giving information i s so weak as to create r e a l questions about any perceptible difference between the two populations i n terms of t h e i r future p a r t i c i p a t i o n i n the 3 d i f f e r e n t types of p a r t i c i p a t i o n measures. This lack of difference i n p a r t i c i p a t i o n between Group 1 and Group 2 can be at least p a r t i a l l y explained by the fact that there were, by chance, 13 prevention oriented persons i n the information-giving Group 2 while the advice-giving Group 1 only had 7 prevention oriented persons. Prevention orientation was found to be s i g n i f i c a n t l y r elated to p a r t i c i p a t i o n i n organizations and p a r t i c i p a t i o n i n organizations was 56 s i g n i f i c a n t l y related to p a r t i c i p a t i n g i n the project i n v i t a t i o n s a f t e r the interviews. Also, Group 1, due to chance, when compared to Group 2 on three health indicators, health awareness, smoking and s e l f -reported l e v e l s of health scored somewhat lower, a factor which may have influenced p a r t i c i p a t i o n to some degree. This difference i n p a r t i c i p a t i o n and health factors was hinged on the one s t a t i s t i c a l l y s i g n i f i c a n t (by chance) difference between Group 1 and Group 2. There were, by accident, quite a few more persons of German Mennonite culture i n Group 2 than i n Group 1 (9 versus 2). Being of the German Mennonite culture seemed to be connected to increased health awareness and s o c i a l p a r t i c i p a t i o n , factors which were linked to the hypothetical constructs i n t h i s project. Table 11 condenses the differences between Group 1 and Group 2 on several key health indicators. The diagram i l l u s t r a t e s some important differences between the groups, some of which may be explained by the c u l t u r a l factor. The German Mennonite factor was the only s t a t i s t i c a l l y s i g n i f i c a n t difference between the two groups, but i t may have played a v i t a l r o l e i n some of the responses, since the German group were also s i g n i f i c a n t l y more l i k e l y to be prevention oriented (r = .356 p. <.Q01) i n t h e i r attitudes and church attending (r = .298 p.<.007) i n t h e i r behaviors. 57 Group 1 Compared to Group 2 on 3 Health Indicators Table 11 Group 1 (advice-giving) and Group 2 (information-giving) on  Health Orientation, Smoking and Health Health Indicators Group 1 Group 2 Total N % N % N % Health awareness/prevention 7 18% 13 33% 20 25% Non "prevention oriented" 33 82% 27 67% 60 75% Smoking 13 32% 7 18% 20 25% Non—smoking 27 68% 33 82% 60 75% Poor to F a i r reported health 16 40% 13 33% 29 36% Good to Excellent rep. health 24 60% 27 67% 51 64% German Mennonite culture 2 5% 9 23% 11 14% Group 1 (N) = 40 Group 2 (N) = 40 The t o t a l p o s i t i v e health indices f o r Group 1 was 58 while the Group 2 score of 73 gave Group 2 a t o t a l p o s i t i v e score of 15 points higher than Group 1. This skew i n the randomly sampled population may have created a difference i n related constructs, thus a f f e c t i n g the comparison between the two groups on key studied parameters. Both treatments of asking f o r advice and information had however, more impact on p a r t i c i p a t i o n than no personal contact at a l l as demonstrated by the p a r t i c i p a t i o n of the control group. However, Group 3 did not have the same opportunity to refuse as Group 1 and 2 when i n i t i a l l y contacted, thus there i s a strong p o s s i b i l i t y that Group 3 had less motivated members. 58 Group 2 Compared to Group 3 i n P a r t i c i p a t i o n Table 12 Independent Samples t - t e s t on P a r t i c i p a t i o n Grouped by Group 2  (information-giving) and Group 3 (control) Group Mean Standard Deviation Group 2 (Information) 1.125 1.265 Group 3 (Control) 0.325 0.730 pooled variances t = 3.465 degrees of freedom = 78 pro b a b i l i t y = .001 A 2 = .10 ES = .20 N = 40 Power = .23 Group 1 compared to Group 3 i n p a r t i c i p a t i o n Table 13 outlines the difference between Group 1, the advice giving group and Group 3, the control group. Table 13 Independent Samples t - t e s t on P a r t i c i p a t i o n Grouped by Group 1  (advice—giving) and Group 3 (control) Group N Mean Standard Deviation Group 1 40 1.150 1.626 Group 3 40 0.325 O.730 pooled variances T = 2.928 degrees of freedom = 78 probab i 1 i t y .004 A 2 = .IO ES = .20 N = 40 Power = .23 There was less than a 23% chance that any difference could be detected between Group 1 and Group 3, as postulated by Cohen's power tables (1977). 59 Personal contact, attention or education may have been the contributing factors to the s i g n i f i c a n t difference between the personally interviewed groups and the non-interviewed group i n terms of p a r t i c i p a t i o n . Sampling procedures referred to i n Chapter 9 under Recommendations i n Research Design may also explain some of the differences i n p a r t i c i p a t i o n . Findings f o r Hypothesis 2 The predicted outcome of the second hypothesis was that the advice-giving Group 1 would score higher on the s e l f esteem scale a f t e r an advice-giving questionnaire than would the information-giving Group 2, to support the theory that giving advice i s more self-esteem boosting than giving information. Table 14 outlines the predicted d i r e c t i o n of the self-esteem scale r e s u l t s . Table 14 Predicted Outcomes of Averages of Self-Esteem Scale Group Before Treatment After Treatment Mean S h i f t Group 1 same as Group 2 +> than Group 2 S h i f t up Group 2 same as Group 1 Lower than Group 1 No s h i f t Group 1 = Advice-Giving Group 2 = Information-Giving A 2 - -lO ES = .20 N = 40 Power = .23 The e f f e c t s i z e again was predicted to be a small one and a difference could not be expected to be detected more than 23% of the time, comparing independent group scores, according to Cohen (1977), which leaves a very small margin f o r detecting differences. 60 Table 15 demonstrates that there was a small s h i f t upwards i n actual numbers i n self-esteem i n both groups of advice-giving and information-giving a f t e r treatment. Table 15 Actual Results of Averages of Self-Esteem Scale Group Before Treatment After Treatment Average S h i f t Group 1 18.425 18.550 0.125 Group 2 18.150 18.225 0.075 Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .IO ES = .20 N = 40 Power = .23 These differences i n Table 15 are i n the predicted d i r e c t i o n , but are they large enough to be s t a t i s t i c a l l y s i g n i f i c a n t ? Table 16 presents the r e s u l t s of paired samples t -tes t s f o r si g n i f i c a n c e . Table 16 Paired Samples t-t e s t f o r Self-Esteem Scale Before and After  Treatment f o r Group 1 and Group 2 Group Mean S h i f t S.D. t df Pr o b a b i l i t y Group 1 +0.125 2.857 .277 39 .783 Group 2 +0.075 2.105 .225 39 .823 Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .10 ES = .20 N - 40 Power = .17 6 1 Table 16 r e s u l t s suggest that giving advice does not l i k e l y promote self-esteem any more than does the opportunity to give information. To be noted, i s that according to Cohen's power tables (1977), there i s a less than 17% chance that a t- t e s t difference w i l l be found using paired samples of Group 1 and Group 2, given the e f f e c t s i z e sought and the number used i n the d i f f e r e n t groups (power of .17). Another q u a l i f i c a t i o n may be tendered; that giving advice might have a greater chance of providing the expected r e s u l t s i f the counsel given i s on a topic with which the respondent i s f a m i l i a r with. The main subject of the research/survey centered around health awareness and prevention. Only 25% of the respondents were discovered to be f a m i l i a r with the concepts of prevention and healthy aging. Giving advice about a subject with which one i s not f a m i l i a r may not be as l i k e l y to promote s e l f -esteem. To support t h i s notion, i f one analyzes the data presented by the small sample of respondents who were f a m i l i a r with the research topic, the predicted d i r e c t i o n of self-esteem i s closer to attainment. Table 17 extracts the sample of prevention oriented indi v i d u a l s i n both groups and analyzes t h e i r differences using paired samples t - t e s t . To be noted i s the upward s h i f t i n a p o s i t i v e d i r e c t i o n of the advice-giving Group 1 compared to the minimal s h i f t of Group 2 f o r t h i s prevention oriented group, who were more conversant with the topic. 6 2 Table 17 Paired Samples t - t e s t on Self-Esteem f o r Those who were Familiar with Concept of Prevention Group Mean S h i f t S.D. t df P r o b a b i l i t y Group 1 +1.143 1.215 +2.489 6 .047 Group 2 -0.077 1.891 -O.147 12 .889 Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .10 ES = .20 N = 7 & 13 Power = .10 The r e s u l t s i n Table 17 demonstrate that i t i s somewhat possible that giving advice upon a f a m i l i a r topic may r a i s e s e l f -esteem. However, the small number of respondents i n t h i s sub-sample render the r e s u l t s inconclusive, (using Cohen's power tables, there i s only about a 10% chance of detecting a difference i n such a small population) but the additional exploration helps define c r i t e r i a f o r sampling procedure, should further research be pursued i n t h i s area. Findings f o r Hypothesis 3 The predicted outcome fo r the t h i r d hypothesis was that the scores of the second half of the locus of control scale measuring i n t e r n a l i t y would be higher f o r Group 1 than Group 2. This hypothesis was based on the assumption that i f the respondent gave advice he/she would f e e l greater self-esteem and would consequently f e e l more powerful, more i n control and t h i s empowerment would- r e g i s t e r i n the subsequent locus of control scale. The predicted outcome i s outlined i n Table 18 and the actual r e s u l t s are presented i n Table 19. 63 Table 18 Predicted Outcomes of Averages f o r tlHLC Group Before Treatment After Treatment Mean S h i f t Group 1 Same as Group 2 > than Group 2 Upward s h i f t Group 2 Same as Group 1 < than Group 1 No S h i f t Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .lO ES = .20 N = 40 Power = .23 We can see from Table 19 that indeed the two means before the treatments were almost i d e n t i c a l , but that advice-giving seemed to create a s h i f t down i n locus of control instead of the predicted upward s h i f t . The information-giving Group 2's mean as predicted, remained f a i r l y unchanged. Table 19 Actual Averages f o r MHLC Before and After Treatment Group Before Treatment After Treatment Mean S h i f t Group 1 27.250 25.650 -1.60 Group 2 27.000 26.250 -0.75 Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .lO ES = .20 N = 40 Power = .23 Are the differences between Group I's two means, before and a f t e r treatment large enough to be s t a t i s t i c a l l y s i g n i f i c a n t ? Can we say that giving advice i n t h i s type of s i t u a t i o n would be "unempowering"? Table 20 outlines the paired samples t- t e s t s which address the differences. 64 Table 20 Paired Samples t—t e s t s on MHLC Before and After the Two Types of Treatment with Group 1 (Advice -Giving) and Group 2 (Information-Giving) Group Mean S h i f t S.D. t df P r o b a b i l i t y Group 1 -1. 60 4.945 -2.046 39 .047 Group 2 -O. 75 3.788 -0.750 39 .218 A 2 = -IO ES = . 20 1 M = 40 Power = .17 Table 20 demonstrates that there was a larger decline i n i n t e r n a l i t y i n Group 1 than i n Group 2 and t h i s decline was just large enough to be s t a t i s t i c a l l y s i g n i f i c a n t . This being o r i g i n a l l y a one-tailed prediction the r e s u l t s r a i s e serious doubts about the v i a b i l i t y of hypothesis 3. As i n the previous hypothesis with self-esteem, could these r e s u l t s be affected by the fact that those who were prevention oriented might have reacted d i f f e r e n t l y to the opportunity to give advice because they are more f a m i l i a r with the topic? The hypothesis was based on the assumption that giving advice would be empowering given that the topic would be a f a m i l i a r and comfortable one to the respondent, so as to create the desired e f f e c t i n increased self-esteem. Table 21 demonstrates the extraction and analysis of the small sample from each group that was f a m i l i a r with the topic of prevention and health awareness, to determine i f giving advice on a known topic might increase i n t e r n a l i t y . Again according to Cohen's tables (1977) given the small sample s i z e and the desired small e f f e c t one could not 65 expect to reach a difference i n the two groups more than about 10% of the time, given that the measurement tests were perfect. Table 21 Paired Samples t - t e s t s on MHLC Before and After the Two  Treatments i n Group 1 and Group 2 by Prevention Orientation Group Mean D i f f . S.D. t df P r o b a b i l i t y Group 1 -2.714 4.030 -1.782 6 .125 Group 2 0.672 2.720 .918 12 .377 Group 1 = Advice-Giving Group 2 = Information-Giving A 2 = .lO ES = .20 N = 7 & 13 Power = 10% Analysis of the r e s u l t s i n Table 21 determines that although the r e s u l t s are inconclusive because of small sample siz e , the numbers do point to the p o s s i b i l i t y that giving advice not only does not increase i n t e r n a l i t y , but rather s h i f t s i n t e r n a l i t y to exter n a l i t y , even f o r those who understand the topic, because the s h i f t moves i n the opposite d i r e c t i o n than predicted. Findings f o r Hypothesis 4 It was hypothesized that Group 1, the advice-giving group, should express greater l i f e s a t i s f a c t i o n than the information-giving Group 2 because those who have given counsel may f e e l more s a t i s f i e d with themselves and consequently experience and report more l i f e s a t i s f a c t i o n . The information-giving group on the other hand would experience less personal s a t i s f a c t i o n i n giving simply information and t h i s would be r e f l e c t e d i n t h e i r l i f e 6 6 s a t i s f a c t i o n scores, r e l a t i v e to Group 1. Table 22 outlines the d i r e c t i o n of the predicted hypothesis. Table 22 Predicted Outcome of Averages of "S a t i s f a c t i o n with L i f e Scale ISWLSl" Group Mean L i f e S a t i s f a c t i o n Group 1 (advice) Higher than Group 2 Group 2 (information) Lower than Group 1 A 2 = .IO ES = .20 N = 40 Power = .23 Table 23 presents the actual findings of the SWLS s t a t i s t i c a l analysis, where the r e s u l t s of the two groups' scores are compared. To be noted again, according to Cohen power analysis tables (1977) there i s no better than 23% chance that a small difference i n the expected d i r e c t i o n between the two groups w i l l be found, given the sample s i z e . Table 23 Results Comparing Averages of Group 1 (Advice-Giving) and Group 2  (Information-Giving) i n the " S a t i s f a c t i o n with L i f e Scale" a f t e r  two Treatments Group Mean Standard Deviation Group 1 (Advice) 26.125 6.244 Group 2 (Information) 25.975 7.259 Separate variances t = .099 df = 78 Probabi l i t y = .921 A 0 = .10 ES = .20 N = 40 Power = .23 67 In Table 23, although i n actual figures the difference bears out the d i r e c t i o n of the prediction, t - t e s t s demonstrate no s t a t i s t i c a l l y s i g n i f i c a n t d i s t i n c t i o n between Group 1 and Group 2 i n t h e i r l i f e s a t i s f a c t i o n scores. Table 24 attempts to f i n d a difference between Group 1 and Group 2, using the prevention oriented group. Table 24 Giving) and Group 2 (Information-Giving) on SWLS Group N Mean Standard Deviation Group 1 7 28.857 3.625 Group 2 13 27.231, 5.657 Separate variances t = .781 df = 17.2 P r o b a b i l i t y = .446 Pooled variances t = .684 df = 18 Probab i l i t y = .503 A 2 = .10 ES = .20 N = 7 & 13 Power = 10% In Table 24, i f one examines the prevention oriented persons i n Group 1 and Group 2, one notes that both means are somewhat higher than they were i n the larger group (Table 23) and the difference between the two groups, although not s t a t i s t i c a l l y d i f f e r e n t , i s greater and closer to the predicted d i r e c t i o n . The experience of l i f e s a t i s f a c t i o n i s only very weakly connected, i f at a l l , to the s t y l e of giving information or giving advice on a health topic. Therefore the hypothesis that giving advice may increase l i f e s a t i s f a c t i o n i s not borne out i n 68 the average scores, bearing i n mind that according to Cohen's tables there i s only a 10% chance of fi n d i n g a difference i n such a small group. Findings f o r Hypothesis 5 Because high i n t e r n a l i t y i s associated with f e e l i n g powerful i t i s hypothesized that there w i l l be a p o s i t i v e co-relationship between health i n t e r n a l i t y of locus of control and self-esteem as c i t e d by C i c i r e l l i (1987) when reviewing the l i t e r a t u r e who finds a p o s i t i v e correlationship between general (not health) in t e r n a l locus of control, l i f e s a t i s f a c t i o n and self-esteem. Results demonstrate only a weak and n o n - s t a t i s t i c a l l y s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p between health i n t e r n a l i t y of locus of control and self-esteem i n the 80 subjects (r = .200 with p r o b a b i l i t y of 0.075). No s i g n i f i c a n t c o r r e l a t i o n between self-esteem and health i n t e r n a l i t y materialized f o r those who were prevention oriented either. Again, the health i n t e r n a l i t y factor didn't move i n the predicted d i r e c t i o n . This suggests that the experience of r e s p o n s i b i l i t y f o r one's own health i s not a simple concept which automatically implies that one also f e e l s more power, or s e l f -respect because one thinks that health i s not primarily i n the hands of fate or experts. Health i n t e r n a l i t y as defined i n the 69 i n t e r n a l i t y subset by Wallston, Wallston and DeVellis, (1978) may not be c l o s e l y related to Rotter's general i n t e r n a l i t y of locus of control. C i c i r e l l i , (1987) points out that Rotter's scales are being further developed to better deal with i t s multi-dimensionality. Findings f o r Hypothesis 6 High self-esteem was predicted to correlate p o s i t i v e l y with high l i f e s a t i s f a c t i o n , because both are related to self-concept and are often correlated p o s i t i v e l y i n previous research (Hunter, Linn & Harris, 1982; George, L. K. 1975, c i t e d i n Mangen and Peterson, 1982). Their p o s i t i v e co-relationship would also serve to v alidate the measurement instruments i n t h i s study. Results of Pearson's product moment co r r e l a t i o n c o e f f i c i e n t f o r L i f e S a t i s f a c t i o n and Rosenberg's Self-Esteem Scale was p o s i t i v e at . 450 with a p r o b a b i l i t y of .ODO. As predicted, l i f e s a t i s f a c t i o n correlates p o s i t i v e l y with self-esteem which supports the l i t e r a t u r e , the v a l i d i t y of the two measures and the consistency of the respondents. Findings f o r Hypothesis 7 If those who have high i n t e r n a l i t y f e e l more i n charge of t h e i r own destinies, might they not also f e e l more confident and demonstrate t h i s confidence with increased loquacity? It was predicted that there i s a p o s i t i v e r e l a t i o n s h i p between 70 i n t e r n a l i t y , loquacity, self-esteem, l i f e s a t i s f a c t i o n and pa r t i c i p a t i o n i n organizations, positing that the common variable here would be greater self-confidence. Volume of speech or loquacity, was correlated, using Pearson's r, separately i n each of the two groups because the nature of the treatment e l i c i t e d d i f f e r e n t volumes from each group. Volume of speech i n Group 1 to: Self esteem before (advice) 0.318 prob. O.Q46 Self esteem a f t e r (advice) 0.164 prob. 0.311 Pa r t i c i p a t i o n i n organizations -0.107 prob. 0.513 Sa t i s f a c t i o n i n l i f e scale -0.091 prob. 0.578 Int e r n a l i t y of locus of control -0.062 prob. 0.702 The most notable r e l a t i o n s h i p here i s between loquacity and self-esteem as noted by the underlined relationship. In Group 1, apparently those who gave more advice had higher self-esteem before they gave advice than a f t e r . This could be possibly explained because Group 1 was n o t i f i e d on the telephone before they had the interview, that they would be asked for advice, whereas i n Group 2 they were t o l d they would be giving information. There was a tendency (not large enough to be s t a t i s t i c a l l y s i g n i f i c a n t ) f o r those who thought they would be giving advice to score a l i t t l e higher i n the self-esteem scale before that actual experience of giving advice. Since we already know that the subject matter was not one that most of the respondents were f a m i l i a r with, the experience of giving advice 71 may not have been as esteem enhancing as was probably expected by the respondents. Those respondents who spoke more (on a subject they were uncertain about), may have experienced a greater sense of disappointment i n t h e i r performance, hence the lower score on the self-esteem scale f o r the persons who spoke more, on the second self-esteem scale. An other explanation f o r t h i s may be that divulging more v u l n e r a b i l i t y on the self-esteem scale (demonstrating less s o c i a l l y desirable responses) may have corresponded to a greater openness on the part of the respondent. After d i s c l o s i n g a great deal of t h e i r ideas during the advice-giving period the respondents may have f e l t more comfortable d i s c l o s i n g aspects of themselves that they had previously portrayed i n a more po s i t i v e l i g h t than they had actually honestly f e l t . Volume of speech i n Group 2: P a r t i c i p a t i o n i n organizations Q.551 Prob. O.OOO Int e r n a l i t y of locus of control -0.015 Prob. 0.927 Sa t i s f a c t i o n of l i f e scale -0.015 Prob. 0.926 Self-esteem before (information) -0.006 Prob. 0.972 Self-esteem a f t e r (information) -0.066 Prob. 0.685 Only the variable of p a r t i c i p a t i o n i n organizations, correlates s i g n i f i c a n t l y with volume of output i n the information-giving group. 72 However, although r e s u l t s did not bear out much of a rel a t i o n s h i p between loquacity and other variables there was found to be a strong p o s i t i v e r e l a t i o n s h i p i n both groups between i n t e r n a l i t y and l i f e s a t i s f a c t i o n (r = .34-8 p. <.002), a predicted f i n d i n g . Summary A predicted high c o r r e l a t i o n , borne out by previous l i t e r a t u r e was found between l i f e s a t i s f a c t i o n and self-esteem which speaks f o r the v a l i d i t y of both measurements and strengthens previous research which found p o s i t i v e correlations between these two constructs. L i f e s a t i s f a c t i o n was also found to correlate highly with i n t e r n a l i t y (r = .348 p. <. 002) as postulated by the l i t e r a t u r e ( C i c i r e l l i , 1987). It was hypothesized that advice-giving would increase s e l f -esteem, i n t e r n a l i t y , l i f e s a t i s f a c t i o n and p a r t i c i p a t i o n . This study f a i l e d to demonstrate such rela t i o n s h i p s . It was also hypothesized that those who spoke more might also experience higher self-esteem and i n t e r n a l i t y , p a r t i c i p a t e more and experience greater l i f e s a t i s f a c t i o n . It was found that loquacity correlated weakly with self—esteem i n one group, strongly with formal group p a r t i c i p a t i o n i n the other and not at a l l with i n t e r n a l i t y or l i f e s a t i s f a c t i o n i n either group. 73 The difference between giving advice and giving information was not large enough, as represented i n the proximity of t h e i r placement on Arnstein's Ladder of P a r t i c i p a t i o n , to create a s t a t i s t i c a l l y s i g n i f i c a n t difference i n response on i n t e r n a l i t y , self-esteem, p a r t i c i p a t i o n or l i f e s a t i s f a c t i o n . Such a difference, however would have been d i f f i c u l t to f i n d given the small sample and e f f e c t s i z e . There was not more than a 23% chance at best of detecting such a small difference between such sizes of populations according to Cohen's power tables (1977). One of the two confounding factors which affected the r e s u l t s i n an unpredictable manner was the fact that only a quarter of the respondents were conversant with the material under study, the concept of preventive health measures as a pro-active stance. The other confounding factor was that the second information-giving group had by chance almost twice as many prevention oriented subjects i n i t than the advice-giving group and the prevention oriented persons as we w i l l see i n the next chapter had s p e c i f i c and t e l l i n g q u a l i t i e s which separated them from the rest of the group. 74 CHAPTER 6: GROUP 1 CHARACTERISTICS RELATED TO RECOMMENDATIONS The Community and Family Health d i v i s i o n of the Ministry of Health, the Matsqui-Abbotsford Community Services and Clearbrook Community Services and other community and governmental agencies, have demonstrated a strong interest i n boosting health oriented s e l f - h e l p e f f o r t s i n the community, for the reasons outlined i n the introductory segment of t h i s work. The following chapter contains the advice of seniors about the best approaches f o r government and community groups to a s s i s t the e l d e r l y i n t h e i r endeavors to remain healthy and independent i n the community as long as possible. The information i s provided i n the format of a condensation of rela t i o n s h i p s between variables and could be used to support program set-up e f f o r t s or program budgetary considerations. A synopsis of these findings w i l l be forwarded to the appropriate governmental department i n the Ministry of Health as was advised to the respondents at the beginning of t h e i r interview. Other interested groups such as the Golden-Agers, the l o c a l chapter of the Healthy Aging Council and the l o c a l public health unit w i l l be informed about the contents of these two following chapters. A l l of the rela t i o n s h i p s i n t h i s chapter were analyzed using Pearson's c o r r e l a t i o n c o e f f i c i e n t and the le v e l of pr o b a b i l i t y was found to be at least .05 i n each re l a t i o n s h i p mentioned. For greater ease of reading the text only includes the relationships 75 without t h e i r s i g n i f i c a n c e l e v e l s . P r o b a b i l i t y s t a t i s t i c s may be found i n Appendix XV. The correlationships i n each paragraph are noted i n descending order of sig n i f i c a n c e and the key variable being correlated, i s underlined f o r easier reference. Group 1 Char a c t e r i s t i c s This following section w i l l outline the relationships of the variables i n the study to cer t a i n key variables: gender, s e l f -reported state of health, prevention orientation, smoking behavior, health i n t e r n a l i t y , health externality, s o c i a b i l i t y with friends, p a r t i c i p a t i o n i n formal groups, l i v i n g accommodation, length of time residing i n the area, l i f e s a t i s f a c t i o n , self-esteem, being coupled or single during actual interview, age, volunteer behavior, church attending behaviors, f e e l i n g useful during survey, f e e l i n g comfortable during survey. In Group 1, women were more l i k e l y than men to be single and to suggest that more available subsidized transportation would ameliorate the concerns of healthy aging. Women f e l t more than men, that chance and luck had very l i t t l e to do with personal health. Women also tended to have more frequent contact with close friends. Those who reported better health were more apt to report f e e l i n g useful and comfortable during the interview. This group f e l t that they themselves were personally responsible f o r t h e i r health, rather than experts or luck. These self-reported 76 healthier i n d i v i d u a l s generally also scored higher on the l i f e s a t i s f a c t i o n scale. This healthier group was not as i n c l i n e d to suggest the need for medical a l e r t response systems as a way to deal with independent healthy aging as was the self-reported less healthy group. Those persons who were prevention oriented were more l i k e l y than non-prevention knowledgeable persons to advocate the r o l e of public health agencies as a necessary service f o r healthy aging. There were more church attenders i n the prevention oriented group than i n the non-prevention oriented group. Prevention oriented seniors believed that luck has l i t t l e to do with personal health and participated more i n formal organizations. This group reported more frequent contact with t h e i r family and were less l i a b l e to smoke. Those persons who smoked were less l i k e l y to have frequent contact with friends and family. Smokers tended to be more health external, that i s , they were more l i k e l y than non-smokers to believe that luck, chance or fate played a part i n t h e i r personal health. Smokers also participated less i n formal organizations, church a c t i v i t i e s and volunteer work i n the community. Smokers also tended to be less aware of prevention issues, and were less l i k e l y to advocate government safety inspections. They were also s l i g h t l y more apt to be coupled f o r the interview. 77 Persons who were more health i n t e r n a l , believing that health i s largely t h e i r own personal r e s p o n s i b i l i t y were much more l i k e l y to advocate the use of education of seniors as a strategy to deal with healthy aging. Higher in t e r n a l s reported better health and were i n more frequent contact with t h e i r f a milies. They reported greater l i f e s a t i s f a c t i o n and didn't seem to think as often as health externals that business and free enterprise had r e s p o n s i b i l i t y to a s s i s t with healthy aging issues. High inte r n a l s f e l t more comfortable with the interview. Health externals, i n terms of t h e i r b e l i e f that luck, chance or fate plays a considerable hand i n personal health, didn't have as much frequent contact with friends as health internals did. Health externals didn't p a r t i c i p a t e i n as many organizations, and generally f e l t that the services i n place f o r seniors are adequate and no additional services were required. As mentioned i n the previous paragraph, health externals were also more l i k e l y to smoke and to be male. Health externals i n terms of b e l i e f s that powerful others such as doctors and nurses are responsible f o r t h e i r personal health omitted the suggestion of walking programs as a strategy f o r prevention of i l l n e s s more than did health i n t e r n a l s . Persons who reported more frequent contact with friends as noted i n the previous paragraph were un l i k e l y to smoke. They believed that luck plays no part i n personal health. Persons who 78 had frequent contact with friends also reported more contact with family and were less l i k e l y to recommend the need for affordable quality housing as often as did those who had less frequent contact with friends. Those who had more frequent contact with friends also f e l t more comfortable with the survey. This group was more represented by women then men. P a r t i c i p a t i o n i n groups was a variable chosen because i t might shed l i g h t on previous habits with p a r t i c i p a t i o n which would illuminate i f " l e v e l of a c t i v i t y " was a deciding factor i n p a r t i c i p a t i o n i n the project. It was found that those who participated more i n formal organizations were also much more l i k e l y to go to church. This c o r r e l a t i o n a l was quite high and very understandable . as church groups and church a c t i v i t i e s increased the p a r t i c i p a t i o n score. High p a r t i c i p a t o r s didn't believe i n the influence of luck i n personal health. They were less l i k e l y to smoke and more i n c l i n e d to volunteer i n the community than low p a r t i c i p a t o r s . High p a r t i c i p a t o r s were generally not coupled during the interview. They tended to l i v e i n a senior complex rather than i n a detached dwelling and were more apt to be prevention oriented. If a senior l i v e d i n a dwelling (often attached), where the neighbours were i n d a i l y contact and assisted one another, these were considered to l i v e i n a senior complex. If they l i v e d i n detached housing and weren't i n frequent contact with t h e i r neighbours they were said to be i n l i v i n g i n detached dwellings. 79 Those who l i v e d i n a senior complex, tended to report considerably higher self-esteem and participated i n more formal organizations. Senior complex dwellers were more i n c l i n e d to suggest that indiv i d u a l s should not r e l y so much on agencies to take care of prevention issues. The Matsqui-Abbotsford area has been a s e t t l e d farming community f o r some time, but recently there has been a large influx of newcomers. Length of time residing i n the area was an included variable because i t could be a factor which might a f f e c t senior p a r t i c i p a t i o n i n the project. Respondents who have l i v e d i n the area longest tended to report more frequent contact with family. This i s presumably because those who have just moved i n have had to leave t h e i r f a m i l i e s elsewhere. Long time residence was related with higher reported l i f e s a t i s f a c t i o n and t h i s group was l i k e l y to o f f e r suggestions that more public health involvement would benefit the health of seniors. Persons who reported high l i f e s a t i s f a c t i o n also reported high self-esteem. High l i f e s a t i s f a c t i o n correlated strongly with f e e l i n g useful a f t e r doing the interview. Those who reported greater l i f e s a t i s f a c t i o n tended to have more frequent contact with t h e i r f a m i l i e s and were unl i k e l y to advocate greater governmental f i n a n c i a l assistance f o r seniors. High l i f e s a t i s f a c t i o n correlated p o s i t i v e l y with length of time the senior had l i v e d i n the area. These seniors were higher health internals i n terms of t h e i r d i s b e l i e f i n the influence of luck or 80 others i n personal health outcome, correlated p o s i t i v e l y with good health. High l i f e s a t i s f a c t i o n Those who scored higher i n self-esteem were more l i k e l y to l i v e i n a complex, f e e l more useful i n the interview and advocate less often the medical a l e r t response device as a prevention strategy. In the survey a husband or wife was randomly selected to be interviewed i n a household, but the non-chosen partner could elect to " s i t - i n " during the survey without p a r t i c i p a t i n g . Some married partners chose to do t h i s and others didn't. Relationships of variables were analyzed to determine i f there was a difference i n responses between those who were "coupled" during the interview and those who were alone, married or unmarried. It was found that the person who had his/her spouse present during the interview were much more l i k e l y to p e t i t i o n f o r higher pensions and monetary subsidies as an approach to deal with prevention issues. The interviewed senior with attending spouse was not as l i k e l y to p a r t i c i p a t e i n formal organizations as persons interviewed singly. Interview partnered persons were also less l i k e l y to go to church and more l i a b l e to be smokers. Older persons more often advocated the concept that the individuals, rather than agencies should take r e s p o n s i b i l i t y for health services. They were more prone to recommend that medical a l e r t response devices were needed f o r independent healthy aging. 81 The older group tended to f e e l that business and free enterprise should provide more services and subsidies f o r seniors. The older senior was less vocal i n general and didn't advocate as read i l y , increasing government services to f i e l d senior health needs. As f o r those who actually volunteered more often, they were more l i k e l y to advocate promoting the organization of se l f - h e l p health groups f o r seniors. Volunteers p a r t i c i p a t e d i n organizations more and were also more l i a b l e to uphold the idea of i n d i v i d u a l r e s p o n s i b i l i t y rather than agency r e s p o n s i b i l i t y f o r healthy aging issues. Volunteers also smoked less. Those who took part i n church a c t i v i t i e s also tended to pa r t i c i p a t e much more i n formal organizations and be prevention oriented. Church goers were unlikel y to smoke and were more probably alone during the interview. Those who declared f e e l i n g most useful i n the survey also f e l t more comfortable i n the survey, claimed better health and scored higher on the l i f e s a t i s f a c t i o n and s e l f esteem scales. They also reported more frequent contact with t h e i r f a m i l i e s . Those who experienced greater comfort i n the survey also f e l t more useful and were much less l i k e l y to assert that business should provide more subsidies to seniors to promote healthy aging concerns. Greater comfort with t h i s survey on 82 health issues was d i r e c t l y related to reported better health and the b e l i e f that health was the indi v i d u a l ' s r e s p o n s i b i l i t y . This group tended to report more frequent contact with family and were more l i k e l y to be i n the quadrant of very healthy individuals. Group 1 Recommendations and Correlated C h a r a c t e r i s t i c s : The following paragraphs are ranked i n descending order of frequency of suggestions made about a p a r t i c u l a r idea recommended as a solution to healthy aging problems or issues. The key recommended variable i s underlined and a l l of the relationships are s i g n i f i c a n t to .05 prob a b i l i t y , but mentioned i n descending order of power of si g n i f i c a n c e . The most often c i t e d suggestion was that more education was needed about prevention of i l l n e s s and the promotion of healthy aging f o r seniors. Those who gave t h i s type of suggestion tended to be the persons who spoke more, scored higher on i n t e r n a l i t y i n health locus of control, generally expressed more ideas o v e r a l l i n the interview and also suggested that quality affordable housing would contribute to the solution of health problems. The next most frequently touted suggestion offered by the seniors, when asked what they would advise i s needed to promote wellness, was the notion that seniors should j o i n together and organize s e l f - h e l p groups and organizations i n order to address issues of healthy aging. These same seniors were more l i k e l y to volunteer i n the community and to note that the in d i v i d u a l should 83 take more r e s p o n s i b i l i t y f o r health issues rather than r e l y i n g on agencies. Self-help promoters were also p a r t i a l to r e c r u i t i n g volunteers as a solution to the problems of independent healthy aging. The t h i r d most championed notion was that more government  services should be provided to f a c i l i t a t e independence fo r seniors i n t h e i r homes, with assistance from such services as provided by public health workers and homemakers. The respondents who counselled t h i s type of solution to senior health needs tended to be younger. They were not as l i k e l y to note that the government should s o l i c i t advice from the seniors when developing p o l i c y . This group were also more disposed to suggest that more homemakers should be recruited and additional government finances should be provided, (increased pensions and subsidies). Some of the suggestions centered around the idea that i t was the r e s p o n s i b i l i t y of the government to provide d i r e c t additional  funds f o r seniors i n provisions such as higher pensions and subsidies. Those who gave t h i s advice were more l i k e l y to suggest that business and free enterprise agencies also provide more subsidies and services f o r seniors. They were l i k e l y to be coupled with t h e i r spouse during the interview. They reported less l i f e s a t i s f a c t i o n and also advocated the need f o r additional government services f o r seniors. 84 Other oft promoted recommendations centered around the concept of i n d i v i d u a l r e s p o n s i b i l i t y f o r health care. This group tended to l i v e i n a senior complex, to be older and they were more apt to volunteer i n the community. They understandably were also more interested i n promoting s e l f - h e l p groups such as neighbourhood watches and walking programs. Affordable qu a l i t y housing was a frequently c i t e d solution to healthy aging issues. The seniors who espoused t h i s concept tended to have s i g n i f i c a n t l y more frequent contact with friends. This group were also proponents of the need f o r more education for seniors on prevention issues. They were i n c l i n e d to be more voluble and advocated the need to r e c r u i t more volunteers to a s s i s t with healthy aging concerns. Some of the recommendations focussed on the need f o r affordable subsidized transportation i n order to answer the questions surrounding prevention issues. Those seniors counselling t h i s type of solution were more l i k e l y to be women and were not l i k e l y to be i n the group that thought government services and funding were already s u f f i c i e n t and adequate to serve seniors' needs. Various responses recommended that the government should s o l i c i t seniors' opinions and advice when determining policy and services which would a f f e c t seniors' health. These seniors were not as apt to advocate as much government services as a solution 85 to health problems as those who didn't suggest that s o l i c i t i n g seniors* opinions from the government was necessary. Several of the responses suggested there was a need f o r more government safety inspections f o r f i r e safety, f a l l i n g hazards and security f o r seniors. Seniors who brought f o r t h these notions also tended to speak more i n the interview and were less l i k e l y to be smokers. About 4% of the suggestions focussed on making available an "Emergency Response Alert Device" attached to t h e i r bodies and connected to a medical center i n order to prevent long unattended periods of incapacitation. Those who volunteered t h i s notion tended to be older and less vocal. They were i n c l i n e d to f e e l that the services available f o r seniors were already adequate and s u f f i c i e n t and didn't need improvement. This group scored lower on the self-esteem questionnaire and reported f e e l i n g less healthy than those who didn't suggest the need f o r an emergency response a l e r t device. Persons who were more l i k e l y to suggest r e c r u i t i n g  volunteers (such as f r i e n d l y v i s i t o r s ) to deal with problems i n healthy aging tended to be German i n ethnic ancestry. They also advocated affordable quality housing f o r seniors and more s e l f -help groups to promote prevention of i l l n e s s . 86 Several responses were made around the need f o r more swimming and senior recreation f a c i l i t i e s . Other recommendations were that there should be more public  health nurses v i s i t i n g seniors i n t h e i r homes. Those giving t h i s advice were very l i k e l y to be more prevention knowledgeable and didn't believe that luck or chance had anything to do with personal health. They tended to have l i v e d longer i n the area. Some of the advice presented the notion that more homemakers would resolve problems around independent healthy aging. Those who suggested the need f o r more homemakers already tended to advocate more government services generally. Almost 2% of the suggestions centered around the idea that services f o r seniors were already e n t i r e l y adequate. These seniors tended to believe that luck, chance and fate had no influence on health (ideas of s e l f - s u f f i c i e n c y ) . This group were apt to be of other ethnic o r i g i n than English or German (Ukrainian, Dutch, Scandinavian etc.) They also were not l i k e l y to be i n the group that saw affordable subsidized transportation as a necessity f o r good health but they tended to advocate the need f o r emergency medical a l e r t devices attached to the body to enable quick help i n emergency si t u a t i o n s . Suggestions about promoting walking programs f o r seniors were presented by some seniors. Those who advocated more walking 87 as a solution to increasing senior wellness also tended to be more in t e r n a l as f a r as "powerful others" such as doctors and nurses. In other words, they f e l t that doctors and nurses and health experts didn't r e a l l y control t h e i r health as much as they themselves personally did. More of the group were i n the quadrant of self-reported very healthy seniors but t h i s group did not p a r t i c i p a t e i n formal organizations as much. The notion that business and free enterprise systems should give more subsidies and service assistance to seniors was one of the least frequently suggested responses to about solutions for prevention problems. These seniors who suggested that business should contribute more to seniors were more l i k e l y to also advocate the need fo r more government financing i n terms of subsidies and increased pensions i n general. Those who responded i n t h i s manner tended to be less comfortable with the interview and less i n t e r n a l (more external) about personal health r e s p o n s i b i l i t y . They also tended to be older. Summary In descending order of frequency of suggestion the following recommendations were made by the respondents to promote healthy and independent aging i n the community: (1) education on the topic of prevention, (2) s e l f - h e l p groups, (3) increased governmental services, (4) increased pensions, (5) individual r e s p o n s i b i l i t y and e f f o r t , (6) better quality affordable housing, (7) better subsidized transportation, (8) governmental e f f o r t to 88 seek seniors' advice, (9) more governmental safety and f i r e inspections, (IO) subsidized and available medical a l e r t response devices, (11) more community volunteers, (12) more seniors' f a c i l i t i e s , (13) more public health involvement, (14) more homemakers, (15) services are already s u f f i c i e n t and adequate, (16) walking programs for seniors, (17) more business subsidies and services. Conclusions It i s to be noted that the two most often suggested remedies fo r healthy aging concerns were not recommendations which required huge governmental outlay. In fa c t , of the 17 suggestions, 7 were not program c o s t l y (1) education, (2) s e l f -help, (5) ind i v i d u a l r e s p o n s i b i l i t y (11) more volunteers (12) services are already s u f f i c i e n t (16) walking programs (17) more business subsidies. However, several of the suggested solutions f o r prevention of i l l n e s s i n seniors did require additional funds: (3) additional government services, (4) additional government pensions and subsidies (6) affordable quality housing f o r seniors (7) subsidized transportation (12) more f a c i l i t i e s f o r seniors (13) more public health services (14) more homemaker services. 89 CHAPTER 7: GROUP 2 CHARACTERISTICS AND RESOURCE CITINGS Group 1 was asked what they would advise i s needed i n the community i n order to best deal with healthy aging issues such as general health concerns, exercise, n u t r i t i o n , safety and i s o l a t i o n . Group 2 was asked what resources they would u t i l i z e or with whom they would consult about these same areas of general health issues, exercise, n u t r i t i o n , safety and s o c i a l i s o l a t i o n . This resource-use information may be useful to a community center, to the l o c a l healthy aging association and other d i r e c t governmental agencies or to s e l f - h e l p groups promoting senior health i n i t i a t i v e s because i t gives indications about which resources are well-known, which ones are under-utilized and what characterizes the seniors who have or do not have program knowledge. The second group's responses were analyzed using Pearson's product moment co r r e l a t i o n (Pearson's r) formula. Following are the community resources which were c i t e d i n descending order of frequency. Along with t h i s c i t a t i o n are c o r r e l a t i o n s to other variables i n the survey: other resource c i t a t i o n s , health indicators, s o c i a l indicators and demographic c h a r a c t e r i s t i c s . The key variable i n each paragraph i s underlined f o r easier reference and the relationships are described i n descending order of s i g n i f i c a n c e . A l l of the re l a t i o n s h i p s mentioned are up to the p. <.05 l e v e l of s i g n i f i c a n c e . 90 Group 2 Cha r a c t e r i s t i c s This following section w i l l outline the relationships of the variables i n the study to selected key variables: gender, volunteer behavior, s o c i a b i l i t y with friends, membership i n formal organizations, type of dwelling, frequency of contact with family, status, l i f e s a t i s f a c t i o n , health i n t e r n a l i t y , prevention orientation, self-esteem, smoking behavior, age, length of time res i d i n g i n area and verbosity during the interview. In Group 2 women (age group of 60-75) tended to be single more often then men by a wide margin and to be unattended by a partner f o r the interview. They were more l i k e l y to go to church functions and pa r t i c i p a t e more frequently i n formal organizations. Women tended to be more verbal during the survey. They expressed more ideas and were more l i k e l y to be i n the quadrant of very high p a r t i c i p a t o r s i n formal organizations. Women referred more often to church and friends as a health resource. Women were also more prone to provide volunteer work i n the community and were more l i k e l y to be prevention oriented. Volunteer work correlated p o s i t i v e l y with p a r t i c i p a t i o n i n formal organizations, church attendance, verbal volume during the interview, having more ideas and being a woman. Volunteers c i t e d friends and homemakers as a resource f o r prevention of i l l n e s s . Volunteers i n Group 2 were more l i k e l y to be German i n ethnic o r i g i n . 91 Those who had more frequent contact with friends were more in c l i n e d to attend church functions and pa r t i c i p a t e i n formal organizations. Respondents who had more frequent contact with friends were l i k e l y to be more prevention oriented, c i t e the church as a resource and report f e e l i n g quite comfortable with the interview. They were not as l i k e l y to say "I don't know" to the questions on resources. More women were represented i n t h i s group and persons who reported frequent contact with friends scored higher on the self-esteem scales. This group was also more l i k e l y to be i n the quadrant of very high p a r t i c i p a t o r s i n formal organizations than those who didn't have as much frequent contact with friends. The seniors who were frequent part i c i p a t o r s i n formal organizations were more oriented to church functions and volunteering i n the community. They had more contact with friends and had more to say i n the interview, with more ideas. High p a r t i c i p a t o r s c i t e d church as a resource more frequently. They tended to be women and were more prevention oriented. High p a r t i c i p a t o r s were more l i k e l y to mention s e l f - h e l p groups. High p a r t i c i p a t o r s said "I don't know" less i n the interview and c i t e d extended medical benefits more often as a possible resource. They were more apt to consult with t h e i r friends on health issues, were less l i k e l y to smoke and more probably resided i n a housing complex. 9 2 Those seniors who l i v e d i n a network oriented housing complex were very apt to c i t e t h e i r housing management or neighbours as a health resource. They were quite unlike l y to be i n the quadrant of high frequency of contact with t h e i r family members. They pointed out more frequently that homemakers and the church were a resource. Senior complex dwellers tended to speak more and not to ref e r to r e l a t i v e s as a resource as often. They had less frequent contact with family. Seniors on the other hand who had more frequent contact with family members were less l i a b l e to c i t e housing management and housing complex "others" or friends as a resource. They spoke less i n the interview and didn't mention neighbours much either, as a source of information or assistance. These seniors were more l i k e l y to be coupled during the interview and more frequently l i v e d i n detached housing. Married persons didn't as often use housing management or friends as a resource. This i s congruent with the findings that i n the population, the r a t i o of married men to married women i s higher, thus when looking at large population c h a r a c t e r i s t i c s , proportionately, married persons were more l i k e l y to be male and l i v i n g i n detached housing. Seniors who chose to keep t h e i r partner as a witness during the interview spoke less. They were more l i k e l y to be men and didn't as often mention friends as a source of information and 93 assistance. More of them reported frequent contact with t h e i r f a m i l i e s and were less l i k e l y to p a r t i c i p a t e i n formal organizations or l i v e i n a senior complex. Those who reported high l i f e s a t i s f a c t i o n also scored high on the s e l f esteem scales. They were more l i k e l y to quote the hospital d i e t i c i a n as a resource and responded "I don't know" less often. They used the media, books, newspapers and magazines more f o r information sources. They also f e l t they were more personally responsible f o r t h e i r health (internal) , than did those who reported lower l i f e s a t i s f a c t i o n . High internals, those who personally took r e s p o n s i b i l i t y f o r t h e i r health were mostly younger and perceived themselves as healthier. They paid more attention to the media, books, magazines f o r information on prevention issues and were less l i k e l y to c i t e extended care benefits as a help f o r healthy aging. High int e r n a l s reported greater l i f e s a t i s f a c t i o n . Seniors who were health in t e r n a l s i n that they didn't believe that luck or chance plays a part i n personal health were more l i k e l y to believe that "powerful others" such as doctors and other health experts do not control health issues. These high internals were prevention oriented and scored higher on the s e l f -esteem scales. They were more l i k e l y to c i t e free enterprise resources such as health stores and aerobic classes, as prevention resources. High int e r n a l s reported being more 94 comfortable during the interview. They were more l i k e l y to be German and didn't c i t e doctors as a resource as frequently as externals did. They were more apt to mention Matsqui-Abbotsford Community Services, and public health workers as sources of information and assistance. Those seniors who were more health in t e r n a l i n terms of t h e i r b e l i e f that experts such as doctors and nurses didn't r e a l l y control t h e i r health, also didn't believe that chance, luck and fate influenced t h e i r health either. They had higher self-esteem but didn't c i t e friends as a resource as often as externals did. They did quote public health more often as a source of assistance i n prevention matters. They were however less l i k e l y to r e l y on government publications although they referred to the Matsqui-Abbotsford Community Services more often than externals did. Those seniors who were more prevention oriented and knowledgeable reported more frequent contact with friends, use and r e f e r r a l to free enterprise health and l e i s u r e businesses. They responded "I don't know" less often, p a rticipated more i n formal organizations and tended to believe that luck and chance had l i t t l e to do with health. Prevention oriented persons were more l i k e l y to go to church, be German i n ethnic o r i g i n and didn't mention t h e i r doctor as often as a source of information and assistance. Prevention oriented persons tended to l i v e i n a 95 housing complex, r e f e r to s o c i a l workers, counsellors, paid-coordinators, community workers and c i t y h a l l as a resource. The seniors who scored higher on the self-esteem scales tended to report higher l i f e s a t i s f a c t i o n and believe experts such as doctors or luck don't control personal health much. They noted higher l e v e l s of comfort with the interview, also reported more frequent contact with friends and attended church functions more. Smokers tended to be younger, non-church goers and non-joiners i n that they didn't belong to as many formal organizations as non-smokers. Older persons are more external i n terms of f e e l i n g that they don't have personal r e s p o n s i b i l i t y and control of t h e i r health. There were very few super high internals i n t h i s group. Older persons were less l i k e l y to smoke, be married and not l i k e l y to report f e e l i n g that they have excellent health. Older persons were more prone to c i t i n g a homemaker as a resource f o r healthy independent aging. They were less l i k e l y to r e f e r to government workers as possible avenues fo r assistance i n health matters (such as s o c i a l workers and counsellors) and they were more l i k e l y to go to church. 96 Those seniors who have l i v e d the longest i n the area also tended to ref e r to friends as an independent healthy aging resource. Part of the interview was typed on a lap top computer, verbatim. Therefore the actual number of words was recorded. Those persons who were more verbal, expressing themselves more voluminously also were more l i k e l y to have more ideas and ref e r to the church and t h e i r housing complex as a resource more often. They were apt to p a r t i c i p a t e i n formal organizations. They were also more prone to c i t e friends and government education material as a resource. They tended to be of other ethnic o r i g i n than English (English persons spoke somewhat l e s s ) . Talkers were more l i k e l y to use books, magazines and the media as sources of information and volunteered i n the community more. Talkers were more l i k e l y to l i v e i n a complex and didn't have a partner as a witness to the interview as often. They didn't report as frequent contact with f a m i l i e s and were more l i k e l y to be German in ethnic o r i g i n . They were also more apt to be women and church attenders. Group 2 Resource Cit i n g s and Cha r a c t e r i s t i c s The following paragraphs are arranged i n descending order of resource c i t i n g frequency. In other words, those resources most frequently referred to come f i r s t . The resources are underlined and related c h a r a c t e r i s t i c s are noted also i n descending order of 97 s t a t i s t i c a l s i g n i f i c a n c e . A l l of the relationships are s i g n i f i c a n t up to the p. <.05 l e v e l . The most often quoted resource was the individual him/herself i n d i c a t i n g s e l f - s u f f i c i e n c y as an approach to dealing with prevention issues. Those who were most l i k e l y to choose t h i s type of response were i n c l i n e d to report better health and they were somewhat less apt to c i t e the doctor as a resource i n prevention concerns. Although t h i s category was c i t e d the most often, only a few individ u a l s were responsible f o r t h i s frequency of response. The doctor was quoted almost as often as the s e l f on questions about prevention resources ( n u t r i t i o n , exercise, loneliness, general health e t c . ) . Prevention oriented persons didn't quote the doctor as a resource as much as non-prevention oriented persons did. Those who were most l i k e l y to quote the doctor as a source of information and assistance tended to believe that luck, chance and fate governed t h e i r health. Relatives, e s p e c i a l l y nurses were noted as the t h i r d most frequently c i t e d resource. Persons who were i n c l i n e d to use r e l a t i v e s as a resource tended to l i v e i n detached housing. This f i t s i n with other r e s u l t s that demonstrated that those l i v i n g i n detached housing tended to be i n closer contact with t h e i r f a m i l i e s and as yet unwidowed. 98 The respondents were given ample permission to say "I don't know" as they were t o l d that i t gave the agency information about what resources were well advertised and which weren't. Those ind i v i d u a l s who frequently said "I don't know" to questions about who they would contact or where they would go i f they sought information on health matters tended not to be so prevention oriented and attended church functions less. They did not have as frequent contact with close friends and scored lower on the l i f e s a t i s f a c t i o n scale. They were more un l i k e l y to p a r t i c i p a t e i n formal organizations. Matsqui-Abbotsford Community Services and services such as Meals on Wheels ranked 4th i n the resources referred to. Those who most frequently quoted t h i s resource tended to be health i n t e r n a l i n that they didn't believe doctors or nurses, luck, chance or fate had anything to do with personal health. They also tended to report better health. No one ethnic grouping quoted community services more than an other and there were no differences between those who mentioned t h i s service and those who didn't, i n the variables of age, gender or other c h a r a c t e r i s t i c s . The f i f t h most frequently quoted resource was the housing  complex members, neighbours and management. The seniors who were more l i k e l y to c i t e t h i s resource tended to l i v e i n a senior complex and speak more during the interviews. They were not l i k e l y to be i n as frequent contact with t h e i r f a m i l i e s and were 99 not as l i k e l y to be married. These findings support those of the previous paragraph which point out that those who tend to l i v e i n complexes r e l y more on t h e i r housing resource to replace the role of t h e i r family. The next most noted information/assistance source were friends. Who are the seniors most l i k e l y to quote friends as an o f t used health resource? Seniors who r e l i e d on friends as a prevention resource tended to speak much more, (quite a wide margin over those who didn't c i t e f r i e n d s ) . They were quite l i k e l y to claim t h e i r church as a resource and not have as much frequent contact with t h e i r f a m i l i e s . They were more apt to be other than English i n ethnic descent. Persons who c i t e d friends as a healthy aging resource were also i n c l i n e d to believe that doctors and nurses had quite a b i t of control over t h e i r health. They had l i v e d i n the area longer and r e l i e d on government publications. They were more probably single, widowed or divorced and very few were i n the quadrant of reporting extreme close contact with family members. This group participated i n formal organizations more often and were more l i a b l e to c i t e neighbours as a resource as well as the media, books and T.V.. They were a b i t more l i k e l y to volunteer i n the community. Self-help groups such as walking programs and neighbourhood watches were the next most frequently c i t e d resource. Seniors who referred to s e l f - h e l p groups as a resource also tended to c i t e government information booklets as a resource quite often. 100 These respondents participated i n formal organizations to a higher degree and c i t e d the hospital d i e t i c i a n i n questions of n u t r i t i o n . Seniors who recommended se l f - h e l p groups were more l i k e l y to ref e r to government services and workers as a reference and resource. The 8th most c i t e d resource were the non governmental ly run, free enterprise businesses such as aerobic centers, toning parlours, health food stores, bowling a l l e y s etc. Seniors who c i t e d t h i s type of resource tended to be prevention oriented, had more ideas, spoke more and c i t e d free enterprise information outlets, such as the media, books, ads and magazines. They tended not to believe i n the r o l e of fate, chance and luck i n terms of personal health. Government workers, such as s o c i a l workers, counsellors, paid coordinators, c i t y h a l l personnel, etc. were the next most quoted source of information and assistance. Those who c i t e d t h i s type of resource, tended to be prevention oriented. They often mentioned s e l f - h e l p groups such as neighbourhood and walking programs as an assistance for healthy aging. Government workers were not c i t e d as often by other ethnic groups than German and English. Public health nurses and workers were quoted as a resource by seniors who were much more l i k e l y to be i n the quadrant of those who scored very high on the self-esteem scale. These 101 respondents also tended to believe that powerful others such as doctors or experts have l i t t l e to do with control of personal health. Seniors who referred to public health also tended to believe that luck, chance and fate have l i t t l e to do with personal health. Homemakers were suggested as a resource by those seniors who were more l i k e l y to l i v e i n a complex, were older and s l i g h t l y more l i k e l y to be volunteers. Church and church based groups were the next most quoted resource. Seniors who referred to t h i s source of assistance and information were more verbal by a large margin. They were much more l i k e l y to go to church and express more ideas. This group was more i n c l i n e d to l i s t f riends as a resource. They participated more i n formal organizations and had more frequent contact with friends. These respondents also tended to be German i n ethnic o r i g i n and female. Media, books, newspaper and magazines were presented as a resource f o r some of the responses on source of prevention information. The seniors who noted t h i s type of resource tended to be more verbal. They c i t e d free enterprises such as gyms and health spas as resources more often, were more health i n t e r n a l i n that they f e l t more responsible f o r t h e i r personal health. They were i n c l i n e d to quote t h e i r neighbours as a resource i n healthy aging. 102 Medical extended benefits, such as chiropractor, physiotherapist, masseuse, pharmacist etc. were the next most often quoted resource f o r prevention questions. These seniors tended to be more health external i n that they f e l t less personal r e s p o n s i b i l i t y f o r t h e i r health. They participated more in formal organizations and tended to report poorer health. On questions about resources f o r n u t r i t i o n the hospital d i e t i c i a n came up more frequently than expected. Those who c i t e d the hospital d i e t i c i a n also reported higher l i f e s a t i s f a c t i o n , and more often stated that s e l f - h e l p groups were a potential solution f o r prevention concerns. A few of the responses indicated that neighbours were used as a resource f o r information and assistance. These seniors seemed to be of other ethnic o r i g i n s than German and English (rather they were Ukrainian, Dutch, Polish, French, Scandinavian, I t a l i a n ) . This group more often quoted government informative sources and garnered information from the media, books and magazines. They were not i n frequent contact with t h e i r f a m i l i e s which may also explain why they r e l i e d on neighbours and other sources of information such as the media, T.V. newspapers and t h e i r friends. This group didn't include as many English persons. 103 Summary The most often c i t e d resources quoted by the respondents i n Group 2 as aids i n solutions f o r independent healthy aging problems, i n descending order of frequency of c i t a t i o n were: (1) the i n d i v i d u a l him/herself, (2) the doctor, (3) r e l a t i v e s , e s p e c i a l l y nurses, (4) didn't know what resources they would access i n r e l a t i o n to the questions (5) Matsqui-Abbotsford Community Services (Christina Ragneborg, senior coordinator) or one of i t s programs such as Meals-on wheels, (6) housing complex management or neighbours i n the housing unit, (7) friends, (8) s e l f - h e l p groups (9) free enterprise businesses such as health-food stores or gyms etc., (10) government workers, such as social-workers, counsellors or paid coordinators i n government centers, (11) government publications, such as pamphlets, (12) homemakers, (13) t h e i r church, (14) the media, T.V., books, newspapers etc., (15) medical extended care benefits such as chiropractors, masseuses, pharmacists, physiotherapists etc., (16) the hospital d i e t i c i a n , (17) neighbours. In terms of c h a r a c t e r i s t i c s , Group 2 only d i f f e r e d s i g n i f i c a n t l y from Group 1, by chance, with i t s increased number of persons who were German i n ethnic o r i g i n . However, being German did correlate with c e r t a i n c u l t u r a l c h a r a c t e r i s t i c s connected with more l i k e l i h o o d of prevention orientation and greater church attendance. 104 CHAPTER 8: KEY VARIABLE RELATIONSHIPS IN BOTH GROUPS The previous two chapters presented data on the relati o n s h i p s between key concepts and other variables within the context of each separate interviewed group. This chapter on the other hand combines c e r t a i n noteworthy variables common to both groups. The r e s u l t s are more powerful because i n t h i s process the questionnaire and scale outcomes are pooled f o r the whole complement of the 80 interviewed respondents. U t i l i z i n g the r e s u l t s from the whole group, t h i s section w i l l examine the findings i n t h i s study i n re l a t i o n s h i p to the various premises introduced i n the l i t e r a t u r e review on the variables connected to the constructs of p a r t i c i p a t i o n , s e l f -reported health and i n t e r n a l i t y . P a r t i c i p a t i o n Correlates The following section examines the s o c i a b i l i t y variables of pa r t i c i p a t i o n i n organizations and frequent contact with friends, i n context of t h e i r r e l a t i o n s h i p to other variables i n the study and findings are compared to the l i t e r a t u r e . McPherson and Kozlik, (1987) discovered i n reviewing the l i t e r a t u r e that there was a decline i n s o c i a l involvement as people aged. This p a r t i c u l a r study i n Abbotsford only looks at pa r t i c i p a t i o n of seniors between the ages of 60 to 75 (considered to be the "young-old") and finds' that there i s no s t a t i s t i c a l 105 r e l a t i o n s h i p between aging and less p a r t i c i p a t i o n i n formal organizations, within the studied age span. Interestingly enough, however, there does seem to be a s l i g h t n o n - s t a t i s t i c a l l y s i g n i f i c a n t decline i n frequency of contact with the family coupled with a s t a t i s t i c a l l y s i g n i f i c a n t r i s e i n frequency of contact with friends as the seniors increase i n age between 60 and 75 (r = .231 p. <.039). This may be explained by the p o s s i b i l i t y that with increasing age, a senior w i l l l i k e l y lose his/her spouse and w i l l consequently begin to r e l y more on friends for s o c i a l supports than on family. Therefore we can conclude that within t h i s age group there does not seem to be a change i n formal group behavior. However i n the informal realm, there i s an increase i n contact with friends with age. McPherson and Kozlik, (1987) ( c i t i n g a study by Hoffman, 1985), note that health can af f e c t p a r t i c i p a t i o n i n a c t i v i t i e s i n the ages between 62 and 74. On page 9, Chapter 1 a study c i t e d by Blunt (1982) demonstrates a negative r e l a t i o n s h i p of formal organization p a r t i c i p a t i o n and health. Health, however, i s i n t h i s p a r t i c u l a r Abbotsford study not s t a t i s t i c a l l y r elated to the variable of p a r t i c i p a t i o n i n organizations, possibly because of the fact that the Abbotsford sample did not include i n s t i t u t i o n a l i z e d , non—ambulatory seniors. Table 25 outlines the relationships with p a r t i c i p a t i o n i n organizations and other factors. 106 Table 25 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between P a r t i c i p a t i o n i n Organizations and Other Variables Those who participated more i n formal organizations also tended to: Pearson's r Probability attend church more. .711 .000 volunteer more i n the community. . 503 .ooo be more prevention oriented. .415 .000 have more contact with friends. .378 -OOl be l e s s l i k e l y to smoke. -0 .361 .001 l i v e i n a senior complex. .350 .001 not be coupled during interview. -0 .316 .004 pa r t i c i p a t e i n survey follow-up. .265 .018 be women .262 .019 report f e e l i n g useful i n survey .249 .026 To be noted i n Table 25 are the c l u s t e r i n g of two key concepts; s o c i a b i l i t y and health attitudes/habits. It seems that those who are more involved i n t h e i r community are also more involved i n t h e i r health, not only with pro-active attitudes (prevention orientation) but also with healthier habits (non-smoking) . The findings i n t h i s study do not indicate a connection between l i f e s a t i s f a c t i o n , self-esteem and p a r t i c i p a t i o n i n organizations as noted by Cutler (1987). L i f e s a t i s f a c t i o n seems to be, (see Table 30), much more related to personal health. 107 Another form of s o c i a b i l i t y i s church a c t i v i t y and membership (see Table 26). Table 26 A c t i v i t i e s and Other Variables Those who attended church more also tended to: Pearson's r Probabili t y p a r t i c i p a t e more i n formal org. .711 .OOO have more contact with friends .447 .000 be more prevention oriented .435 .000 volunteer more i n community .391 . OOO be less l i k e l y to smoke -0.364 .001 be German i n ethnic o r i g i n .298 . 007 not be of B r i t i s h I sles o r i g i n -0.286 .010 not be coupled i n interview -0.269 .016 l i v e i n a senior complex .261 .019 be a woman .252 .024 have higher self—esteem .243 . 030 be older . 228 .042 Though in d i v i d u a l s may believe that luck, chance or fate do not control t h e i r physical well-being, t h i s does not necessarily mean that they assume personal r e s p o n s i b i l i t y f o r t h e i r own health. We can see i n Table 26 that church going a c t i v i t i e s do not correlate with i n t e r n a l i t y i n terms of personal f e e l i n g s of r e s p o n s i b i l i t y f o r health. This might be explained by the 108 f i n d i n g that several church attending respondents staunchly maintained that God determined the state of t h e i r health. P a r t i c i p a t i o n i n church a c t i v i t i e s has been associated with "higher l e v e l s of psychological well-being" (Cutler, 1987, p. 298). Indeed those who engage i n more church a c t i v i t i e s may experience increased well-being, but i n the Abbotsford study, t h i s well-being translates more into other forms of s o c i a b i l i t y and p o s i t i v e health habits and attitudes. However (as with p a r t i c i p a t i o n i n formal organizations i n general), we note that s o c i a b i l i t y , (as i n attending church a c t i v i t i e s ) and p o s i t i v e health habits and attitudes are not associated with increased l i f e s a t i s f a c t i o n , or actual reported better health (see Table 25 & 26). A l l three c l u s t e r s ( p a r t i c i p a t i o n i n formal organizations, church going a c t i v i t i e s , frequent contact with friends) describe s o c i a b i l i t y patterns outside of the home and family and i l l u s t r a t e a strong connection to health attitudes, habits and s o c i a l p a r t i c i p a t i o n . Whereas Table 25, and 26 describe relationships to s o c i a l p a r t i c i p a t i o n , Table 27 demonstrates relationships to frequent contact with friends. We note the absence of association i n t h i s c l u s t e r to increased l i f e s a t i s f a c t i o n , self-reported better health and i n t e r n a l i t y , with the exception that church attendance i s correlated to an increase i n self-esteem. There i s no 109 r e l a t i o n s h i p to increased contact with friends and l i v i n g i n a complex, but friends are more r e l i e d on with progressive age. Table 27 Contact with Friends and Other Variables Persons who reported more contact with friends tended to: Pearson's r Probab i l i t y attend church more. .447 .000 p a r t i c i p a t e i n groups more. .378 .001 report more comfort i n survey. .370 .001 smoke less. -0.340 .002 be more prevention oriented. . 335 .002 be women. . 324 -003 have more contact with family. .321 .004 not believe luck controls health. -0.280 .012 be older. .231 .039 report f e e l i n g useful i n survey .229 .041 In Chapter 1 Bennett (1980) postulates that i s o l a t i o n creates problems which can a f f e c t the e l d e r l y person negatively, both mentally and physically. There seems to be no substantiation of t h i s claim i n the Abbotsford study, because those who claim higher l i f e s a t i s f a c t i o n do not also claim to be very involved i n t h e i r community. Smoking behavior, however, which has been incontrovertible determined to be detrimental to health i s related negatively to s o c i a b i l i t y as we can see i n 110 Table 28. Smokers do not seem to associate greatly with others outside of the home and they tend to be younger. Table 28 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Smoking and Other  Variables Those who smoked were i e s s l i k e l y to: Pearson's r Probabil i t y attend church -0.364 .001 pa r t i c i p a t e i n formal org. -0.361 .001 have frequent contact with friends -0.340 .002 be prevention oriented -0.267 .017 be older -0.264 .018 have frequent contact with family -0.251 .025 It i s evident when Table 28 a c t i v i t y connected with persons i s examined who are that smoking i s an s o c i a l l y isolated. Either t h i s i s because smokers are s o c i a l i s o l a t e s to begin with and they have not had the opportunity to have been influenced by others to stop smoking or because smokers f e e l unwelcome i n the company of others. Of course, both may apply, as the smoker may have f e l t uncomfortable i n the company of others o r i g i n a l l y and thus has never found any reason to stop smoking, as the habit offended no one. Interestingly enough, smokers did not report poorer health, poorer self-esteem or more health externality. However, there are less smokers i n the older age group. I l l Neither church p a r t i c i p a t i o n , p a r t i c i p a t i o n i n organizations and frequency of contact with friends i s s t a t i s t i c a l l y related to l i f e s a t i s f a c t i o n or reported better health, what c h a r a c t e r i s t i c s r e l a t e to better health? Table 29 includes the s t a t i s t i c a l l y s i g n i f i c a n t r elationships to reported better health. Health Correlates According to Table 29, l i f e s a t i s f a c t i o n , f e e l i n g s of usefulness, experienced comfort i n the survey and i n t e r n a l i t y are a l l r e lated to reported better health. Note again that s o c i a b i l i t y does not figure into the r e l a t i o n s h i p with health and l i f e s a t i s f a c t i o n . Women are not reporting s i g n i f i c a n t l y better health than men, (although they l i v e longer) nor young people superior health to the old. Married persons are not reporting better health, nor are persons l i v i n g i n a complex. There are no ethnic differences either i n self-reported health. We note also that i n Table 29, self-reported better health i s not s t a t i s t i c a l l y related to prevention orientation or to the concept that luck, chance or fate does not control health, which demonstrates that prevention orientation may not be a factor determining actual health. However there seems to be a strong c u l t u r a l component influencing the construct of prevention orientation. When the German population i s removed i n the study, the construct of prevention i s linked to better health, increased l i f e s a t i s f a c t i o n and more contact with family as well as the factors outlined i n Table 31; p a r t i c i p a t i o n i n formal organizations, church attendance and frequent contact with friends. Table 29 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Reported Health  and Other Variables. Persons who report better health tend to report more: Pearson's r Probab i l i t y health i n t e r n a l i t y . .409 -OOO comfort with survey .338 .002 f e e l i n g s of usefulness i n survey .312 .005 frequent contact with family .238 .033 l i f e s a t i s f a c t i o n . .231 .039 We must assume that studies undertaken such as these have the underlying premise that they attempt to benefit the studied population i n some profound and meaningful manner. Such an attempt would possibly aim at a wide reaching underlying construct such as improving health or l i f e s a t i s f a c t i o n . What seems to be connected to l i f e s a t i s f a c t i o n i n the e l d e r l y ? The l i t e r a t u r e points out that l i f e s a t i s f a c t i o n i s intimately related to health: "Health emerges as the most potent predictor of subjective well—being. However, s e l f — r a t e d health i s a much stronger predictor of subjective well-being than physician-rated health (Okun, Stock, Haring, & Witter, 1984)" (Okun, 1987). Table 30 outlines the Abbotsford study's l i f e s a t i s f a c t i o n correlates. To be noted i s that l i f e s a t i s f a c t i o n correlates with more frequent contact with family rather than more frequent 113 contact with friends, which does not figure with increased l i f e s a t i s f a c t i o n , but rather with increased age. Table 30 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between L i f e S a t i s f a c t i o n and Other Variables Persons with higher l i f e s a t i s f a c t i o n scores also tended to report higher: Pearson' s r Probabi l i t y self-esteem. 0.450 .000 health i n t e r n a l i t y . 0.348 .002 frequency of contact with family. 0.266 .017 better health. 0.231 .039 Prevention orientation i s linked to the s o c i a b i l i t y c l u s t e r s of p a r t i c i p a t i o n i n organizations, church-going and frequency of contact with friends. Table 31 outlines other correlates to t h i s construct. Again, we note, as i n other c l u s t e r s , prevention orientation i s not related to l i f e s a t i s f a c t i o n , self-esteem, better health, or more frequent contact with family. Prevention orientation, however i s very strongly linked to the concept that luck, chance or fate does not control health, yet i t i s not necessarily connected to the idea that the ind i v i d u a l him/herself i s the responsible party i n personal health (health i n t e r n a l i t y ) . This q u a l i f i e d notion that chance i s not responsible, but neither may be the in d i v i d u a l could be linked to the in d i v i d u a l ' s b e l i e f i n the influence of God. The cor r e l a t i o n s demonstrate that those 114 who attend church more frequently do not believe i n chance a f f e c t i n g health, but they do not necessarily report f e e l i n g greater personal r e s p o n s i b i l i t y f o r t h e i r health either. Table 31 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Prevention  Oriented Persons and other Variables Prevention oriented persons tend to: Pearson's r Probabi l i t y attend church more. - 4-35 .ooo p a r t i c i p a t e more i n formal org. - 415 .ooo not believe luck controls health. -O. 405 .000 have more contact with friends. • 401 .ooo be German. - 356 -OOl smoke less. -o. 267 . 000 I n t e r n a l i t y Correlates Does health i n t e r n a l i t y , the construct of health i n t e r n a l locus of control, (that the in d i v i d u a l him/herself i s ultimately responsible f o r personal health) d i f f e r noticeably from the construct of prevention orientation? Where does t h i s concept f i t i n with the various clusters? We can see from Table 32 that health i n t e r n a l i t y does not correlate negatively or p o s i t i v e l y with p a r t i c i p a t i o n i n organizations, gender, status, frequency of contact with church, family, friends or organizations, type of dwelling, self-esteem or smoking behaviors. Health i n t e r n a l i t y unlike general 115 i n t e r n a l i t y doesn't seem to correlate p o s i t i v e l y with self-esteem (Aloia, 1973; DeCoster, 1987; Teitelman, 1983). Table 32 S t a t i s t i c a l l y S i g n i f i c a n t Relationships Between Health  I n t e r n a l i t y and Other Variables Persons who were more health Internal also tended to: Pearson's r Probabi l i t y report being healthier .403 .001 report higher l i f e s a t i s f a c t i o n .348 .002 be younger -0.299 .007 In Chapter 1 i t was noted that i t was not known i f i n t e r n a l i t y decreased with age. The Abbotsford study demonstrates that health i n t e r n a l i t y (not general i n t e r n a l i t y of reinforcement) does decrease between the ages of 60 and 75. Interestingly, there i s no evidence that actual self-reported health or l i f e s a t i s f a c t i o n decreases with age i n t h i s study (there i s a s l i g h t n o n - s t a t i s t i c a l l y s i g n i f i c a n t decrease i n health with age, but no decrease at a l l i n l i f e s a t i s f a c t i o n ) . This i s i n spi t e of the fact that these two variables do correlate p o s i t i v e l y to health i n t e r n a l i t y (see Table 32). Summary Upon examination of the d i f f e r e n t c l u s t e r s surrounding p a r t i c i p a t i o n , health and i n t e r n a l i t y , i t becomes possible to discern patterns of rela t i o n s h i p s which condense to a few underlying concepts: 116 (1) S o c i a b i l i t y , that i s , p a r t i c i p a t i o n i n formal organizations, i s s u r p r i s i n g l y unconnected to self-esteem, l i f e s a t i s f a c t i o n or better self-reported health except f o r the fact that church attendance i s linked to increased self-esteem. (2) Prevention knowledge or orientation i s not to be confused with health i n t e r n a l i t y . Prevention orientation seems to be more connected to the s o c i a b i l i t y factor. The idea of prevention may even be a construct created and maintained i n the s o c i a l climate. To support t h i s notion, prevention orientation figures i n a l l of the high s o c i a b i l i t y c l u s t e r s and i s negatively correlated to smoking which i s p r a c t i c a l l y the only completely "non-social" c l u s t e r . However, i f the most s a l i e n t c u l t u r a l component of Germanic ancestry i s considered and the persons of German extraction are l e f t out of the correlationships, than prevention orientation does correlate s i g n i f i c a n t l y with health, l i f e s a t i s f a c t i o n and closer contact with family, as well as with more attendance i n church a c t i v i t i e s and more p a r t i c i p a t i o n i n organizations and with friends. Thus the c u l t u r a l component influences t h i s construct to some notable degree, but not i n ways which can be e a s i l y explained. (3) The concept of not believing that luck or chance has anything to do with health i s much more p o s i t i v e l y correlated to the construct of prevention orientation than to " i n t e r n a l i t y " which i t i s a subset to. (Prevention to health locus of control-117 chance, r = -0.405 p. < .000 with a high score meaning less b e l i e f i n chance whereas there i s no s t a t i s t i c a l r e l a t i o n s h i p at a l l to i n t e r n a l i t y and the concept of prevention). In other words, those who are prevention oriented do not necessarily believe that they themselves are responsible f o r t h e i r own physical well-being as much as they believe that luck has nothing to do with health. Some respondents, who are church attenders believe that God determines health, which can be interpreted to mean that, luck does not control health and neither does the ind i v i d u a l . (3) Health i n t e r n a l i t y i s as i t s name implies, more of a concept which i s not seemingly s o c i a l l y driven and less dependent on influences from outside of the home. Health i n t e r n a l i t y appears to be, a much more powerful construct than prevention orientation or s o c i a b i l i t y since i t i s related f a i r l y exclusively to l i f e s a t i s f a c t i o n and better health. It i s not associated with church attendance or the b e l i e f that luck or chance do not control health. Health i n t e r n a l i t y i s not related either to the concept that doctors, nurses and other health experts control health. Health internals simply attach a greater amount of importance to t h e i r own r e s p o n s i b i l i t y i n c o n t r o l l i n g t h e i r physical well being. (4) Those who are health i n t e r n a l , although they do not s o c i a l i z e overly outside of the home are not true i s o l a t e s as they tend to report frequent contact with t h e i r f a m i l i e s . 1 1 8 (5) Smokers on the other hand can be categorized as much more s o c i a l l y i s o l a t e d because they associate neither with family, friends or strangers i n organizations. They do not however report lower l i f e s a t i s f a c t i o n , self-esteem or worse health. 119 CHAPTER 9: SUMMARIES, CONCLUSIONS AND RECOMMENDATIONS This chapter summarizes and draws conclusions about the two d i s t i n c t parts of t h i s project, the survey component and the experimental component. The survey element i s the type of advice given by the seniors i n Group 1 as well as the resource c i t i n g s by Group 2. The experimental element are the r e s u l t s of the hypotheses and what elements of the study support or refute current l i t e r a t u r e . This chapter also notes and draws conclusions about the key re l a t i o n s h i p s i n the study. Associations to the background l i t e r a t u r e are construed throughout and some recommendations are included with each section. SURVEY COMPONENTS OF THE PROJECT what Seniors i n Group 1 Advised was Needed i n the Community  to Promote Healthy Aging Group 1, the advice-giving respondents gave the following recommendations about what i s needed i n the community to promote healthy, independent aging, i n descending order of frequency: (1) more education on the topic of prevention, (2) more sel f - h e l p groups, (3) increased governmental services, (4) increased pensions, (5) i n d i v i d u a l r e s p o n s i b i l i t y and e f f o r t , (6) better quality affordable housing, (7) better subsidized transportation, (8) governmental e f f o r t to seek seniors' advice on health matters, (9) more governmental safety and f i r e inspections, (lO) 120 subsidized and available medical a l e r t response devices, (11) more community volunteers, (12) more seniors' f a c i l i t i e s , (13) more public health unit involvement, (14) more homemakers, (15) services are already s u f f i c i e n t and adequate, (16) walking programs fo r seniors, (17) more business subsidies and services. A s izable number of the suggestions were not c a p i t a l intensive and could make f u l l use of the concept of r e c r u i t i n g seniors to a s s i s t seniors. Recommendat ions If a government or community agency were to examine these r e s u l t s with promoting healthy aging goals i n mind the most e f f i c i e n t approach might be to provide more education f o r seniors about prevention issues and to r e c r u i t already motivated seniors to do t h i s whilst encouraging s e l f — h e l p i n i t i a t i v e s . Because of t h e i r sheer frequency i t seems sensible to combine several of the f i r s t suggestions. Thus we could propose that those seniors who are already health oriented could be recruited to a s s i s t i n self-help endeavors to educate other seniors i n t h e i r homes about prevention issues. If smokers were a population (one quarter of the respondents were smokers) that were deemed necessary to reach, i t i s obvious that such an e f f o r t could not be successful i f attempted through any of the usual s o c i a l channels. Here again, intervention might best be undertaken by communicating d i r e c t l y to the person i n the home. 121 S p e c i f i c recommendations can be combined keeping i n mind the s e l f - h e l p model, budgetary concerns and promoting education. Some of these suggestions could be implemented without monumental costs to the government, such as: (1) stepping up and enforcing l e g i s l a t e d safety and f i r e inspections within the structures of building codes, housing and personal insurance p o l i c i e s . (2) providing educational and suggestion seeking material i n the same envelope as the pension checks. (3) encouraging shopping mall managements to promote walking and other senior programs within the mall structures during l i g h t e r or non-shopping hours. (4) encouraging businesses to provide delivery and other transportation services f o r seniors with a tax shelter incentive. (5) promoting senior volunteer work within existent public, governmental and community organizations and structures by providing t r i p s , s p e c i a l membership p r i v i l e g e s , bonus l o t t e r y opportunities, special publicized community recognition or other valued enducements as incentive to a s s i s t with healthy aging enterprises. 122 (6) opening up e x i s t i n g f a c i l i t i e s f o r additional hours to service community groups at appropriate hours, staffed with community volunteers. (7) provide tax shelters f o r private homes who rent quality housing f o r seniors within t h e i r premises, whether they are r e l a t i v e s or not. Since s e l f reported better health and higher l i f e s a t i s f a c t i o n were correlated with i n t e r n a l i t y and more frequent contact with family members, perhaps these connections should be strengthened i n the e f f o r t to promote healthy aging. These rela t i o n s h i p s could be enhanced with: (1) encouraging more research about what creates and maintains health i n t e r n a l i t y . (2) encouraging additional research about what enhances and maintains close family t i e s . (3) enabling seniors to remain i n closer contact with t h e i r f a m i l i e s , with appropriate tax rebates, transportation and telephone subsidies. (4) increasing public education about health i n t e r n a l i t y issues to promote more personal r e s p o n s i b i l i t y f o r preventive health care. 123 (5) involving church and other senior organizations to acquire additional r e s p o n s i b i l i t y f o r t h e i r own health i n the i n t e r n a l i t y education process, since those who pa r t i c i p a t e i n the community are already prepared by virtue of t h e i r i n c l i n a t i o n s to pro-active health attitudes and habits. what Resources Group 2 (Information Giving) were Most Apt to Cite i n Response to Inquiries about Healthy Aging Issues The most often c i t e d resources quoted by the respondents i n Group 2 as aids i n solutions f o r independent healthy aging problems, i n descending order of frequency of c i t a t i o n were: (1) the i n d i v i d u a l him/herself, (2) the doctor, (3) r e l a t i v e s , e s p e c i a l l y nurses, (4) didn't know what resources they would access i n r e l a t i o n to the questions (5) Matsqui-Abbotsford Community Services (Christina Ragneborg, senior coordinator) or one of i t s programs such as Meals—on Wheels, (6) housing complex management or neighbours i n the housing unit, (7) friends, (8) sel f - h e l p groups (9) free enterprise businesses such as health-food stores or gyms etc., (lO) government workers, such as social-workers, counsellors or paid coordinators i n government centers, (11) government publications, such as pamphlets, (12) homemakers, (13) t h e i r church, (14) the media, T.V., books, newspapers etc., (15) medical extended care benefits such as chiropractors, masseuses, pharmacists, physiotherapists etc., (16) the hospital d i e t i c i a n , (17) neighbours. 124 Group 2 seniors demonstrated a considerable interest i n remaining independent because the most often quoted health resource was the i n d i v i d u a l him/herself. The doctor was predictably uppermost i n most of t h i s age group's mind as a health prevention resource. To be noted also was that 66% of the resources named were people which the respondent knew. This included: (1) s e l f , (2) doctor, (3) r e l a t i v e s , (5) Christine Ragneborg, senior coordinator at Matsqui-Abbotsford Community Services, (6) persons i n the respondent's housing complex, (7) friends, (8) s e l f - h e l p groups (13) church, (17) neighbours. Conceivably the seniors know some of the i n d i v i d u a l s i n the other resources also, but by and large the seniors tend to r e l y on "known person resources" rather than on books, agencies or strangers. Those seniors who l i v e d i n community type housing seemed to benefit more than just economically, since many of t h e i r physical and mental health needs were reported to be taken care of i n t h i s type of housing context. Recommendat ions Prevention information could most e a s i l y be dispersed through the doctor, either verbally or with simple a t t r a c t i v e l i t e r a t u r e , because the doctor i s s t i l l i n the front l i n e for prevention i n the view of the senior, even i f doctors are presumed to concentrate much of t h e i r practice i n diagnosis, 125 treatment and prescription. According to the findings, those who are not prevention oriented are much more ready to consult with t h e i r doctors than those who are prevention knowledgeable. Community services and centers on the other hand who have access to the more prevention oriented and health conscious may f i n d i t possible to r e c r u i t volunteers (ex-nurses are used by t h e i r r e l a t i v e s quite often) who would provide healthy aging programs such as walking programs, health monitoring and information dispersal i n i t i a t i v e s and other s e l f - h e l p enterprises. Housing complex managements, co-operatives and church groups which are already a s i g n i f i c a n t resource f o r many seniors could also r e c r u i t t h e i r more health sophisticated and motivated members to form the core groups who reach out to the more s o c i a l l y i s o l a t e d i n the community. Some seniors (smokers) who do not p a r t i c i p a t e i n organizations and are also s o c i a l l y i s o l a t e d from friends could be informed about resources with the telephone or through a "f r i e n d l y v i s i t o r s " program or by some other means than through church or formal organizations. 126 EXPERIMENTAL COMPONENTS OF THE PROJECT Hypotheses Findings Giving advice about health topics was not found to increase the p o s s i b i l i t y of p a r t i c i p a t i o n i n those areas related to that topic, nor did i t increase self-esteem, health i n t e r n a l i t y or l i f e s a t i s f a c t i o n . In support of the l i t e r a t u r e and the v a l i d i t y of the measurement instruments, l i f e s a t i s f a c t i o n was found to correlate highly with self-esteem. Health i n t e r n a l i t y was not found to correlate markedly with self-esteem or speaking more during the interview. Health i n t e r n a l i t y on the other hand was discovered to correlate p o s i t i v e l y and quite s i g n i f i c a n t l y with l i f e s a t i s f a c t i o n . Loquacity during the interview/survey was noted to correlate p o s i t i v e l y with the self-esteem before the experience of giving advice i n Group 1 and with p a r t i c i p a t i o n i n formal organizations i n Group 2. Recommendations about Research Design If such a study were pursued again i t would be important to es t a b l i s h that the respondents knew and understood the topic on which advice i s to be given, s u f f i c i e n t l y well (e.g. housing for seniors) to f e e l at ease with the topic. 127 It would also be desirable f o r any future research i n t h i s area to set up a design that had the p o s s i b i l i t y of expressing a greater difference between the two most important variables (advice-giving and information-giving). These two variables were next to each other as rungs on Arnstein's Ladder of P a r t i c i p a t i o n and did not prove to be very d i f f e r e n t on the empowerment dimension. In other words, Group 2 f e l t that i t s information-giving was just as useful as Group 1 f e l t that i t s advice-giving was and the f e e l i n g of usefulness i s assumed to be connected to the empowerment p r i n c i p l e i n Arnstein's design. To ensure a better c a l i b e r of sampling procedure i t would be advisable i n the future to ask the respondents from the control group i f they would be interested i n being interviewed (without a c t u a l l y making a commitment to interview them) so that a l l respondents from the three groups would be equally motivated to p a r t i c i p a t e at the onset. In the actual study, the control group respondents were contacted and i t was established that they indeed were available, but no interview was mentioned (except as with the other two groups, i n the introductory l e t t e r ) . Thus the control group contained an unknown number of unmotivated respondents which may have affected t h i s group's p a r t i c i p a t i o n rates. Fortunately Group 3's p a r t i c i p a t i o n was not an important component to the study as most of the comparisons were meant to be made between the interviewed groups 1 and 2. 128 Relationships Between the Key Variables Two f a i r l y mutually exclusive groups of variables c l u s t e r around the two constructs of s o c i a b i l i t y / p a r t i c i p a t i o n and health i n t e r n a l i t y . It seems from the r e s u l t s that prevention orientation and s o c i a b i l i t y with friends and organizations are not related to self-esteem, l i f e s a t i s f a c t i o n or better health. The findings about s o c i a l p a r t i c i p a t i o n i n formal organizations are aligned with the findings reviewed i n the l i t e r a t u r e by Cutler (1987), (Cutler, 1973; Edwards & Klemmack, 1973; Lemon, Bengston & Peterson, 1972; Longino & Kart, 1982) that there i s no r e l a t i o n s h i p to membership i n organizations and psychological well-being. In f a c t , as mentioned i n Chapter 1, Blunt (1982) found i n a study on p a r t i c i p a t i o n and s o c i a l stress and health, that although health was p o s i t i v e l y associated with learning, p a r t i c i p a t i o n i n formal s o c i a l organizations had negative e f f e c t s upon health. As mentioned i n Chapter 1, perhaps lack of i n t e r n a l i t y may be connected with the experience of p a r t i c i p a t i n g i n organizations not being connected with higher self-esteem and l i f e s a t i s f a c t i o n . When one examines the c l u s t e r of relationships around p a r t i c i p a t i o n i n formal organization, contact with friends and contact with church a c t i v i t i e s , health i n t e r n a l i t y does not figure as one of the related constructs. Could i t be that those high p a r t i c i p a t o r s tend to be more 129 externally oriented i n more ways than just t h e i r health? The question would bear more research as C i c i r e l l i (1987) mentioned in Chapter 1, who reviewed the l i t e r a t u r e on aging and locus of control (not health locus of control, but general locus of control, a construct formulated by Rotter) found that s o c i a l p a r t i c i p a t i o n was associated with i n t e r n a l i t y of control. Prevention orientation seems to be a construct c u l t i v a t e d i n a s o c i a l milieu which i s not connected to health i n t e r n a l i t y , but much more with association with others and a strong b e l i e f that chance does not control health. Health i n t e r n a l i t y on the other hand, or a f e e l i n g that the s e l f i s mainly responsible for health i s quite related to more frequent contact with family members, l i f e s a t i s f a c t i o n and better health. The difference between the two c l u s t e r s of health i n t e r n a l i t y and s o c i a b i l i t y seems to reside i n the notion that those who no longer or have never had frequent contact with family members, seem to r e l y more on outside supports, but do not necessarily enjoy greater self—esteem, l i f e s a t i s f a c t i o n or better health along with t h i s greater outside p a r t i c i p a t i o n . It i s also important not to leap to conclusions and assume that non-contact with family members necessarily means loss i n terms of widowhood or distance. Loss of frequent contact may also mean that meaningful and rewarding contact i s not possible with other 130 family members and thus the reliance on friends and outside contacts. 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ETHICS COMMITTEE CERTIFICATE OF APPROVAL 138 APPENDIX 11: AGENCY LETTER OF INTRODUCTION OF RESEARCHER 140 M A T S Q U I , A B B O T S F O R D ™J™^l*F-C O M M U N I T Y S E R V I C E S ABBOTSFORD, B.C. V2S 3S9 In order to provide better service and programs, Matsqui-Abbotsf ord Community Services i s conducting a research study with i t s Seniors. We have a Masters student i n S o c i a l Work who w i l l be conducting the research i n co-operation with Community Services. Her name i s Anne St. Onge and she w i l l be interviewing Seniors, with t h e i r permission. The questions i n the survey w i l l a s s i s t i n our knowledge about the needs of the Seniors i n the area of prevention of i l l n e s s and health needs. Anne St. Onge w i l l be c a l l i n g you by telephone and asking you i f you are open to an appointment f o r the interview. This meeting should take about an hour and a half and w i l l only occur once. You may choose to have the interview i n your own home or any other place of your choice and you can l e t Anne know t h i s when she speaks to you on the phone. The answers on the questionnaires w i l l be compiled. These answers added together should give us a sense of what the Seniors are concerned about. The information on the questionnaires w i l l be used s t r i c t l y f o r the purposes of the study. Names w i l l not be attached to the summaries and the raw data connected to personal i d e n t i f i c a t i o n w i l l be destroyed a f t e r the study i s completed. Your name has been randomly selected as a p o t e n t i a l p a r t i c i p a n t i n the survey. You may e l e c t not to p a r t i c i p a t e i f you wish. If you choose to p a r t i c i p a t e , you can refuse to answer any s p e c i f i c question you wish. If you refuse any part of t h i s project, t h i s w i l l have no bearing on any of the services you receive or w i l l receive i n the future by Community Services. Thank you very kindly f o r you attention. Yours t r u l y , Walter Paetkau Executive Director P.S. Any further information about the project can be f i e l d e d by the research student, Anne St. Onge, at the phone number: 853-8871 and i f she i s not home, leave your name and phone number on the answering machine and she w i l l respond to any of your i n q u i r i e s . Or phone C h r i s t i n a Ragneborg at 859-7681 f o r more information. 141 APPENDIX 111: MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL SCALE - FIRST HALF by Wallston, Wallston and DeVellis, 1978 142 C O D E N U M B E R : Q U E S T I O N N A I R E A l : A G E : S E X : M S T R O N G L Y M O D E R A T E L Y S L I G H T L Y S L I G H T Y ' M O D E R A T E L Y S T R O N G L Y D I S A G R E E D I S A G R E E D I S A G R E E A G R E E A G R E E A G R E E 1 . I F I G E T S I C K , I T I S MY OWN B E H A V I O R WHICH D E T E R M I N E S HOW SOON I G E T W E L L A G A I N . 2 . NO M A T T E R WHAT I D O , I F I AM G O I N G T O G E T S I C K , I W I L L G E T S I C K . 3 . H A V I N G R E G U L A R C O N T A C T W I T H MY P H Y S I C I A N I S T H E B E S T WAY F O R ME T O A V O I D I L L N E S S . 4 . MOST T H I N G S T H A T A F F E C T MY H E A L T H H A P P E N T O ME B Y A C C I D E N T . 5 . W H E N E V E R I D O N ' T F E E L W E L L . I S H O U L D C O N S U L T A M E D I C A L L Y T R A I N E D P R O F E S S I O N A L . 6 . I AM I N C O N T R O L O F MY H E A L T H . 7 . MY F A M I L Y H A S A L O T T O DO W I T H MY B E C O M I N G S I C K OR S T A Y I N G H E A L T H Y . 8 . WHEN I G E T S I C K , I AM T O B L A M E . 9 . L U C K P L A Y S A B I G P A R T I N D E T E R M I N I N G HOW S O O N I W I L L R E C O V E R F R O M A N I L L N E S S . 1 0 . H E A L T H P R O F E S S I O N A L S C O N T R O L MY H E A L T H . 1 1 . MY GOOD H E A L T H I S L A R G E L Y A M A T T E R O F GOOD F O R T U N E . 1 2 . T H E M A I N T H I N G WHICH A F F E C T S MY H E A L T H I S WHAT I M Y S E L F D O . 1 3 . I F I T A K E C A R E O F M Y S E L F , I C A N A V O I D I L L N E S S . 1 4 . WHEN I R E C O V E R F R O M A N I L L N E S S , I T ' S U S U A L L Y B E C A U S E O T H E R P E O P L E ( F O R E X A M P L E , D O C T O R S , N U R S E S , F A M I L Y , F R I E N D S ) H A V E B E E N T A K I N G GOOD C A R E O F M E . 1 5 . NO M A T T E R WHAT I D O , I ' M L I K E L Y T O G E T S I C K . 1 6 . I F I T ' S M E A N T T O B E , I W I L L S T A Y H E A L T H Y . 1 7 . I F I T A K E T H E R I G H T A C T I O N S , I C A N S T A Y H E A L T H Y . 1 8 . R E G A R D I N G MY H E A L T H , I C A N O N L Y DO WHAT MY D O C T O R T E L L S ME T O D O . 143 APPENDIX IV: MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL SCALE - SECOND HALF by Wallston, Wallston and DeVellis, 1978 144 C O D E N U M B E R : Q U E S T I O N N A I R E A 2 : 1 2 3 4 5 6 * * * * * * S T R O N G L Y M O D E R A T E L Y S L I G H T L Y S L I G H T L Y • M O D E R A T E L Y S T R O N G L Y D I S A G R E E D I S A G R E E D I S A G R E E A G R E E A G R E E A G R E E 1 . I F I B E C O M E S I C K , I H A V E T H E POWER TO M A K E M Y S E L F W E L L A G A I N . 2 . O F T E N I F E E L T H A T NO M A T T E R WHAT I D O , I F I AM G O I N G T O G E T S I C K , I W I L L G E T S I C K . 3 . I F I S E E A N E X C E L L E N T D O C T O R R E G U L A R L Y , I AM L E S S L I K E L Y T O H A V E H E A L T H P R O B L E M S . 4 . I T S E E M S T H A T MY H E A L T H I S G R E A T L Y I N F L U E N C E D B Y A C C I D E N T A L H A P P E N I N G S . 5 . I C A N O N L Y M A I N T A I N MY H E A L T H B Y C O N S U L T I N G H E A L T H P R O F E S S I O N A L S . 6 . I AM D I R E C T L Y R E S P O N S I B L E F O R MY H E A L T H . 7 . O T H E R P E O P L E P L A Y A B I G P A R T I N WHETHER I S T A Y H E A L T H Y OR B E C O M E S I C K . 8 . W H A T E V E R G O E S WRONG W I T H MY H E A L T H I S MY OWN F A U L T . 9 . WHEN I AM S I C K , I J U S T H A V E TO L E T N A T U R E RUN I T S C O U R S E . 1 0 . H E A L T H P R O F E S S I O N A L S K E E P ME H E A L T H Y . 1 1 . WHEN I S T A Y H E A L T H Y . I ' M J U S T P L A I N L U C K Y . 1 2 . MY P H Y S I C A L W E L L - B E I N G D E P E N D S ON HOW W E L L I T A K E C A R E O F M Y S E L F . 1 3 . WHEN I F E E L I L L , I KNOW I T I S B E C A U S E I H A V E NOT B E E N T A K I N G C A R E O F M Y S E L F P R O P E R L Y . 14.. T H E T Y P E O F C A R E I R E C E I V E FROM O T H E R P E O P L E I S WHAT I S R E S P O N S I B L E F O R HOW W E L L I R E C O V E R F R O M AN I L L N E S S . 1 5 . E V E N WHEN I T A K E C A R E O F M Y S E L F , I T ' S E A S Y T O G E T S I C K . 1 6 . WHEN I B E C O M E I L L , I T ' S A M A T T E R O F F A T E . 1 7 . I C A N P R E T T Y MUCH S T A Y H E A L T H Y B Y T A K I N G GOOD C A R E O F M Y S E L F . 1 8 . F O L L O W I N G D O C T O R ' S O R D E R S T O T H E L E T T E R I S T H E B E S T WAY F O R ME T O S T A Y H E A L T H Y . 145 APPENDIX V: ROSENBERG'S SELF-ESTEEM SCALE by Rosenberg (1965, c i t e d i n Mangen & Peterson, eds. 1982) 146 CODE NUMBER: QUESTIONNAIRE B2: BELOW ARE 10 STATEMENTS WITH WHICH YOU MAY AGREE OR DISAGREE. USING THIS SCALE, GIVE YOUR LEVEL OF AGREEMENT WITH EACH ITEM, PLACING THE APPROPRIATE NUMBER ON THE LINE BEFORE THAT ITEM. PLEASE BE OPEN AND HONEST IN YOUR RESPONDING. 1 2 3 _ * _ 4 STRONGLY DISAGREE AGREE DISAGREE STRONGLY AGREE 1. I FEEL THAT I'M A PERSON OF WORTH, AT LEAST ON AN EQUAL PLANE WITH OTHERS. I FEEL THAT I HAVE A NUMBER OF GOOD QUALITIES. 3. ALL IN ALL, I AM INCLINED TO FEEL THAT I AM A FAILURE. 4. I AM ABLE TO DO THINGS AS WELL AS MOST OTHER PEOPLE. 5. I FEEL I DO NOT HAVE MUCH TO BE PROUD OF. 6. I TAKE A POSITIVE ATTITUDE TOWARD MYSELF. 7. ON THE WHOLE, I AM SATISFIED WITH MYSELF. 8. I WISH I COULD HAVE MORE RESPECT FOR MYSELF. I CERTAINLY FEEL USELESS AT TIMES. lO. AT TIMES I THINK I AM NO GOOD AT ALL. (Rosenberg, taken from Mangen & Peterson, 1982) 147 APPENDIX VI: GROUP 1 ADVICE-ASKING QUESTIONNAIRE 148 CODE NUMBER: QUESTIONNAIRE #1: I AM GOING TO ASK FOR YOUR OPINION AND FOR YOUR ADVICE ON COMMUNITY PROGRAMS ABOUT HEALTH, PREVENTION OF ILLNESS AND KEEPING WELL. WE NEED THE ADVICE AND SUGGESTIONS OF SENIORS IN THIS AREA SO WE CAN KNOW WHAT TYPES OF PROGRAMMING TO ORGANIZE. SUGGESTIONS ARE USEFUL FOR COMMUNITY WORKERS SO THAT THEY CAN IMPROVE EXISTING PROGRAMS AND THE BEST PERSONS TO GIVE ADVICE ABOUT THESE POSSIBLE IMPROVEMENTS ARE THE SENIORS THEMSELVES. 1. HEALTH AND PREVENTION OF ILLNESS: GENERAL PROGRAMS. l.O l IF YOU HAD TOTAL CONTROL AND PROVINCIAL AND FEDERAL MONIES WERE AT YOUR DISPOSAL, WHAT WOULD YOU ADVISE IS NEEDED IN THE AREA OF PROGRAMS AND SERVICES FOR SENIORS SO THEY CAN REMAIN AS HEALTHY AS POSSIBLE? 1.02 YOU HAVE TOTAL CONTROL AND GOVERNMENT MONEY IS AT YOUR DISPOSAL, WHAT WOULD YOU ADVISE IS NEEDED TO SEE THAT SENIORS REMAIN AS INDEPENDENT AS LONG AS POSSIBLE? 1.03 YOU ARE IN CONTROL OF GOVERNMENT MONEY, WHAT WOULD YOU ADVISE SHOULD BE DONE TO MAKE SURE THAT SENIORS ARE THE ONES WHO HAVE A SAY ABOUT WHAT THESE PROGRAMS ARE? 2. HEALTH AND PREVENTION OF ILLNESS: EXERCISE 2.01 AGAIN, YOU HAVE TOTAL CONTROL AND MONEY IS NO REAL PROBLEM, WHAT WOULD YOU LIKE TO SEE POSSIBLE IN TERMS OF EXERCISE AS PREVENTION OF ILLNESS FOR SENIORS? 14-9 2.02 WHAT WOULD YOU ADVISE IS NEEDED TO ENSURE THAT SENIORS INCLUDE EXERCISE IN THEIR LIVES TO PROMOTE HEALTH AND PREVENT ILLNESS? 2.03 WHAT WOULD YOU ADVISE IS NEEDED TO ENSURE THAT THE SENIORS GET TO HAVE AN EFFECTIVE SAY ABOUT GOOD EXERCISE PROGRAMS FOR SENIORS? 3- HEALTH AND PREVENTION- NUTRITION: 3.01 WHAT WOULD YOU ADVISE IS NEEDED TO ENSURE THAT SENIORS  GET HEALTHY NUTRITION THAT WILL KEEP THEM WELL? 3.02 WHAT WOULD YOU ADVISE IS NEEDED SO THAT THE VIEWS OF  SENIORS ARE CONSIDERED IN THE DECISION MAKING PART OF THESE PROGRAMS? 4. HEALTH AND PREVENTION- SAFETY 4.01 WHAT WOULD YOU ADVISE SHOULD BE DONE TO MAKE CERTAIN THAT SENIORS ARE SAFE IN THEIR HOMES FROM FIRE HAZARDS? 4.02 WHAT WOULD YOU ADVISE IS NEEDED TO SEE THAT SENIORS ARE SAFER IN THEIR HOME IN TERMS OF BEING ALONE AND HAVING FALLS? 150 4.03 WHAT WOULD YOU ADVISE IS NEEDED TO ASSIST IN THE PROTECTION OF THE ELDERLY FROM CRIMINAL BEHAVIOR? 5. HEALTH AND PREVENTION: NURTURING RELATIONSHIPS 5.01 WHAT WOULD YOU ADVISE IS NEEDED TO INCREASE THE POSSIBILITY THAT SENIORS GET THE NURTURING RELATIONSHIPS THEY WANT? 5.02 WHAT WOULD YOU ADVISE IS NEEDED TO PREVENT LONELINESS AMONGST SENIORS? 6.01 HAVE YOU HEARD OF THE CONCEPT OF "WELLNESS", "PREVENTION" AND WHERE HAVE YOU HEARD THE TOPIC? DOES IT MEAN ANYTHING TO YOU? FOR EXAMPLE, ON TELEVISION, BOOKS, WITH FRIENDS ETC.? HAVE YOU EVER SEEN OR BOUGHT THE "PREVENTION" MAGAZINE? 151 APPENDIX V l l : GROUP 2 INFORMATION-ASKING QUESTIONNAIRE i 152 CODE NUMBER QUESTIONNAIRE #2: I AM GOING TO ASK YOU ABOUT WHAT YOU KNOW ABOUT SOME COMMUNITY PROGRAMS WHICH ARE CURRENTLY AVAILABLE AND WHICH YOU MIGHT KNOW ABOUT. WE ALSO WISH TO KNOW WHO YOU TURN TO FOR INFORMATION. WE NEED TO KNOW HOW WELL ACQUAINTED THE SENIORS ARE WITH SERVICES IN THIS AREA, SO THAT WE KNOW WHAT TYPES OF COVERAGE THESE PROGRAMS HAVE. THE BEST PERSONS TO GIVE US INFORMATION ABOUT THIS ARE THE PEOPLE IN THE COMMUNITY. 1- HEALTH AND PREVENTION- GENERAL PROGRAMS: 1.01 WHO WOULD YOU CONTACT IF YOU HAD A HEALTH PROBLEM? (LIST IN PRIORITY). 1.02 WHAT HEALTH AND MEDICAL PROGRAMS ARE AVAILABLE IN THE COMMUNITY WHICH YOU KNOW OF? 1.03 WHO WOULD YOU ASK ABOUT PROGRAMS FROM IN THE COMMUNITY BESIDES A PROFESSIONAL? (FRIEND, RELATIVE, ACQUAINTANCE, NEIGHBOR?) LIST IN PRIORITY. 1.04 IF SOMETHING HAPPENS TO YOUR HEALTH THAT LEAVES YOU WITH SOME DISABILITY, WHERE WOULD YOU TURN TO FOR SPECIAL PHYSICAL ASSISTANCE (NO FUNDING,) TO ENABLE YOU TO STAY IN THE HOME? 153 2. HEALTH AND PREVENTION:EXERCISE 2.01 WHO WOULD YOU CONTACT IF YOU WISHED TO BEGIN AN EXERCISE PROGRAM TO IMPROVE YOUR HEALTH? (LIST IN PRIORITY) 2.02 WHAT TYPES OF EXERCISE PROGRAMS ARE NOW AVAILABLE IN THE COMMUNITY THAT YOU ARE AWARE OF? 2.03 WHO WOULD YOU ASK ABOUT EXERCISE OPPORTUNITIES IN THE COMMUNITY BESIDES A PROFESSIONAL? (A FRIEND, RELATIVE, ACQUAINTANCE, NEIGHBOR?) (LIST IN PRIORITY). 3. HEALTH AND PREVENTION-NUTRITION 3.01 WHO WOULD YOU CONTACT IF YOU HAD QUESTIONS ABOUT HEALTHY NUTRITION? (LIST IN PRIORITY). 3.02 WHAT HEALTH AND PREVENTION PROGRAMS FOR HEALTHY NUTRITION ARE AVAILABLE IN THE COMMUNITY WHICH YOU KNOW OF? (LIST IN PRIORITY). 3.03 WHO WOULD YOU ASK ABOUT HEALTHY NUTRITION FROM OR PROGRAMS ABOUT NUTRITION BESIDES A PROFESSIONAL? (FRIEND, RELATIVE, ACQUAINTANCE, NEIGHBOR?). (LIST IN PRIORITY) . 154 4. HEALTH AND PREVENTION- SAFETY 4.01 WHO WOULD YOU CONTACT IF YOU HAD A CONCERN ABOUT SAFETY IN THE HOME FROM FIRE HAZARDS? 4.02 WHAT SERVICES DO YOU KNOW OF THAT ARE AVAILABLE IN THE COMMUNITY WHICH DEAL WITH FIRE HAZARDS? 4.03 WHO WOULD YOU CONTACT IF YOU HAD A CONCERN ABOUT SAFETY IN THE HOME FROM THE DANGERS OF FALLS OR BEING ALONE DURING A FALL? 4.04 WHO WOULD YOU CONTACT IF YOU HAD A CONCERN ABOUT ALL ROUND SAFETY IN THE STREET AND HOME FROM THE TYPES OF INCIDENTS WHICH YOU MIGHT FIND OF CONCERN? THIS INCLUDES CRIMINAL ACTIVITIES? 4.05 WHO WOULD YOU ASK ABOUT SAFETY FROM ACCIDENTS OR CRMINAL ACTIVITY CONCERNS FROM IN THE COMMUNITY THAT IS NOT A PROFESSIONAL? (FRIEND, RELATIVE, ACQUAINTANCE, NEIGHBOR) (LIST IN PRIORITY). 155 5. HEALTH AND PREVENTION: NURTURING RELATIONSHIPS 5.01 WHO WOULD YOU CONTACT IF YOU WERE LONELY OR IF YOU FELT THAT YOUR RELATIONSHIPS WERE NOT SATISFACTORY? 5.02 WHAT RESOURCES AND PROGRAMS ARE AVAILABLE IN THE COMMUNITY FOR PERSONS WHO ARE LONELY OR WHO HAVE HURTFUL RELATIONSHIPS? 6.01 "HAVE YOU HEARD OF THE CONCEPT OF "WELLNESS", "PREVENTION" AND WHERE HAVE YOU HEARD THE TOPIC? DOES IT MEAN ANYTHING TO YOU? FOR EXAMPLE, ON TELEVISON, BOOKS, WITH FRIENDS ETC. HAVE YOU EVER SEEN OR BOUGHT THE "PREVENTION" MAGAZINE? 156 APPENDIX V l l l : SATISFACTION WITH LIFE SCALE by Ed Diener, Robert A. Emmons, Randy J. Larsen and Sharon G r i f f e t h (1985) 157 C O D E N U M B E R : Q U E S T I O N N A I R E C : BELOW A R E F I V E S T A T E M E N T S W I T H WHICH Y O U MAY A G R E E OR D I S A G R E E . U S I N G T H I S S C A L E G I V E YOUR L E V E L O F A G R E E M E N T W I T H E A C H I T E M B Y P L A C I N G T H E A P P R O P R I A T E NUMBER ON T H E L I N E B E F O R E T H A T I T E M . P L E A S E B E O P E N AND H O N E S T I N YOUR R E S P O N D I N G . 1 2 3 4 5 6 7 * * * * * * * S T R O N G L Y D I S A G R E E S L I G H T L Y N E I T H E R S L I G H T L Y A G R E E S T R O N G L Y D I S A G R E E D I S A G R E E A G R E E A G R E E A G R E E NOR D I S A G R E E I N MOST WAYS MY L I F E I S C L O S E T O MY I D E A L . T H E C O N D I T I O N S O F MY L I F E A R E E X C E L L E N T . 3 . I AM S A T I S F I E D W I T H MY L I F E . 4 . S O F A R i H A V E G O T T E N T H E I M P O R T A N T T H I N G S I WANT I N L I F E . 5 . I F I C O U L D L I V E MY L I F E O V E R , I WOULD C H A N G E A L M O S T N O T H I N G . ( t a k e n f r o m C o r c o r a n , K . , 8c F i s c h e r J . , 1 9 8 7 ) . 158 APPENDIX IX: ORGANIZATION PARTICIPATION QUESTIONNAIRE based on F. S. Chapin's (1939) "Social P a r t i c i p a t i o n Scale" (as c i t e d i n M i l l e r , 1983) 159 CODE NUMBER: ORGANIZATION QUESTIONNAIRE: AN ORGANIZATION MEANS SOME ACTIVE OR ORGANIZED GROUPING, USUALLY, BUT NOT NECSSARILY IN THE COMMUNITY OR NEIGHBORHOOD OF RESIDENCE, SUCH AS CLUB, LODGE, BUSINESS OR POLITICAL OR PROFESSIONAL OR RELIGIOUS ORGANIZATION, LABOUR UNION, ETC. SUBGROUPS OF A CHURCH OR OTHER INSTITUTION ARE TO BE INCLUDED SEPARATELY PROVIDED THEY ARE ORGANIZED AS MORE OR LESS INDEPENDENT ENTITIES. ATTENDANCE OR NON-ATTENDANCE WITHOUT REGARD TO THE NUMBER OF MEETINGS ATTENDED, WITHIN THE LAST YEAR. RECORD UNDER CONTRIBUTIONS, YES OR NO, BUT NO AMOUNT. PREVIOUS MEMBERSHIPS, COMMITTEE WORK, OFFICES HELD ETC. SHOULD NOT BE COUNTED OR RECORDED OR USED. YES/NO YES/NO YES/NO YES/NO NAME OF ORG. ATTENDANCE CONTRIBUTION COMMITTEE OFFICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. (based on Chapin's "Social P a r t i c i p a t i o n Scale") 160 APPENDIX X: DEMOGRAPHICS QUESTIONNAIRE 161 CODE NUMBER: AMOUNT OF CONTACT I HAVE WITH INTIMATE SUPPORTIVE FAMILY IN AREA: 1 2 3 4 5 6 7 8 9 10 Not F a i r Excellent at a l l AMOUNT OF CONTACT I HAVE WITH INTIMATE SUPPORTIVE FRIENDS: 1 2 3 4 5 6 7 8 9 10 Not F a i r Excellent at A l l STATE OF HEALTH: 1 = Poor 2 = F a i r 3 = Good 4 = Excellent STATE OF HEALTH OF SPOUSE: 1 = Poor 2 = F a i r 3 = Good 4 = Excellent ETHNIC GROUP: AMOUNT OF TIME LIVED IN THE AREA: On a scale of 1 to IO how do you f e e l a f t e r t h i s survey? "I f e e l that I have been useful and been able to contribute i n t h i s survey". 1 2 3 4 5 6 7 8 9 IO Not F a i r Excellent Useful At A l l "I have f e l t coatfor-tsble with the nature of t h i s survey o v e r a l l " . 1 2 3 4 5 6 7 8 9 IO Not F a i r Excellent at a l l TYPE OF HOUSING: SMOKING: 162 APPENDIX XI: RESPONDENT'S CONSENT FORM 163 APPENDIX X l l : LETTER # 1 - INVITATION TO PARTICIPATE # 1 166 M A T S Q U I , A B B O T S F O R D 2420 M O N T R O S E S T . Dear We w i l l have a v a i l a b l e several free well written and i l l u s t r a t e d books on the topic of "Choosing Wellness: An Approach  to Healthy Aging". The "Choosing Wellness" book has chapters f o r seniors on health, making choices, n u t r i t i o n , companionship, keeping the body i n tune and the concept of "Wellness". This book was written 'by the Ministry of Health and i s popular so i t i s being reprinted again f o r r e d i s t r i b u t i o n . If you wish to have one ordered f o r you please f i l l i n the request at the bottom of the page and mail i t to the: shipment of books has arr i v e d . I am requesting a copy of the book on "Choosing Wellness": An Approach to Healthy Aging". Please order a copy of t h i s book f o r me and c a l l me at "Health Awareness Senior Project" c/o Senior Services Matsqui-Abbotsford. Community Services 2420 Montrose Street Abbotsford, B.C. V2S 3S9 Your name w i l l be added to the l i s t of persons who have requested i t and you w i l l be phoned to pick up the book when the when my book has a r r i v e d . (phone #) Signed: (sign your name here) 167 APPENDIX X l l l : LETTER 2 - INVITATION TO PARTICIPATE # 2 168 M A T S Q U I , A B B O T S F O R D C O M M U N I T Y S E R V I C E S 2420 MONTROSE ST. ABBOTSFORD, B.C. V2S 3S9 Dear Several members of the community, made up of seniors and persons who work with seniors, are forming a group f o r increasing health awareness to seniors which i s ( u n t i l we f i n d a better name), c a l l e d "Advisory Council on Healthy Aging". We need more ideas and input from members of the senior community and are i n v i t i n g you to become involved. If you are interested i n attending our meetings and being on our mailing l i s t please f i l l i n the bottom of t h i s page and mail i t to the following address: "Health Awareness Senior Project" c/o Senior Services Matsqui-Abbotsford Community Services 2420 Montrose Street Abbotsford, B.C. V2S 3S9 I would l i k e to be placed on the mailing l i s t f o r the group, "Advisory Council on Healthy Aging" and n o t i f i e d of the meetings. I may not be able to attend a l l the meetings but I would l i k e to be kept posted about what i s happening on t h i s topic. Please send any notice of the meetings to me at: (please sign your name and give your address and phone number). (sign here) (phone number) Address: 169 APPENDIX XIV: LETTER # 3 - INVITATION TO PARTICIPATE # 3 170 APPENDIX XV: CORRELATION MATRIX OF PARTICIPATION, HEALTH AND OTHER INDICATORS CORRESPONDING TO TABLES 25, 26, 27, 28, 29, 30, 31, 32. 172 \ Correlation Matrix of Pa r t i c i p a t i o n , Health and Other Indicators Corresponding to Tables 25, 26, 27, 28, 29, 30, 31, 32. Variables 1 1 X 2 3 4 5 6 7 8 2 .711** X 3 .415** .435** X 4 5 .378**-0.361** .447**-0.364** .335**-0.267* X -0.340** X 6 7 .350**-0.316*= -0.269* ns ns ns ns .261* ns ns ns X 8 .265* ns ns ns ns ns ns X Variables 9 10 11 12 13 14 1 .262* .249* ns ns .503** ns 2 .252* ns ns ns .391** .298 3 ns ns ns ns ns .356 4 .324** .229* .320** 324** ns ns 5 ns ns -0.251* ns ns ns 6 ns ns ns ns ns ns 7 -O.385** ns ns _ 507** -0.222* ns 8 ns .262* ns ns .315** ns 9 X ns ns -0 . 502** .235* ns IO X ns ns ns ns 11 X 248* ns ns 12 X ns ns 13 X ns 14 X 15 16 17 ns .555** ns ns ns ns 18 ns ns ns ns ns ns 19 ns .322** .238* ns ns ns 20 ns ns ns ns ns ns 21 ns .216* .266* ns ns ns 22 ns ns ns ns ns ns Variables 1 2 3 4 5 6 17 ns ns ns 370** ns ns 18 ns -0.237* -0.405** -o , 280* ns ns 19 ns ns ns ns ns ns 20 ns ns ns ns ns ns 21 ns ns ns ns ns ns 22 ns .243* ns ns ns .273 15 ns 28< ns ns ns 16 ns . 356* .231* -0.264* ns ns ns ns ns ns ns ns -0.489** X ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns X ns ns ns 0.299* ns ns ns ns ns ns ns ns ns ns ns ns ns ns * - S i g n i f i c a n t at the .05 l e v e l . * * - S i g n i f i c a n t at the ns-Not s i g n i f i c a n t . N = 80 Ol l e v e l 173 Code f o r Variable Numbers. 1 P a r t i c i p a t i o n i n formal organizations. Positive f o r increased p a r t i c i p a t i o n , 0 f o r none. 2 Church or church a c t i v i t y attendence. Pos i t i v e f o r more attendence, O f o r none. 3 Knowledge of prevention concept. Yes = 1, No = •. 4 Pos i t i v e f o r increased contact with friends. 5 Smoking, yes =1, no = 0. Smoking has a p o s i t i v e value here. 6 Li v i n g i n a senior complex = 1. Detached housing = 2. 7 Coupled f o r the interview = 1. Single during interview = 0. 8 Pos i t i v e f o r increased p a r t i c i p a t i o n a f t e r interview. 9 Gender, p o s i t i v e f o r femaleness. women = 2. Men = 1. 10 Reported f e e l i n g of being useful during interview. P o s i t i v e f o r increased f e e l i n g of usefulness during interview. 11 P o s i t i v e f o r increased contact with family. 12 Married status = 2. Single = 1. 13 Pos i t i v e f o r increased volunteering i n the community. 14 German i n ethnic o r i g i n = 1. Non-German = O. 15 B r i t i s h i n ethnic o r i g i n = 1. Non-British = 0. 16 Age, p o s i t i v e f o r increased age. 17 Pos i t i v e with increased reported comfort i n the survey. 18 B e l i e f that luck does not control health. High score f o r b e l i e f that luck controls health and lower score f o r b e l i e f that luck has nothing to do with health. 19 P o s i t i v e f o r better health. 20 Health i n t e r n a l i t y . The more the person believes he/she i s the one who controls his/her health, the higher the score. 21 Po s i t i v e f o r increased l i f e s a t i s f a c t i o n . 22 Po s i t i v e f o r increased self-esteem. 174 

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