Home-based health promotion for chronically ill older persons: results of a randomized controlled trial of a critical reflection approach

The purpose of this study was to test a health promotion intervention for p eople over 65 years of age discharged from hospital to care at home for chr onic medical conditions. Researchers hypothesized that chronically ill olde r people who received the intervention would have a significantly more posi tive mindset (or attitude toward their life, self health, and health cave), would use significantly less hospital and home care services and would hav e a significantly better quality of life. At the time of discharge from hos pital, 298 seniors were randomized to receive the usual home care plus the intervention, or to an attention control group receiving the usual home car e. The intervention was comprised of approximately 10 weekly hour-long sess ions in which a nurse facilitated critical reflection on life and health. D ata collected by personal interview at baseline, 22 weeks, and 1 year later were analyzed using ANOVA and logistic regression, controlling for age, ge nder, living arrangements, accommodation, number of chronic medical problem s and baseline differences, as appropriate. Results: Those who received the intervention had significantly greater independence (p = 0.008) and percei ved ability to manage their own health (p = 0.014) and significantly less d esire for information (p = 0.021) immediately post-intervention. At the 1-y ear follow-up, the pattern persisted although significant differences were limited to independence (p = 0.007) and desire for information (p = 0.035). As well, at I-yens the intervention group had higher yet more significantl y declined self-care agency (p = 0.025) and focus of authority (p = 0.017). Comparison of changes in health resource utilization by the two groups did not differ significantly. However, the intervention group had a significan tly greater (p = 0.006) chance of having higher quality of life immediately post-intervention This trend persisted at I year, although differences wer e non-significant. Results suggest the clinical potential of critical refle ction to enhance the health of chronically ill older persons. Further inves tigation with less frail populations is needed.