Implementation of community-based health checks and peer-to-peer support to promote functional ability for older people living in rural Zimbabwe

实施基于社区的健康检查和同伴支持，以提高津巴布韦农村老年人的功能能力

• 批准号: MR/Y019520/1
• 负责人: Celia Gregson
• 金额: $ 135.56万
• 依托单位: University of Bristol
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY019520%2F1
• 关键词: Implementation; community; based; health; checks

Thanks to advances in health and sanitation, around the world people are living longer than ever before, with the greatest improvement in life expectancy happening in sub-Saharan Africa. In these added years of life, older people understandably want health and wellbeing, that is 'healthy ageing'. However, currently many African countries, with challenged healthcare services and limited resources, are struggling to provide for their rapidly ageing populations, meaning older people are more likely to be living with disability and dependence.The World Health Organization (WHO) describes healthy ageing as an older person's ability to walk, see and hear, and function mentally within the place they live. As countries develop health services to meet the growing needs of ageing populations, there is an opportunity now to proactively plan innovative ways of providing holistic healthcare to help people age well. In sub-Saharan Africa most older people retire to their rural homes (called Kumusha in Zimbabwe). Here we will develop a 'Healthy Ageing Check-up', run by nurses and therapy technicians in local rural communities, where older people can be assessed and offered practical management to maintain health as they age. We will work with a range of stakeholders, healthcare experts and older people themselves, to develop a health check-up for people aged 65 years and older, that we will test in Zimbabwe. The check-up will assess for example, walking, balance, nutrition, memory, mood, eyesight, and hearing. We expect most older people will have problems in several areas. When we find a problem we will offer advice, practical solutions, local peer support meetings and, if needed, facilitate specialist referral. We will continue to work closely with local communities throughout the research to understand perspectives, seek advice, feedback progress and importantly, develop effective peer support groups, each led by a lay community champion, trained in particular aspects of healthy ageing by our team. Peer support groups will bring together older people with similar conditions to enable group-based self-management and activities (e.g., group exercises, group work on diet, cooking and nutrition, memory exercises).We will test how well the roll-out of these health checks and the solutions work, for example how often we identify a health problem, how often we can offer a solution and, when we follow them up again after 4 months, how frequently the older person has taken up the recommendations. In theory, access to public healthcare is free for older people in Zimbabwe, although in practice this is not always the case. So, as well as calculating how much it costs to provide the health check-ups and care, we will see if people experience extra 'out-of-pocket' costs because of the health checks, and if so, the reasons for this. Throughout, we will gather detailed feedback from patients, families, and healthcare workers, about the health check-up programme, so that we can refine and improve the process. Finally, communicating with the WHO, we will develop a 'Healthy Ageing Intervention Toolkit' to guide the structured, comprehensive, person-centred assessment and management of older people in community settings, suitable for scale-up to other countries across sub-Saharan Africa.Zimbabwe is an ideal place to do this research, which we have agreed with WHO Africa, as the findings will reflect the situation in similar neighbouring countries in the region, where healthcare services face similar challenges. Plus, our research team have long-standing working relationships with the Ministry of Health, so that our research findings can directly inform healthcare solutions. Over the four years, we will grow a highly skilled and experienced global health and ageing research team to ensure positive impacts on older people's health for many years to come, and build capability to conduct further important research in this area.

由于健康和卫生方面的进步，世界各地人们的寿命比以往任何时候都更长，其中撒哈拉以南非洲地区的预期寿命改善幅度最大。在生命的这些岁月里，老年人想要健康和福祉，这就是“健康老龄化”，这是可以理解的。然而，目前许多非洲国家的医疗保健服务面临挑战，资源有限，正在努力应对迅速老龄化的人口，这意味着老年人更有可能患有残疾和依赖。世界卫生组织 (WHO) 将健康老龄化描述为老年人在他们居住的地方行走、看、听以及心理运作的能力。随着各国发展卫生服务以满足人口老龄化日益增长的需求，现在有机会积极规划提供整体医疗保健的创新方式，帮助人们安享晚年。在撒哈拉以南非洲地区，大多数老年人退休后回到农村家园（津巴布韦称为库穆沙）。在这里，我们将开展一项“健康老龄化检查”，由当地农村社区的护士和治疗技术人员开展，对老年人进行评估并提供实用的管理，以保持老年健康。我们将与一系列利益相关者、医疗保健专家和老年人本身合作，为 65 岁及以上的人开发一种健康检查方法，我们将在津巴布韦进行测试。检查将评估步行、平衡、营养、记忆、情绪、视力和听力等。我们预计大多数老年人都会在几个方面遇到问题。当我们发现问题时，我们将提供建议、实用的解决方案、当地同行支持会议，并在需要时促进专家转介。我们将在整个研究过程中继续与当地社区密切合作，了解观点、寻求建议、反馈进展情况，重要的是，建立有效的同伴支持小组，每个小组都由一名非专业社区冠军领导，并由我们的团队接受过健康老龄化特定方面的培训。同伴支持小组将把具有相似条件的老年人聚集在一起，以进行基于小组的自我管理和活动（例如小组练习、饮食、烹饪和营养方面的小组工作、记忆练习）。我们将测试推出的效果如何这些健康检查和解决方案是有效的，例如，我们多久发现一次健康问题，多久提供一次解决方案，以及当我们在 4 个月后再次跟进时，老年人接受建议的频率。理论上，津巴布韦老年人可以免费获得公共医疗保健，但实际上情况并非总是如此。因此，除了计算提供健康检查和护理的费用外，我们还将了解人们是否因为健康检查而承受额外的“自付费用”，如果是的话，原因是什么。在整个过程中，我们将收集患者、家属和医护人员对健康检查计划的详细反馈，以便我们完善和改进流程。最后，我们将与世界卫生组织沟通，开发“健康老龄化干预工具包”，指导社区环境中对老年人进行结构化、全面、以人为本的评估和管理，适合推广到撒哈拉以南非洲其他国家津巴布韦是开展这项研究的理想地点，我们已与世界卫生组织非洲分部达成一致，因为研究结果将反映该地区类似邻国的情况，这些国家的医疗服务面临类似的挑战。此外，我们的研究团队与卫生部有着长期的合作关系，因此我们的研究成果可以直接为医疗保健解决方案提供信息。在四年内，我们将培养一支技术精湛、经验丰富的全球健康和老龄化研究团队，以确保在未来许多年对老年人的健康产生积极影响，并建立在该领域开展进一步重要研究的能力。