Examining the Perceptions,Preferences,and Practices That Influence Healthy Aging for African American Older Adults

Abstract

This study explored the healthy aging and health promotion perceptions, preferences, and practices of a purposive sample of African American older adults who resided in two communities in the south. An ecological framework was used to capture environmental factors, perceptions regarding access to health promotion resources, and health behavior preferences and practices. A mixed-method approach was used. Health supporting amenities were mapped, focus groups were conducted, and demographic information was obtained. The data were merged to create consolidated themes. The results indicated that health promotion amenities were available, but with some limitations. Convenient access to transportation strongly affected ability to use resources. Older adults were interested in preserving their health and independence, but some had difficulty staying motivated to maintain a healthy lifestyle. They wanted easier access to amenities. Implications for best practice include attention to culturally responsive outreach, motivating with social support and incentives, and developing community-based culturally compatible programming.

Keywords

health promotion healthy aging older adults health disparity African American

We have moved into an era with the possibility of good health and increased longevity as one ages. Older adults are interested in remaining healthy as they age but may not be engaged in health promoting behaviors or lifestyles or have access to resources. This is particularly true for African American older adults who disproportionately suffer the ill effects of chronic illness as they age (Center for Disease Control and Prevention [CDC], 2005; Kirby & Kaneda, 2006; Reid, Hatch, & Parrish, 2003). To better understand why this might occur it is important to explore the perceptions, preferences, and practices that influence healthy aging and health promotion for African American older adults using an ecological lens.

There is research that has examined perceptions, preferences, and practices regarding healthy aging and health promotion activities in relationship to individual behavior, primarily physical activity and nutrition (Henderson & Ainsworth, 2000; Ralston, 2008; Rimmer, Wang, & Smith, 2008; Walcott-McQuigg & Prohaska, 2001; Wilcox, Brecht, Bopp, Cameraman, & McElmurray, 2005). This research examines what older adults think about healthy aging, health behaviors, and participation in specific forms of health promotion activities. However, less has been reported regarding the ecological factors that may affect healthy aging, health promotion activities, and access to resources (Darling, 2007; Fisher, Brownson, O’Toole, & Shetty, 2005; Robinson, 2008; Ryerson Espino & Trickett, 2008). This study provides a framework to facilitate an ecological understanding by examining the perceptions of older adults regarding healthy aging, social support, and access to health supporting amenities and resources. Preferred amenities and resources, as well as cultural influences and availability, are also considered. Engagement in healthy aging practices is also examined. Perceptions, health behavior preferences and practices, environmental resources, and their interactions as reported by older adults can provide insight and a fuller picture of the person in their health promotion environment.

African American older adults, who are aging in place in their homes and communities, have perceptions, preferences, and practices regarding health, aging, the health promotion environment in which they find themselves, and access to preferred resources. The health promotion environment refers to the community’s physical ecology as well as the history, culture, services, and programs that may be used to enhance or maintain one’s health as the person ages. Lack of knowledge regarding effective health behaviors and resources and difficulty accessing amenities contribute to poor health outcomes (Kirby & Kaneda, 2006; Ross & Mirowsky, 2001). Limited access to health promoting amenities and services within a community (e.g., safe places to exercise, health care facilities, senior centers, affordable healthy foods, food security, and transportation) has implications for good health outcomes for older adults (Balfour & Kaplan, 2002; Bouchard, Blair, & Haskell, 2007; Ross & Mirowsky, 2001). Understanding, perceptions, preferences, and practices, regarding health and aging as well as the health promotion environment and access to resources may be useful in addressing health disparities experienced by African American older adults (Musa, Schulz, Harris, Silverman, & Thomas, 2009).

The issue of access to resources that affect healthy aging is a complicated matter. Geographic accessibility is one factor. Rimmer et al. (2008) state that no knowledge of how and where to exercise are barriers to use of health promotion amenities. The USDA has examined the impact of “food deserts” as a phenomena that affects health. The Older American Act Nutrition Program provides congregate meal programs and other resources to reduce food insecurity and to promote health and well-being. However, even if resources are available nearby, older adults may be unaware, have difficulty traveling to programs, and in some cases the cost may be prohibitive (Kirby & Kaneda, 2006; Quandt et al., 2009; Rimmer et al., 2008). Insufficient availability of ancillary services (transportation; Rimmer et al., 2008), lack of consumer information (McKeehan, Trettin, & May, 2008), and culturally inappropriate or insensitive service provisions (Dancy & Ralston, 2002) discourage potential users.

A few studies have explored African American older adults’ perceptions, preferences, and practices regarding healthy aging and health promotion. Seven consistent individual, interpersonal, environmental themes have emerged pertaining to maintaining good health: (1) desire to maintain a moderate level of activity; (2) a holistic view of health that includes the mind, body, and spirituality; (3) appreciate family relationships and social interaction with others; (4) value the ability to take personal responsibility for one’s health; (5) receiving helpful information and resources is important; (6) improved accessibility to services and amenities is needed; and (7) the significance of spirituality and religious practices to health (Cowart, Sutherland, & Harris, 1995; Roff, Klemmack, Parker, & Koenig, 2005; Wellman, Kamp, Kirk-Sanchez, & Johnson, 2007; Wilcox et al., 2005). Collectively, this research implicitly addresses individual, interpersonal, and environmental themes but does not examine ecological interactions. This study used such an approach and explored healthy aging perceptions, preferences, and practices, as well as health promotion environments using an ecological framework.

Ecological Perspective for Health Promotion

The ecological perspective highlights individuals within the context of the social environment and the community in which they live and supports a strengths-based perspective (Greene & Sullivan, 2004). It captures the context in the broadest sense and includes physical, social, cultural, and historical aspects (Darling, 2007; Sanders, Fitzgerald, & Bratteli, 2008). An ecological perspective regarding healthy aging and health promotion holistically brings a focus to individual, social, cultural, and environmental determinants of behavior (Marshall & Altpeter, 2005; McLaren & Hawe, 2005; McLeroy, Bibeau, Steckler, & Glanz, 1988). It captures the ecological influences on health behavior and acknowledges individual perceptions, practices, as well as interpersonal and environmental influences.

There is much value in using an ecological, health promotion perspective that addresses the relationships between people and their environment. Best et al. (2003) point to the complex interplay among individual-, family-, organization-, and community-level factors as they influence health. They also advocate for a health promotion perspective that integrates comprehensive, participatory, and collaborative approaches to address social, cultural, and environmental contexts. Exploring not only individual behavior but also the environmental context in which older adults reside provides valuable insight. The ecological perspective applied to this study included three levels for exploration: individual (micro systems), interpersonal (meso systems), and community (macro systems). The individual level examines perceptions, preferences, and practices regarding healthy aging, social support, and access to health supporting amenities and resources. The interpersonal level explores social support, engagement, cultural influences, and perceptions regarding interpersonal interactions. Finally, the community level looks at healthy aging amenities and resources in the physical environment and perceptions and preferences regarding access. An ecological perspective is used to explore and understand perceptions and practices and the interaction across all three levels. This approach facilitates an integrative understanding of the factors that may influence healthy aging for older African Americans and inform strategies for addressing their health and well-being.

African American Older Adults: A North Carolina Context

Because of its sociodemographic and geographic characteristics, North Carolina is a good location to explore the ecology of health promotion for African American older adults. African American older adults (65 and older) have a significant representation in North Carolina, where they make up approximately 15.8% of the state’s population, compared with the national average of 8%. In North Carolina racial and ethnic older adults experience a lower life expectancy at birth than whites, 72.4 years, compared to 76.8 years, and a higher poverty rate than white older adults, 28.1%, compared to 8.9 % (U.S. Census, 2000b, 2010). Many chronic health conditions (hypertension, diabetes, and heart conditions) are more prevalent among African Americans contributing to health disparity.

This study explored the health promotion environment of two municipalities in Wake County North Carolina, Southeast Raleigh (SE Raleigh), and Zebulon. These two communities were selected because of their high concentrations of African American older adults. SE Raleigh includes a historically African American–embedded section, with a communal legacy represented by family homes, and longstanding historically Black Colleges. Census data (U.S. Census, 2000b) show that SE Raleigh, located in the city of Raleigh, has an urban/suburban context and 71.5% of its population is African American. Zebulon is a town located in the northeastern part of Wake County and began as an agricultural community. It has a more rural/suburban context, and 39.7% of the population is African American.

A blended model, consisting of the ecological perspective within a framework of culturally competent practice, was used to conduct a mixed-method design. The aim of this study was to examine the perceptions, preferences, and practices that influence healthy aging and health promotion for African American older adults. The specific research question was

Research Question 1: What are the consolidated ecological themes regarding healthy aging and health promotion perceptions, preferences, and practices as informed by a sample of African American’s older adults.

In addition, strategies that might be used to support healthy aging and the health promotion environment for African American older adults are also discussed.

Method

A mixed methodology, multilevel triangulation design was developed using graphic information system (GIS), which included focus group interviews and a questionnaire. This method was used to address different levels of a system (individual, interpersonal, and community), and the findings from each level were analyzed and merged together (Creswell, Guttman, & Plano Clark, 2002; Creswell & Clark, 2007; Tashakkori & Teddlie, 2002). In this design, the researcher concurrently collected and analyzed qualitative and quantitative data, and then merged all data during the interpretation phase. The qualitative components held greater weight in this study. This study allowed for different types of data and levels of analysis within a system, with the intent of consolidating all data to form an overall interpretation (Creswell & Clark, 2007). It also included a CBPR (community-based participatory research) component.

A CBPR approach was used. As suggested by Best et al. (2003), CBPR ensures the involvement of members of the community as active participants of the research study. CBPR incorporates a collaborative effort to pursue knowledge creation that is relevant to the community and is empowerment oriented (Engel & Schutt, 2005). This study, which grew out of interest in promoting healthy aging for African American older adults in North Carolina, used this approach to guide the study. The principal investigator (PI) assembled a 10-member Research Advisory Council (RAC) consisting of older adults, community members, and aging service providers and administrators. They were all leaders in the local aging network. The RAC provided guidance, pilot tested the focus group questions, assisted with recruitment for informants, reviewed aggregate findings, provided input regarding the interpretation of the findings, and contributed to research translation and dissemination.

A research team consisting of the PI and one project director (graduate assistant) met weekly to plan and carry out the study and to work with the RAC. Three additional graduate students joined the team during the data collection phase, and all participated in the interpretation and analysis. The study was approved by the Institutional Review Board, and focus groups, questionnaire, and maps were carried out from November 2006 through July 2007.

Sample

A purposive sample for the focus groups and questionnaire was drawn. The participant inclusion characteristics were African American adults aged 65 and older who resided in the study areas and had no observable cognitive impairments. A growing body of evidence addresses best practices for recruiting participants of historically underrepresented groups into research studies (Curry & Jackson, 2003; Dilworth-Anderson & Williams, 2004). Based on this knowledge, the study used a recruitment strategy with consultation from the RAC. The strategy included the following:

Identifying community leaders and inviting them to participate in the RAC or focus groups,

Making focus groups easily accessible to participants

Informing participants about the expected outcomes and that their participation will help others in the future, and

Minimizing paperwork. All the materials, invitations, consent forms, resource packets, questionnaire, and focus group questions were prepared by the researchers with input from the RAC to ensure clarity and a respectful style.

Cultural Competence and Compatibility

Cultural competence and cultural compatibility are elements of critical importance to an ecological perspective. When working with culturally diverse communities, it is important to acknowledge traditions, worldviews, and strengths while remaining cognizant of the dynamic nature of culture (Crewe, 2007; Waites, 2009; Waites, Macgowan, Pennell, Carlton-LaNey, & Weil, 2004). Brach and Fraser (2000) add that culturally competent health promotion, which seeks to encourage good health and care of chronic illness, should include awareness and attention to culture-specific attitudes, values, and public information. Consulting with key informant provides culturally specific information and enhances the cultural competency of the methodology.

Data Collection

Qualitative mapping—graphic information system (GIS)

Although GIS is often used quantitatively, in this study the maps are used for a qualitative analysis, to supplement the other data. Qualitative mapping is a representation of spatial phenomena or a visualization of spatial information in the form a map (Puebla, 2009). It is an assessment technique that identifies community indicators, in this case, as they relate to healthy aging. Maps are created using GIS computing, a system designed to store, manipulate, analyze, and output map-based, or spatial, information (Steinberg & Steinberg, 2006). For this study, publicly available databases were obtained from U.S. and NC Census, Wake County Government, and Triangle J Area Agency on Aging. The researcher identified senior centers, health departments, hospitals, parks/greenways, trails, and public transportation (bus routes), the relevant and available mapped amenities. Maps were produced to display the health promotion amenities in the communities focused upon in the study.

Focus groups and questionnaire

Four focus groups were conducted, with two groups in each community, between May and July2007. The size of each group ranged from 5 to 11 participants. Three focus groups were hosted by members of the RAC and the fourth by a community leader. They invited participant using a recruitment flyer prepared by the research team. Focus groups were held at three different churches (two at one location) that were accessible to informants. Information packets with health information and a US$20 gift card were provided as incentives to focus group participation.

The PI, project director, and three graduate assistants (the research team) facilitated the focus groups. There were two moderators and one observer/note taker for each focus group. Each session was audio–recorded, and a research protocol was used to structure the facilitation. A research protocol that outlined the study, procedures, and confidentiality was reviewed with all research team members as well as with the RAC.

The focus group sessions were approximately 90 minutes in length. The informants were asked: (1) What does healthy aging mean to you? (2) What do you do to stay healthy? (3) Where are some of the places you can go to participate in physical activities or other healthy activities? (4) Tell us about organizations/groups that provide healthy aging programs/activities. (5) Where do you shop for groceries? (6) What sorts of public transportation do older adults use in your community? Participants were advised about informed consent, focus group process, efforts to maintain their privacy, and how the information would be used. No one who attended the focus group refused to participate in the study.

At the beginning of each focus group, a questionnaire was administered. Information was collected regarding participants’ age, gender, education, retirement and employment status income, methods of transportation, and self-reported overall health (see Table 1). The research team met immediately after each focus group for debriefing, to share observations and to submit observation notes that contributed to the analysis.

Table 1.

Demographic characteristics.

	All	SE Raleigh	Zebulon
Age
50 to 60	3	—	6
61 to 70	44	31	56
71 to 80	31	44	19
81 and older	22	25	19
Gender
Male	15	6	25
Female	85	94	75
Education
College graduate	31	35	27
Some college	22	30	13
High school graduate	25.	30	20
Some high school.	19	5	33
Other	3		7
Employment status
Work full-time	3	—	7
Retired—working part-time	13	11	14
Retired	68	61	79
Retired volunteering	13	22	—
Other	3	6	—
Annual household income
US$5,000-US$24,999	39	20	47
US$25,000-US$44,999	17	20	15
US$45,000-US$64,999	17	—	23
US$65,000-US$84,999	5	20	—
Other	22	40	15
Transportation—self
No	9	—	19
Yes	91	100	81
Transportation—family member
No	85	100	69
Yes	15	—	31
Transportation—public
No	97	100	94
Yes	3	—	6
Self-describe overall health
Excellent	6	13	—
Very good	19	13	25
Good	47	68	25
Fair	28	6	50

Note: N = 32.

Analysis

Concurrent analyses of the qualitative and quantitative data were conducted. The data from the questionnaire were entered and analyzed to identify descriptive information about the informants using SPSS. Audio-taped focus group sessions were transcribed, and Atlas-ti (Muhr, 2004, 2008) was used to analyze the data. The analysis also included debriefings with moderators and review of observation notes with research team. First sentence-by-sentence open coding was conducted by the PI, followed by writing and reviewing memos and then focused coding. A member of the research team, a graduate assistant, also coded a focus group session and assisted in refining the coding frames. This provided cross-checking of codes.

Environmental data regarding health promotion resources were geocoded by the researcher, using ArcGIS (ESRI, 2007) to produce maps. The maps (spatial data) were reported in terms of the amenities, infrastructure, and access to senior centers and other health promotion resources (i.e., adult day and congregate meals programs, parks, greenways, transportation services, hospitals, and health departments). The numbers and location of the health promotion resources were analyzed by the research team and discussed with the RAC. Emergent themes were identified.

Qualitative and quantitative data were merged, using an inductive process in which subthemes were derived from the maps and then compared to the focus groups’ emergent subthemes (for example see Table 2) and both were later compared to the questionnaire results. This process provided a joint review of all data types to create consolidated themes and a data set expressed both in quantitative (but mostly) qualitative forms (Creswell et al., 2002; Tashakkori, & Teddlie, 2002; see Table 3).

Table 2.

Focus groups subthemes.

Focus group subthemes (in italics) and representative quotes
Being independent and taking care of oneself is important
“means taking some action to take care of the aches and pains and things that come up and figuring out how to be comfortable.”
Relying on faith and spirituality to maintain ones health as they age
“I stay healthy . . . exercising and tending to the Lord.”
Feeling that leisure physical activities is a new concept
“A lot of us worked hard on our jobs and when we came home we had to prepare meals, lots of us had to prepare meals doe the children and so forth, so when they did settles down some people.” were just knocked out…so… it created an environment of no exercise.
Staying motivated to maintain a healthy lifestyle is difficult
“I use to walk every day. . . . But I’ve just gotten to the place where I’m lazy.”
“The exercise they do now is too strenuous.”
Appreciating group activities
“We try to go to the senior center they have lots to do. . . .”
“We use to walk together every morning. . . . I don’t like doing it by myself.”
“I eat at the Center when I can get there . . . sometimes I eat at (congregate meal site).”
Attempting to eat a well-balanced diet, but access to healthy foods is challenging.
“[Speaking of a food market in another community] They had navel oranges which were much cheaper than those in the stores in my neighborhood.”
Having a social support system
“I drive a short distance. I can’t go but so far. Then I have to get someone to take me.”
“A group of us walk at the track at the church. . . . I don’t like to walk alone.”
Traveling to health related programs is inconvenient and often not affordable
“I don’t drive long distances. . . . I’m having this problem with going to the doctor.”
“You can get a cab, but do you know how much a cab is?”
Wanting more programs offered in the community
“If they could get a Van and pick people up and have something at the church.”
Worrying about their community and safety when walking for exercise
“Well, times have changed and um, places that were once safe to walk are no longer safe.”
Volunteering and having a voice in planning activities
“My idea is instead of expanding the church, cause we have 3 services and neither service over flowing . . . build a building right out there and you can . . . have a computer room you can have an exercise room.”
“We I get a truck load of fruit I make sure that I bring it by the center. . . . I do this on my own.”

Table 3.

Themes and consolidated analyses.

Ecological factors	Grouped subthemes from all data^a
Environmental	Aging in place in communities where they have lived most of their lives Traveling to neighboring communities to participate in healthy aging programs, health promotion programs, and senior center activities is a barrier Commuting and arranging transportation is expensive, inconvenient, and challenging Walking in parks or around the neighborhood for physical exercise is not safe Desiring more amenities and easier access to health promotion and healthy aging programs Wanting better access to high-quality, reasonably priced healthy foods (fruits and vegetables)
Interpersonal	Engaging in leisure health promotion activity as part of a healthy lifestyle is a new concept Enjoying social and group activity that promotes a healthy lifestyle when they participate Having a social support system is important
Individual	Being independent and taking care of oneself is important Relying on faith and spirituality to maintain ones health as one ages Feeling that leisure physical activities is a new concept Staying motivated to maintain a healthy lifestyle is difficult Wanting more information and help to prepare healthy and nutritious meals
Consolidated themes
Wanting to be self-reliant and independent as they age in place Difficulty navigating the barriers to accessing health supporting amenities and wanting health promotion programs that were easier to access Engaging in a healthy lifestyle is challenging because some of these health behaviors and practices are new and it is difficult staying motivated Wanting to have a healthy diet, but find it difficult due to transportation barriers, cost, and overall lack of access to helpful information and assistance Feeling that their spirituality, religion, and helping others are associated with a healthy lifestyle Needing social incentives, including interaction with peers, and meaningful activities

Themes from the maps, focus group, and questionnaire data.

The research team and RAC also reviewed the emergent coding frameworks, maps, and aggregated questionnaire results as well as the consolidated themes. They confirmed the accuracy of the themes and overall strategies. In addition, a community summit was conducted 7 months after the data were collected to disseminate the findings to the larger community and to discuss the implications of the findings. There were about 45 attendees at the half-day event and community views were obtained. The summit participants included representatives from local organizations and health care facilities that provide services to older adults, community volunteers, focus group participants who voluntarily provided contact information, researchers, and the RAC. This interactive process provided additional insight regarding community resources. Information obtained from RAC and summit lead to the refinement of themes. Their perspectives are reflected in the analysis and strategies sections.

Results

Study Informants and Questionnaire

The 32 African American older adults who participated in the study were 60 to 89 years old, 85% were women (5 male and 28 female), retired, and living in the communities in the study (see Table 1). The median age was 61 to 70 (44%) for all informants. Most did not use public transportation (97%) and usually drove themselves to appointments and around town (91%). It should be noted that the Zebulon participants were more likely to rely on family members for transportation (31%). The SE Raleigh group was slightly older; most were between 71 to 80 years old (44%). Older adults in this group had some college education, their incomes were higher, and they reported slightly better health than the Zebulon informants. Because informants from both study sites consistently gave similar responses to the focus group questions, the results are reported in aggregate form.

Maps: Aspects of the Physical Environment

Overall, amenities and health promotion programs for older adults were available in the county and with some access to the areas studied. The maps displayed the county and the two study areas (see Figure 1). Specific health promotion amenities, parks, and trails, as well as Senior Centers, Adult Day Centers, and hospitals (see Figures 1 and 2) are highlighted. The maps show that 5 Senior Centers, 10 Adult Day Centers (usually for adults with some disability or impairment), and 7 congregate meal sites were located in adjacent communities, but not specifically in the study areas. The maps show that places to walk and exercise (trails, greenways, parks) are available. Most were located outside the study areas. There were several bus routes in the section of SE Raleigh, but no regular bus routes were available in Zebulon. The themes that emerged were (a) location of most programs and amenities were in adjacent communities, and (b) public transportation was limited.

Figure 1.

Health promotion environment map.

Focus Groups

The informants indicated that they were longstanding members of their respective communities and were aging in place. Several themes emerged and are reported in Table 2. A strong desire to maintain their independence and to stay physically and mentally active was expressed by informants. Some older adults participated in regular physical activities and others found physical activity programs too strenuous. One common theme was evident; they appreciated the idea of leisure exercise but related that it was a new concept for most of them. Staying motivated to engage in a healthy lifestyle was difficult. They relied on their faith and spirituality to provide spiritual well-being and support. In addition, informants also agreed that social activities with peers and group activities at senior centers, churches, and other community-based facilities were the preferred methods for delivering healthy aging programs.

Informants also reported environmental issues. Limited access to safe and convenient places to exercise, lack of transportation, and access to healthy, reasonably priced food emerged as consistent problems. Health promotion amenities and programs were often located in adjacent communities, and transportation difficulties were very real for these older adults. Many depended on family and friends to take them to medical appointments because they did not drive “long distances.” Many attempted to include the recommended amounts of fruits and vegetables in their diets but found it very expensive. Access to high-quality, reasonably priced foods meant shopping outside of their immediate community. They expressed that more programs focused on nutrition and healthy food preparation classes are required in their communities.

Consolidated Themes

The ecological themes regarding healthy aging and health promotion and the consolidated analyses are identified in Table 3. Overall, informants wanted to preserve their continued independence as they aged in place; however, they encounter barriers to a healthier lifestyle and access health supporting amenities. Some lacked motivation to be active and they desired incentives, including social connections and interaction with peers. Practices important to maintaining a healthy life style, including leisure exercise and healthy diets, were new and building them into their daily routine was challenging. It was difficult staying motivated. Environmental factors, including transportation, cost, access to amenities, and helpful information and programs, presented real challenges to a healthy lifestyle. Spirituality, religion, volunteer work, and helping others were viewed as being central to healthy aging and an important resource. Social incentives, including interaction with peers, was also associated with a healthy lifestyle. The informants wanted meaningful activities and health promotion resources that were convenient, easy to access, and in their communities.

Discussion

The study provided an ecological view of the health promotion environment and the perceptions and practices regarding healthy aging and health promotion for a group of African American older adults. This approach of viewing issues through an ecological lens with mostly qualitative data enabled integration across levels of analysis. A concern such as insufficient transportation was associated with lifestyle quandaries, such as access to senior centers or healthy foods and the resulting challenges to healthy behaviors. The themes and consolidated analysis bring to the forefront how individual, interpersonal, and environmental factors are sometimes inextricably linked.

The consolidated ecological analysis provided an integrated view of healthy aging for these older adults. Their health promotion environment, in terms of transportation, cost, access to resources, and amenities within a community, was recognized by informants as integral to maintaining one’s health as they aged in place. This supported previous research (Balfour & Kaplan, 2002; Bouchard et al., 2007; Ross & Mirowsky, 2001). These informants shared that the proximity of resources is an important factor as well. While independence and self-reliance was highly valued by these informants, as found in previous studies (Balfour & Kaplan, 2002; Bouchard et al., 2007; Ross & Mirowsky, 2001), motivation to remain engaged in health promoting activities was not always present and needed ongoing encouragement and social incentives. Spirituality and faith also emerged as a key factor to healthy aging. These informants linked meaningful activities, volunteering, and helpful information regarding diet and other healthy aging guidelines as being linked to motivation and enhancing their health promotion environment.

Best Practice: Strategies to Promote Healthy Aging

Based on the implications derived from the findings of this study, four best-practice strategies are proposed. They are (1) working with community members to tailor compatible outreach services to engage older adults, (2) offering social support and incentives to motivate participation, (3) providing healthy eating and good nutrition opportunities and programs, and (4) emphasizing cultural compatibility.

Outreach

Providing access to meaningful health promotion activities, and information is indicated. This might take the form of outreach services or satellite programs that engage older adults in their communities. Senior center and recreation program staff can identify community leaders, including older adults themselves, who are interested in the health and well-being of older adults. Together they can take a leadership role by reaching out to older adults who are less active or who have difficulty attending in-house senior center activities because of distance or transportation issues. Another option is to organize or support block clubs, so that older adults who live near each other can meet and form walking groups or share transportation to center activities. Efforts to locate centers or center activities in local communities should not be ignored and could be accomplished by establishing partnership with local organizations, churches, and older adult community leaders.

Motivating with social support and incentives

Providing opportunities for older adults to engage in meaningful activities that have social components is indicated. Older adults describe situations in which they are socially isolated and in need of activities that connect them with peers. The social aspect of connecting with others can serve as an incentive to routinely engage in any activity. There is also a need to make the activity culturally compatible. Older adults in this generational cohort have indicated they did not participate in leisure exercise as young adults. Involvement in community and church activities may be a more familiar starting point (Crew, 2007). Tapping into the social networks in place and supporting these networks as they engage in health promotion activity may prove to be beneficial. Older adults expressed involvement in walking groups and crop walks (walking to support social causes). These were meaningful activities that had both a social component and health benefits. Aging network organizations can work with local churches, lodges, fraternities, and so on, as well as community leaders, to organize and support health promotion activities. Mall walking, intergenerational walking groups, health fairs, all can be located in the community in partnerships with churches, recreation centers, and other community organizations.

Nutrition and healthy foods

Increasing access to affordable fresh fruits and vegetables is also important. Older adults often depend on local convenience stores and may have very limited access to community farmers’ markets and other affordable options (Ralston, 2008; Robinson, 2008; Wellman et al., 2007). It may be beneficial to work with local organizations and churches to create and maintain food co-ops or sponsoring community gardens in which older adults and other community members can work together to provide inexpensive fresh fruits and vegetables. Some older adults preferred a more hands-on approach. This might take the form of cooking demonstrations, cooking clubs, or healthy-choice luncheons to supplement lectures on nutrition.

Emphasis on Cultural Compatibility

Healthy aging and health promotion programs for older adults must provide culturally responsive outreach and activities. In this study, older adults expressed a connection between their spiritual beliefs and healthy aging. Partnering with the faith community has been identified as a best practice in prior studies (Arcury, Quandt, & Bell, 2000; Reid et al., 2003; Wellman et al., 2007) and is an important component of cultural compatible programs for African American older adults. Facilitating a partnership with the faith community and becoming joint sponsors of health promotion activities is indicated. This form of collaboration may facilitate culturally appropriate strategies for health promotion.

A limitation to this study was the small sample confined to two communities. In addition, there were some differences in age and reliance on family members for transportation between the two groups. This may be related to cultural or environmental variations that are not fully explored in this study. For these reasons, the results cannot be generalized to the larger African American community but do seem to build on previous research (Arcury et al., 2000; Bopp et al., 2007; McLeroy et al., 1988; Rasheed & Rasheed, 2003). In addition, one researcher coded all of the focus group transcripts: A second researcher coded one group as presenting an opportunity to compare themes as suggested by Barbour (2001), though in a somewhat limited way. However, the coding frame and themes were routinely reviewed by the research team and later by the RAC and summit participants. In addition, the study did not include data regarding all of the service programs (formal and informal) that may take place in the study areas. The researchers looked at the programs that older adults had knowledge of and reported in the focus groups as well as the physical location of advertised aging organizations. The study did not include an exhaustive list of health promotion amenities. Future studies may more fully examine other types of health promotion programs. Finally, the paucity of men in this study is another issue. However, it is well documented that African American women outnumber African American men as the age (Satcher et al., 2005).

Conclusions

Viewed through an ecological lens, health promotion and healthy aging take into account the person in the environment dynamic and provide multilevel awareness of factors and strategies. This approach is especially appropriate when working with African American older adults, who may be less involved in healthy aging services. Understanding ecological interactions provides a fuller picture of the healthy aging realities for African American older adults and their health promotion needs. This study supported the need to use an ecological lens to understanding healthy aging and health promotion for African American older adults who are most vulnerable to chronic illness.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by the John A. Hartford Foundation’s Geriatric Social Work Faculty Scholars program and is administered by The Gerontological Society of America.

Author Biography

Cheryl Waites is a professor and dean at Wayne State University in August 2007. She is a Hartford Geriatric Social Work Faculty Scholar Cohort VII. Her research areas include healthy aging, health promotion, inter-generational relationships, and culturally appropriate and responsive practice. She has also studied promising practices for enhancing gerontological social work education and training.

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