“Impact of Health Promotion Practices on Health-Related Quality of Life (HRQoL) among Geriatric population in Karachi, Pakistan.”

“Impact of Health Promotion Practices on Health-Related Quality of Life (HRQoL) among Geriatric population in Karachi, Pakistan.” | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Impact of Health Promotion Practices on Health-Related Quality of Life (HRQoL) among Geriatric population in Karachi, Pakistan.” Ambreen Merchant This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3886928/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract Background Demographic transition has resulted in increased life expectancy among older adults that will lead to the emergence of new illnesses, long-term impairments, and alterations in social attitudes. The need to prioritize actions for this population, with a focus on enhancing the quality of life, fostering autonomy and independence, and promoting active and healthy aging, has made health education for the elderly a topic of global interest due to current demographic and epidemiological changes. The purpose of this study is to assess the impact of health promotion on enhancing health-related quality of life among elderly people in Karachi, Pakistan. Study Setting & Design: Data was collected at a Senior Citizen & Recreation center, located near the participants' residence in Karachi, Pakistan. A well-structured generic HRQoL instrument (SF-36) short form was used. Methods One-group pre-test and post-test interventional (Quasi-experimental) research design using a mixed method approach (Qualitative and Quantitative). Inferential statistics are drawn through paired sample t-test to compare the mean of pre-test HRQoL scores with post-test HRQoL scores. The qualitative analysis was made through a thematic categorical method. Results Revealed significant impact of health-promoting activities on 3 sub-scales of HRQoL. However, on other subscales of HRQoL, health-promoting interventions produced little impact. Conclusion Health promotion can play a significant role in improving health-related quality of life. Health-related Quality (HRQoL) geriatrics health promotion healthy aging Low-Middle Income Countries (LMIC) elderly older adults Figures Figure 1 Background Geriatrics is a discipline of internal medicine that focuses on the treatment of aging adults to improve their overall health by preventing and treating illnesses and disabilities. ( 1 ). Aging is a natural process and is associated with the gradual accumulation of molecular and cellular damage. ( 2 ). With time, the damage progresses and results in the loss of physiological functioning of an individual, deteriorating general health and capacity. Thus, it increases the risk of illnesses leading to death. ( 3 ). The aging population is a worldwide phenomenon involving both developed and developing countries. ( 4 ). Global population aging is occurring at a rapid pace. Demographic transition has resulted in increased life expectancy among older adults to an extend that according to an estimate, more than 20% of people in the World will be 65 or older by 2050. ( 5 ).The elderly population is growing with a decline in their health condition because of rapid transformation and growth. ( 4 , 6 ). The number of people aged 80 and more is expected to quadruple by 2050, from 143 million in 2019 to 426 million. Also, it is expected that approximately 8 in 10 of the world’s elderly population will reside in developing parts of the world by 2050. ( 7 ). In Pakistan, currently there are 11.3 million elderly population; by 2050, it will increase to 43.3 million, or roughly 15.8% of the country's overall population. ( 8 ). According to UNFPA and Help Age International data, Pakistan ranks seventh among 15 nations in the world with more than 10 million older people. The average life expectancy in the country is of 62 years, an aging index of 12.8, and a dependence ratio of 6.6. ( 5 ). An increase in the elderly population will lead to the emergence of new illnesses, long-term impairments, and alterations in social attitudes.( 8 ). In terms of healthcare expenditure in Pakistan, the elderly population relies on the younger generation for financial support. ( 9 ). In a survey regarding identifying health and needs of geriatric patients; a significant number of respondents stated financial issues. ( 10 ). The rise in life expectancy, a lack of safety nets, and poverty all contribute to an increase in stress and deteriorating health. Only government employees and some private organization employees receive a certain degree of financial protection from the government after retirement in the form of pensions. ( 9 ). From healthcare lens, there are multiple geriatric healthcare issues which need to be focused upon such as limited number of geriatric residential and rehabilitation centers; lack of proper geriatric and elderly care trainings of healthcare professionals to identify physical, social, spiritual and mental health needs and provide quality care to them accordingly. ( 11 , 12 ). In order to address such healthcare issues, it is of prime importance to focus on primary level of prevention along with planning strategies secondary and tertiary level of care. Primary prevention consists of health promotion which means to create awareness among people to adopt healthy lifestyle through health education sessions, awareness campaigns, counseling programs to financial incentives. ( 13 ). The need to prioritize actions for this population, with a focus on enhancing quality of life, fostering autonomy and independence, and promoting active and healthy aging, has made health education for the elderly a topic of global interest due to current demographic and epidemiological changes. ( 14 ). Moreover, several research suggest that health promotion shows significant role in reducing burden of disease, ceasing functional decline, increasing life span and improving quality of life. ( 15 ). The purpose of this study is to assess the impact of health promotion on enhancing health-related quality of life among elderly people in Karachi, Pakistan. Methods Study Design This study is based on a one-group pre-test and post-test interventional (Quasi-experimental) research design using a mixed method approach (Qualitative and Quantitative). The reason for choosing this design as it allows the researcher to compare outcomes before and after intervention, which aids in quantifying impact more precisely.( 16 ) A questionnaire tool (SF-36) was administered before and after conducting the intervention. Interventions were comprised of Health promotion activities i.e., a physical fitness session; a stress management workshop, and an Education session on General Health responsibility as these all are major domains of health-related Quality of life (HRQoL). In physical fitness sessions, simple exercises suitable for all seniors according to their level of activity were taught. Furthermore, in the stress management session, a few relaxation exercises and tips to manage and overcome stressful situations were enforced. Lastly, a group of nurses gave them a health education session on preventing and controlling non-communicable diseases, general health responsibilities, adherence to medication regimen, regular eye and dental follow-ups, avoiding polypharmacy, etc. to manage health and encouraged them to take responsibility and accountability for their health in order to stay fit and healthy. All nurses were professionals and involved in health education sessions on a voluntary basis. Figure. 1 explains the overall design of this study as it was conducted in a single setting over a period of 2 months, whereby, participants were assessed at Time one (T1) as the pretest and second time (T2) as the post-test for the outcome variable (HRQoL). Figure. 1 Study Design Process Study Participants In this study, a Nonprobability purposive sampling technique was used for the selection of the participants. This sort of sampling method involves the selection of study participants based on certain features as discussed in the inclusion and exclusion criteria. Moreover, data was collected from a sample size of 300 elderly people including both males and females. Inclusion Criteria The study participants were comprised of elderly people who were at the age of 60 and above; showed interest in participating and provided consent. Secondly, able to comprehend Urdu or English Language and has no hearing impairment or any complex health problems. Lastly, participants were selected irrespective of their gender (male or female); education status (literate or illiterate); and marital status (married/unmarried or divorced). Exclusion criteria Those elderly people who didn’t provide consent and were not interested in participating. Also, those who were with hearing impairment or having complex medical health issues were excluded. Study Setting & Data Collection Data was collected at a Senior Citizen & Recreation center, located near the participants' residence in Karachi. All seniors involved in the study were residents of the same or nearby residential area. They attend and participate in Center activities regularly. A well-structured generic HRQoL instrument (SF-36) short form was used to collect data from the study participants before and after conducting health promotion interventions to compare pre- and post-interventional responses and to accurately measure the positive or negative impact of the intervention. This tool (SF-36) was adopted from “rand health- 36 items short form survey”. The survey instrument comprised two sections A and B. In the end of interventions, participants feedback and evaluation were taken verbally and in written form to identify their perspectives on health promotion interventions and does these interventions have produced any sort of impact in improving their health-related quality of life (HRQoL). Measurements Questionnaire tool’s Section A consists of demographic data involving the questions related to the background details of the participants. Section B of the SF-36 tool consists of 36 close-ended questions on 8 dimensions or sub-scales of HRQoL i.e., Physical functioning, Role limitation due to physical health, Role limitation due to emotional problems, Energy/Fatigue, Emotional well-being, social functioning, Bodily pain, and General health. These sub-scales are measured through a Likert scale associated with each self-rated question from each sub-scale. Each sub-scale score ranges from 0-100 with interpretation as the highest scores reflect better health conditions and lower scores reflect deteriorated health status. Data Analysis Quantitative analysis for the categorical variables of socio-demographic details of study participants is made through frequencies and percentages. Independent variables of the study include Gender is denoted as male and female ; Age is categorized as 60-65.9 years, 66-70.9 years, 71-75.9 years, 76–80 and above 80 years ; Marital Status is denoted as unmarried, married, widowed and divorced ; Education is represented as no education, primary education (class 1–5), middle education (class 6–8), Secondary School Certificate (Matriculation), Higher Secondary School Certificate (Intermediate) and Higher Education Levels (Bachelors/Masters/doctoral). Inferential statistics are drawn by applying a paired sample t-test to compare the mean of pre-test HRQoL scores with post-test HRQoL scores. The confidence level of 95% and p-value less than 0.05 have been considered significant throughout the analysis. Qualitative analysis has been made through a thematic categorical method and from those analysis, three themes emerged by the analysis of participant’s feedback and comments. Results Study participants' socio-demographic data showed that overall, 56% of the participants were females and 44% were males. Furthermore, most of the elderly participants were from the age group between 66 years to 75 years of age. Table 1 shows the other socio-demographic presentations of participants. Table 1 The Socio-demographic characteristics of the study participants. Table 1 The Socio-Demographic Characteristics of the Elderly Participants (n = 300) Characteristics Results Characteristics Results Gender Age Male 132 (44%) 60-65.9 years 38 (12.6%) Female 168 (56%) 66-70.9 years 82 (27.3%) Education 71-75.9 years 106 (35.3%) No education 86 (28.6%) 76–80 years 48 (16%) Primary Education (class 1 to 5) 68 (22.6%) Above 80 years 26 (8.6%) Middle Education (class 6 to 8) 64 (21.3%) Marital Status Secondary School Certificate (Matriculation) 42 (14%) Married 156 (52%) Higher Secondary School Certificate (Intermediate) 30 (10%) Un-married (single) 24 (8%) Higher Education Levels (Bachelors / Masters/Doctoral) 10 (3.3%) Widowed/Divorced 120 (40%) Quantitative Results By applying a paired t-test to draw inferential statistics, depicted in Table 2 : Pair 1 of pre-and post-interventional scores of physical functioning showed that there is no significance as their mean difference from the pre-test to post-test is 1.72 (SD +/- 6.61), and p-value of 0.72. Similarly, Pair 2 role limitation due to physical health and Pair 3 role limitation due to emotional problem showed no significance from the pre-test to post-test as their mean score were 1.00 (SD +/- 8.14) and p-value 0.389 and 6.05 (SD +/- 23.09) and p-value 0.070 respectively. Pair 5 emotional well-being and pair 7 bodily pain also reflect non-significance as their mean difference were 0.830 (SD +/- 5.89) and p-value 0.325 and 1.67 (SD +/- 4.57) and p-values 0.013 respectively. This concludes that there is no significant impact of health promotion activities in improving physical health, role limitation due to physical health and emotional problems, and alleviating bodily pain. However, pair 4 energy/fatigue mean difference-17.65600 (SD +/-8.37441) and p-value of 0.00, pair 6 social functioning is -10.75 (SD +/-10.22), and p-value 0.00 and pair 8 general health mean difference is -12.17 (SD +/- 10.35) and p-value 0.00 reflects the significant impact of health promotion on this health-related quality of life sub-scales. Therefore, for Energy/ Fatigue; Social Functioning, and General Health perspective, we conclude that there is a significant impact of Health Promotion on the health-related quality of life (HRQoL) of the elderly. Table 2 : Paired sample t-Test 8 sub-scales SF-36 questionnaire Table 2 Instrument SF- 36 questionnaire (08 sub-scales)Paired Sample t- Test Sub- Scales Mean Std. Deviation 95% Confidence Interval of the Difference t-scores Lower Upper Pair 1 Physical Functioning (Pre-test) - Physical Functioning (Post-test) 1.72000 6.61797 − .16081 3.60081 1.838 Pair 2 Role Limitation due to Physical Health (Pre-test) - Role Limitation due to Physical Health (post-test) 1.00000 8.14411 -1.31453 3.31453 .868 Pair 3 Role Limitation due to Emotional Problem (Pre-test) - Role Limitation due to Emotional Problem (Post-test) 6.05500 23.09569 − .50872 12.61872 1.854 Pair 4 Energy/Fatigue (Pre- test) - Energy/Fatigue (Post-test) -17.65600 8.37441 -20.03598 -15.27602 -14.908 Pair 5 Emotional Wellbeing (Pre-test) - Emotional Wellbeing (Post-test) .83000 5.89847 − .84633 2.50633 .995 Pair 6 Social Functioning (Pre-test) - Social Functioning (Post-test) -10.75000 10.22614 -13.65624 -7.84376 -7.433 Pair 7 Pain (Pre-test) – Pain (Post-test) 1.67000 4.57657 .36935 2.97065 2.580 Pair 8 General Health -12.17600 10.35777 .36935 2.97065 2.580 Qualitative Results Participants were highly motivated and engaged in health promotion activities throughout the study. They provided verbal and written feedback in the evaluation forms, which were categorized thematically. Empowerment and increased confidence in self-health management; improved mental health; need of more such activities were the three themes that emerged from the analysis. 1. Motivation and Increased confidence in self-management The majority of the study participants felt motivated while involved in health promotion activities on various preventive and home-health management issues. They were able to learn from these sessions as the sessions were according to their level of understanding and well-paced. These sessions and hands-on activities have enhanced their understanding and boosted their confidence in self-care. One of the participants mentioned, “These days (during the study period), I felt empowered and able to take care of my and my wife’s health as we live alone. Previously, I was too scared as we age; health becomes more fragile and we get ill more frequently. However, now I know how to prevent and care for myself through the knowledge and skills we learned.” 2. Improved mental health and wellbeing Health promotion activities posed a positive impact on the mental health and well-being of the participants. During these sessions, all elderly participants were able to interact and socialize, exchange their thoughts, and get to know each other’s ideas and complications. Increased opportunities for socialization enabled them to feel positive and valued. Participant's social functioning has improved which was found significant in quantitative analysis as well. One of the participants mentioned, Usually I cannot attend health camps and campaigns arranged by the hospitals due to non-affordability to cover travel costs and spending a lot on follow-ups and registrations of such camps as there are very few free health awareness and medical camps arranged for us (elderly). However, these health promotion activities and health awareness provided to us enabled us to share and discuss our health concerns and also we were able to interact with each other and learn from each other. 3. Need for more such activities Elderly participants acknowledged the initiative and recommended to their senior citizen center management to continue arranging such sessions for them in the future. They understand the importance of prevention which can help them to maintain their health status while going through the natural process of aging. Such health promotion initiatives and awareness sessions play a pivotal role in optimizing the general health of elderly people and minimizing and delaying their health-related complications due to the degenerative process of aging. Discussion This study unpacks the impact of health promotion as a primary care intervention in improving health-related quality of life among the elderly. Health promotion activities in this study comprised of health education sessions on basic Range of Motion (ROM) exercises, stress management, prevention and management of Non-Communicable Diseases (NCDs), fall and fall prevention and associated morbidities, and energy conservation techniques are all basic yet essential and critical areas that require the attention of health systems to offer such health awareness campaigns for elderly to address their concerns and frequent reiteration is must. ( 17 ). It can assist people in managing both their mental and physical illnesses, as well as strengthening their personal, familial, and social health and quality of life. In addition, it reduces waste and needless medical expenses while extending the average healthy life expectancy. ( 18 ). Several surveys and research studies have shown that age-related and degenerative health concerns cause older people above 60 years old and more to have more health problems and seek healthcare services more frequently. Thus, making them higher consumer of healthcare services. ( 19 ). Furthermore, according to another research study, older individuals are less likely to use the internet as compared to other adults and consequently more susceptible in terms of their health literacy capacity. ( 20 , 21 ). In such instances, arranging health promotion activities as a On-ground activity, in senior citizen centers, rehabilitation centers and on other electronic or print medium such as Radio, TV, newspaper and magazines will contribute to a greater extend in enabling older adults to prevent themselves from morbidities and reduce hospitalizations. ( 22 ). This study results also indicate the strength of health promotion consisting of disseminating health awareness through health promotion and primary prevention. In this study, three domains of Health-related Quality of Life (HRQoL) (social functioning, Energy/fatigue, and General Health) among elderly participants were found significant as it produced positive impact in improving their health conditions. First the social functioning, various research studies have shown strong positive associations of social participation with improved level of health literacy because social interaction through exchanging ideas, knowledge and experiences with others enhances social functioning. ( 20 , 23 ). Similarly, Energy and general health domains were found to be directly proportional to HRQoL as health promotion activities can help older people to understand the importance of self-care practices to manage their own health. Consequently, they feel more empowered and gain control of their aging process and feel less fatigued. Adopting self-care early in life is necessary to attain an ideal physical and mental health at older age. ( 24 ). Besides, the other domain of HRQoL i.e., Bodily pain, physical functioning, role limitation due to physical health and emotional problem and emotional wellbeing are found to have inversely proportional relationship with HRQoL and were not significant through health promotion activities. It's widely believed that staying physically active is essential to a long, healthy life. On the physical activity domain, however, study participants scored poorly. This result is in line with earlier research showing that this group of people is the least physically active in society. ( 25 ). When included as a personal habit at an early age, physical activity and other related health-promoting activities have been shown to endure into adulthood. ( 26 ). Despite the established health advantages, data indicate that many youths do not opt to participate in physical exercise to improve their health. Because good and unhealthy behaviors are acquired at a very young age, this results in a decline in health quality that has an impact far into old life. ( 27 ). Recommendations and Way Forward The elderly are a particularly vulnerable and fragile segment of the population. As people age, their body functionality declines. Aging people are more susceptible to diseases than young people and take longer to recover. With the senior population growing by the year, the healthcare system cannot ignore their relevance. It is critical to preserve the health of Pakistan's senior population in order to prevent disability and health-care costs. Extended life must be regarded as a valued resource, and this can be accomplished by extending a healthy middle-life. ( 28 ). Pakistan is a developing country with several challenges such as a sluggish economy, an inadequate health budget, and a fragmented health-care system. Many people must rely on out-of-pocket health care expenses. ( 9 ). Studies suggests that prioritizing the health promoting practices for Pakistan’s elderly population will contribute to enhance their health and reduces their overall healthcare costs. ( 29 ). To promote primary prevention at mass level, healthcare sector needs to up-scale primary healthcare system of Pakistan. In this notion, Public-private partnership could be one of the best possible solutions. According to a study, there was a case whereby, 104 BHU’s of Rahim Yar Khan District in Pakistan was contracted to an NGO to improve PHC setup. The contracted NGO bought numerous innovations like improving infrastructure of BHU, up scaling of salaries of medical officers and other interventions to bring the concept of accountability and responsibility were introduced. As per third party evaluation of this initiative, eventually situations were improved in terms of Utilization of BHU’s; increased community satisfaction rate; physical structure of BHU’s; improved technical quality of care; availability of medications and trained staff and budgeted expenditure and cost-effectiveness. This initiative should be expanded to other cities and districts as well. ( 30 ). In 1999, the government of Pakistan developed the National Policy to promote the optimal health of the elderly. This approach involved training doctors for primary care in geriatrics, providing dental treatment, domiciliary care, and establishing a system of health care providers for the elderly, including physical therapists and social workers. Unfortunately, this policy has yet to be implemented. ( 31 , 32 ). The Public Sector Development Programme (PSDP) and the Ten-Year Prospective Plan emphasized the care, well-being, and protection of the elderly by constructing senior citizen homes and local senior citizen clubs where older people can exchange their experiences, knowledge, and expertise. However, all of these measures must be properly implemented. The government has also prioritized the establishment of geriatric units in hospitals. ( 33 ). A survey report suggested that most of the older respondents requested senior citizen clubs and recreational centers where they can attend health promotion practices, discuss their concerns with geriatric experts, socialize, can form support groups to understand each other’s concerns being in same age group and facing same sort of challenges. This illustrates the senior population's need and desire to socialize. ( 10 ). This initiative works in line with the support group concept which aids in improving the social functioning and mental wellbeing of elderly. Also, it will serve as an avenue for healthcare professionals to easily access older people to provide them primary healthcare services and conduct health promotion practices and in case of severity of condition, early identification and timely referral will be an added advantage to reduce disease complexity and sufferings. ( 34 ). In such recreational spaces where senior citizens meet and spend time, public health can expand its health education initiatives. These places can be the focus of health marketing. In fact, public health has a greater potential to improve Health Literacy in the elderly due to easily accessible targets through health promotion. ( 19 , 35 ). Conclusion It can be concluded that health promotion practices can help to healthcare system to reduce preventable illnesses and decrease the complexity of health deterioration among elderly. This will ultimetly be helpful in reducing healthcare and hospitalization costs and national disease burden. The present study is innovative because it combines pertinent thematic areas for research and elder care, allowing readers to gain a deeper understanding of the key concepts and techniques employed while also pointing out areas that require more investigation. Declarations Ethical Consideration Initially, all the study participants were made well aware of the purpose of the study as they were recruited voluntarily, and informed consent was signed before. Moreover, participants were given the right to hold their responses or to withdraw from the study at any point in time during the survey administration or health promotion intervention process, without any penalties. Also, privacy and confidentiality were ensured while collecting and analyzing data, and for this individual code numbers on the participants’ questionnaire were allocated. The study proposal was reviewed by Institutional Review board with registration number HP-2511. Consent for Publication I, as the primary author of this manuscript, agree to publish my manuscript with BMC Public Health. Availability of Data and Materials All data sets analyzed or generated are mentioned in the manuscript and are available to declare on request. Competing Interest The author has no competing interest to claim. Funding No funding was received for this project. Author’s Contribution Not applicable Acknowledgements I would like to acknowledge my supervisor Dr. Faraz Wajidi and my advisors Ms. Yasmin Parpiyo, Assistant Professor, School of Nursing & Midwifery, Aga Khan University and Dr. Tazeen Saeed Ali, Professor and Associate Dean, Research, School of Nursing & Midwifery, Aga Khan University. 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(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Aging is a natural process and is associated with the gradual accumulation of molecular and cellular damage. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). With time, the damage progresses and results in the loss of physiological functioning of an individual, deteriorating general health and capacity. Thus, it increases the risk of illnesses leading to death. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aging population is a worldwide phenomenon involving both developed and developing countries. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Global population aging is occurring at a rapid pace. Demographic transition has resulted in increased life expectancy among older adults to an extend that according to an estimate, more than 20% of people in the World will be 65 or older by 2050. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).The elderly population is growing with a decline in their health condition because of rapid transformation and growth. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The number of people aged 80 and more is expected to quadruple by 2050, from 143\u0026nbsp;million in 2019 to 426\u0026nbsp;million. Also, it is expected that approximately 8 in 10 of the world\u0026rsquo;s elderly population will reside in developing parts of the world by 2050. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Pakistan, currently there are 11.3\u0026nbsp;million elderly population; by 2050, it will increase to 43.3\u0026nbsp;million, or roughly 15.8% of the country's overall population. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). According to UNFPA and Help Age International data, Pakistan ranks seventh among 15 nations in the world with more than 10\u0026nbsp;million older people. The average life expectancy in the country is of 62 years, an aging index of 12.8, and a dependence ratio of 6.6. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). An increase in the elderly population will lead to the emergence of new illnesses, long-term impairments, and alterations in social attitudes.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn terms of healthcare expenditure in Pakistan, the elderly population relies on the younger generation for financial support. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In a survey regarding identifying health and needs of geriatric patients; a significant number of respondents stated financial issues. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The rise in life expectancy, a lack of safety nets, and poverty all contribute to an increase in stress and deteriorating health. Only government employees and some private organization employees receive a certain degree of financial protection from the government after retirement in the form of pensions. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). From healthcare lens, there are multiple geriatric healthcare issues which need to be focused upon such as limited number of geriatric residential and rehabilitation centers; lack of proper geriatric and elderly care trainings of healthcare professionals to identify physical, social, spiritual and mental health needs and provide quality care to them accordingly. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn order to address such healthcare issues, it is of prime importance to focus on primary level of prevention along with planning strategies secondary and tertiary level of care. Primary prevention consists of health promotion which means to create awareness among people to adopt healthy lifestyle through health education sessions, awareness campaigns, counseling programs to financial incentives. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The need to prioritize actions for this population, with a focus on enhancing quality of life, fostering autonomy and independence, and promoting active and healthy aging, has made health education for the elderly a topic of global interest due to current demographic and epidemiological changes. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Moreover, several research suggest that health promotion shows significant role in reducing burden of disease, ceasing functional decline, increasing life span and improving quality of life. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe purpose of this study is to assess the impact of health promotion on enhancing health-related quality of life among elderly people in Karachi, Pakistan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study is based on a one-group pre-test and post-test interventional (Quasi-experimental) research design using a mixed method approach (Qualitative and Quantitative). The reason for choosing this design as it allows the researcher to compare outcomes before and after intervention, which aids in quantifying impact more precisely.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) A questionnaire tool (SF-36) was administered before and after conducting the intervention.\u003c/p\u003e \u003cp\u003eInterventions were comprised of Health promotion activities i.e., a physical fitness session; a stress management workshop, and an Education session on General Health responsibility as these all are major domains of health-related Quality of life (HRQoL). In physical fitness sessions, simple exercises suitable for all seniors according to their level of activity were taught. Furthermore, in the stress management session, a few relaxation exercises and tips to manage and overcome stressful situations were enforced. Lastly, a group of nurses gave them a health education session on preventing and controlling non-communicable diseases, general health responsibilities, adherence to medication regimen, regular eye and dental follow-ups, avoiding polypharmacy, etc. to manage health and encouraged them to take responsibility and accountability for their health in order to stay fit and healthy. All nurses were professionals and involved in health education sessions on a voluntary basis. \u003cem\u003eFigure. 1\u003c/em\u003e explains the overall design of this study as it was conducted in a single setting over a period of 2 months, whereby, participants were assessed at Time one (T1) as the pretest and second time (T2) as the post-test for the outcome variable (HRQoL).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure. 1\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design Process\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eIn this study, a Nonprobability purposive sampling technique was used for the selection of the participants. This sort of sampling method involves the selection of study participants based on certain features as discussed in the inclusion and exclusion criteria. Moreover, data was collected from a sample size of 300 elderly people including both males and females.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003e The study participants were comprised of elderly people who were at the age of 60 and above; showed interest in participating and provided consent. Secondly, able to comprehend Urdu or English Language and has no hearing impairment or any complex health problems. Lastly, participants were selected irrespective of their gender (male or female); education status (literate or illiterate); and marital status (married/unmarried or divorced).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eThose elderly people who didn\u0026rsquo;t provide consent and were not interested in participating. Also, those who were with hearing impairment or having complex medical health issues were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting \u0026amp; Data Collection\u003c/h2\u003e \u003cp\u003eData was collected at a Senior Citizen \u0026amp; Recreation center, located near the participants' residence in Karachi. All seniors involved in the study were residents of the same or nearby residential area. They attend and participate in Center activities regularly.\u003c/p\u003e \u003cp\u003eA well-structured generic HRQoL instrument (SF-36) short form was used to collect data from the study participants before and after conducting health promotion interventions to compare pre- and post-interventional responses and to accurately measure the positive or negative impact of the intervention. This tool (SF-36) was adopted from \u0026ldquo;rand health- 36 items short form survey\u0026rdquo;. The survey instrument comprised two sections A and B. In the end of interventions, participants feedback and evaluation were taken verbally and in written form to identify their perspectives on health promotion interventions and does these interventions have produced any sort of impact in improving their health-related quality of life (HRQoL).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eQuestionnaire tool\u0026rsquo;s Section A consists of demographic data involving the questions related to the background details of the participants. Section B of the SF-36 tool consists of 36 close-ended questions on 8 dimensions or sub-scales of HRQoL i.e., \u003cem\u003ePhysical functioning, Role limitation due to physical health, Role limitation due to emotional problems, Energy/Fatigue, Emotional well-being, social functioning, Bodily pain, and General health.\u003c/em\u003e These sub-scales are measured through a Likert scale associated with each self-rated question from each sub-scale. Each sub-scale score ranges from 0-100 with interpretation as the highest scores reflect better health conditions and lower scores reflect deteriorated health status.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eQuantitative analysis for the categorical variables of socio-demographic details of study participants is made through frequencies and percentages. Independent variables of the study include \u003cem\u003eGender\u003c/em\u003e is denoted as \u003cem\u003emale and female\u003c/em\u003e; \u003cem\u003eAge\u003c/em\u003e is categorized as \u003cem\u003e60-65.9 years, 66-70.9 years, 71-75.9 years, 76\u0026ndash;80 and above 80 years\u003c/em\u003e; \u003cem\u003eMarital Status\u003c/em\u003e is denoted as \u003cem\u003eunmarried, married, widowed and divorced\u003c/em\u003e; \u003cem\u003eEducation\u003c/em\u003e is represented as \u003cem\u003eno education, primary education (class 1\u0026ndash;5), middle education (class 6\u0026ndash;8), Secondary School Certificate (Matriculation), Higher Secondary School Certificate (Intermediate) and Higher Education Levels (Bachelors/Masters/doctoral).\u003c/em\u003e Inferential statistics are drawn by applying a paired sample t-test to compare the mean of pre-test HRQoL scores with post-test HRQoL scores. The confidence level of 95% and p-value less than 0.05 have been considered significant throughout the analysis. Qualitative analysis has been made through a thematic categorical method and from those analysis, three themes emerged by the analysis of participant\u0026rsquo;s feedback and comments.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eStudy participants' socio-demographic data showed that overall, 56% of the participants were females and 44% were males. Furthermore, most of the elderly participants were from the age group between 66 years to 75 years of age. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the other socio-demographic presentations of participants.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eThe Socio-demographic characteristics of the study participants.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Socio-Demographic Characteristics of the Elderly Participants (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eResults\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eResults\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60-65.9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66-70.9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71-75.9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u0026ndash;80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Education (class 1 to 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (22.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbove 80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle Education (class 6 to 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary School Certificate (Matriculation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156 (52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Secondary School Certificate (Intermediate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUn-married (single)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Education Levels (Bachelors\u003cb\u003e/\u003c/b\u003eMasters/Doctoral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWidowed/Divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Results\u003c/h2\u003e \u003cp\u003eBy applying a paired t-test to draw inferential statistics, depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Pair 1 of pre-and post-interventional scores of physical functioning showed that there is no significance as their mean difference from the pre-test to post-test is 1.72 (SD +/- 6.61), and p-value of 0.72. Similarly, Pair 2 role limitation due to physical health and Pair 3 role limitation due to emotional problem showed no significance from the pre-test to post-test as their mean score were 1.00 (SD +/- 8.14) and p-value 0.389 and 6.05 (SD +/- 23.09) and p-value 0.070 respectively. Pair 5 emotional well-being and pair 7 bodily pain also reflect non-significance as their mean difference were 0.830 (SD +/- 5.89) and p-value 0.325 and 1.67 (SD +/- 4.57) and p-values 0.013 respectively. This concludes that there is no significant impact of health promotion activities in improving physical health, role limitation due to physical health and emotional problems, and alleviating bodily pain.\u003c/p\u003e \u003cp\u003eHowever, pair 4 energy/fatigue mean difference-17.65600 (SD +/-8.37441) and p-value of 0.00, pair 6 social functioning is -10.75 (SD +/-10.22), and p-value 0.00 and pair 8 general health mean difference is -12.17 (SD +/- 10.35) and p-value 0.00 reflects the significant impact of health promotion on this health-related quality of life sub-scales. Therefore, for Energy/ Fatigue; Social Functioning, and General Health perspective, we conclude that there is a significant impact of Health Promotion on the health-related quality of life (HRQoL) of the elderly.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: \u003cb\u003ePaired sample t-Test 8 sub-scales SF-36 questionnaire\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Instrument SF- 36 questionnaire (08 sub-scales)Paired Sample t- Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eSub- Scales\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eStd.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eDeviation\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95% Confidence\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eInterval of the\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eDifference\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et-scores\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eLower\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eUpper\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePhysical Functioning\u003c/b\u003e (Pre-test) - Physical Functioning (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.72000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.61797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.16081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.60081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRole Limitation due to Physical Health\u003c/b\u003e (Pre-test) - Role Limitation due to Physical Health (post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.14411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.31453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.31453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRole Limitation due to Emotional Problem\u003c/b\u003e (Pre-test) - Role Limitation due to Emotional Problem (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.05500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.09569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.50872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.61872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEnergy/Fatigue\u003c/b\u003e (Pre- test) - Energy/Fatigue (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-17.65600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.37441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-20.03598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-15.27602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-14.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmotional Wellbeing\u003c/b\u003e (Pre-test) - Emotional Wellbeing (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.83000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.89847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.84633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.50633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.995\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSocial Functioning\u003c/b\u003e (Pre-test) - Social Functioning (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-10.75000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.22614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-13.65624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-7.84376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-7.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain (Pre-test) \u0026ndash; Pain (Post-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.67000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.57657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.36935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.97065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePair 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-12.17600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.35777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.36935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.97065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Results\u003c/h2\u003e \u003cp\u003eParticipants were highly motivated and engaged in health promotion activities throughout the study. They provided verbal and written feedback in the evaluation forms, which were categorized thematically. \u003cem\u003eEmpowerment and increased confidence in self-health management; improved mental health; need of more such activities\u003c/em\u003e were the three themes that emerged from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e1. Motivation and Increased confidence in self-management\u003c/h2\u003e \u003cp\u003eThe majority of the study participants felt motivated while involved in health promotion activities on various preventive and home-health management issues. They were able to learn from these sessions as the sessions were according to their level of understanding and well-paced. These sessions and hands-on activities have enhanced their understanding and boosted their confidence in self-care.\u003c/p\u003e \u003cp\u003eOne of the participants mentioned, \u003cem\u003e\u0026ldquo;These days (during the study period), I felt empowered and able to take care of my and my wife\u0026rsquo;s health as we live alone. Previously, I was too scared as we age; health becomes more fragile and we get ill more frequently. However, now I know how to prevent and care for myself through the knowledge and skills we learned.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2. Improved mental health and wellbeing\u003c/h2\u003e \u003cp\u003eHealth promotion activities posed a positive impact on the mental health and well-being of the participants. During these sessions, all elderly participants were able to interact and socialize, exchange their thoughts, and get to know each other\u0026rsquo;s ideas and complications. Increased opportunities for socialization enabled them to feel positive and valued. Participant's social functioning has improved which was found significant in quantitative analysis as well. One of the participants mentioned,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eUsually I cannot attend health camps and campaigns arranged by the hospitals due to non-affordability to cover travel costs and spending a lot on follow-ups and registrations of such camps as there are very few free health awareness and medical camps arranged for us (elderly). However, these health promotion activities and health awareness provided to us enabled us to share and discuss our health concerns and also we were able to interact with each other and learn from each other.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3. Need for more such activities\u003c/h2\u003e \u003cp\u003eElderly participants acknowledged the initiative and recommended to their senior citizen center management to continue arranging such sessions for them in the future. They understand the importance of prevention which can help them to maintain their health status while going through the natural process of aging. Such health promotion initiatives and awareness sessions play a pivotal role in optimizing the general health of elderly people and minimizing and delaying their health-related complications due to the degenerative process of aging.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study unpacks the impact of health promotion as a primary care intervention in improving health-related quality of life among the elderly. Health promotion activities in this study comprised of health education sessions on basic Range of Motion (ROM) exercises, stress management, prevention and management of Non-Communicable Diseases (NCDs), fall and fall prevention and associated morbidities, and energy conservation techniques are all basic yet essential and critical areas that require the attention of health systems to offer such health awareness campaigns for elderly to address their concerns and frequent reiteration is must. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). It can assist people in managing both their mental and physical illnesses, as well as strengthening their personal, familial, and social health and quality of life. In addition, it reduces waste and needless medical expenses while extending the average healthy life expectancy. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral surveys and research studies have shown that age-related and degenerative health concerns cause older people above 60 years old and more to have more health problems and seek healthcare services more frequently. Thus, making them higher consumer of healthcare services. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Furthermore, according to another research study, older individuals are less likely to use the internet as compared to other adults and consequently more susceptible in terms of their health literacy capacity. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In such instances, arranging health promotion activities as a On-ground activity, in senior citizen centers, rehabilitation centers and on other electronic or print medium such as Radio, TV, newspaper and magazines will contribute to a greater extend in enabling older adults to prevent themselves from morbidities and reduce hospitalizations. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study results also indicate the strength of health promotion consisting of disseminating health awareness through health promotion and primary prevention. In this study, three domains of Health-related Quality of Life (HRQoL) (social functioning, Energy/fatigue, and General Health) among elderly participants were found significant as it produced positive impact in improving their health conditions. First the social functioning, various research studies have shown strong positive associations of social participation with improved level of health literacy because social interaction through exchanging ideas, knowledge and experiences with others enhances social functioning. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, Energy and general health domains were found to be directly proportional to HRQoL as health promotion activities can help older people to understand the importance of self-care practices to manage their own health. Consequently, they feel more empowered and gain control of their aging process and feel less fatigued. Adopting self-care early in life is necessary to attain an ideal physical and mental health at older age. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBesides, the other domain of HRQoL i.e., Bodily pain, physical functioning, role limitation due to physical health and emotional problem and emotional wellbeing are found to have inversely proportional relationship with HRQoL and were not significant through health promotion activities. It's widely believed that staying physically active is essential to a long, healthy life. On the physical activity domain, however, study participants scored poorly. This result is in line with earlier research showing that this group of people is the least physically active in society. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). When included as a personal habit at an early age, physical activity and other related health-promoting activities have been shown to endure into adulthood. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Despite the established health advantages, data indicate that many youths do not opt to participate in physical exercise to improve their health. Because good and unhealthy behaviors are acquired at a very young age, this results in a decline in health quality that has an impact far into old life. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations and Way Forward\u003c/h2\u003e \u003cp\u003eThe elderly are a particularly vulnerable and fragile segment of the population. As people age, their body functionality declines. Aging people are more susceptible to diseases than young people and take longer to recover. With the senior population growing by the year, the healthcare system cannot ignore their relevance. It is critical to preserve the health of Pakistan's senior population in order to prevent disability and health-care costs. Extended life must be regarded as a valued resource, and this can be accomplished by extending a healthy middle-life. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Pakistan is a developing country with several challenges such as a sluggish economy, an inadequate health budget, and a fragmented health-care system. Many people must rely on out-of-pocket health care expenses. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Studies suggests that prioritizing the health promoting practices for Pakistan\u0026rsquo;s elderly population will contribute to enhance their health and reduces their overall healthcare costs. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo promote primary prevention at mass level, healthcare sector needs to up-scale primary healthcare system of Pakistan. In this notion, Public-private partnership could be one of the best possible solutions. According to a study, there was a case whereby, 104 BHU\u0026rsquo;s of Rahim Yar Khan District in Pakistan was contracted to an NGO to improve PHC setup. The contracted NGO bought numerous innovations like improving infrastructure of BHU, up scaling of salaries of medical officers and other interventions to bring the concept of accountability and responsibility were introduced. As per third party evaluation of this initiative, eventually situations were improved in terms of Utilization of BHU\u0026rsquo;s; increased community satisfaction rate; physical structure of BHU\u0026rsquo;s; improved technical quality of care; availability of medications and trained staff and budgeted expenditure and cost-effectiveness. This initiative should be expanded to other cities and districts as well. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 1999, the government of Pakistan developed the National Policy to promote the optimal health of the elderly. This approach involved training doctors for primary care in geriatrics, providing dental treatment, domiciliary care, and establishing a system of health care providers for the elderly, including physical therapists and social workers. Unfortunately, this policy has yet to be implemented. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Public Sector Development Programme (PSDP) and the Ten-Year Prospective Plan emphasized the care, well-being, and protection of the elderly by constructing senior citizen homes and local senior citizen clubs where older people can exchange their experiences, knowledge, and expertise. However, all of these measures must be properly implemented. The government has also prioritized the establishment of geriatric units in hospitals. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). A survey report suggested that most of the older respondents requested senior citizen clubs and recreational centers where they can attend health promotion practices, discuss their concerns with geriatric experts, socialize, can form support groups to understand each other\u0026rsquo;s concerns being in same age group and facing same sort of challenges. This illustrates the senior population's need and desire to socialize. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This initiative works in line with the support group concept which aids in improving the social functioning and mental wellbeing of elderly. Also, it will serve as an avenue for healthcare professionals to easily access older people to provide them primary healthcare services and conduct health promotion practices and in case of severity of condition, early identification and timely referral will be an added advantage to reduce disease complexity and sufferings. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In such recreational spaces where senior citizens meet and spend time, public health can expand its health education initiatives. These places can be the focus of health marketing. In fact, public health has a greater potential to improve Health Literacy in the elderly due to easily accessible targets through health promotion. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt can be concluded that health promotion practices can help to healthcare system to reduce preventable illnesses and decrease the complexity of health deterioration among elderly. This will ultimetly be helpful in reducing healthcare and hospitalization costs and national disease burden. The present study is innovative because it combines pertinent thematic areas for research and elder care, allowing readers to gain a deeper understanding of the key concepts and techniques employed while also pointing out areas that require more investigation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, all the study participants were made well aware of the purpose of the study as they were recruited voluntarily, and informed consent was signed before. Moreover, participants were given the right to hold their responses or to withdraw from the study at any point in time during the survey administration or health promotion intervention process, without any penalties. Also, privacy and confidentiality were ensured while collecting and analyzing data, and for this individual code numbers on the participants\u0026rsquo; questionnaire were allocated. The study proposal was reviewed by Institutional Review board with registration number HP-2511.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI, as the primary author of this manuscript, agree to publish my manuscript with BMC Public Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data sets analyzed or generated are mentioned in the manuscript and are available to declare on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has no competing interest to claim.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to acknowledge my supervisor Dr. Faraz Wajidi and my advisors Ms. Yasmin Parpiyo, Assistant Professor, School of Nursing \u0026amp; Midwifery, Aga Khan University and Dr. Tazeen Saeed Ali, Professor and Associate Dean, Research, School of Nursing \u0026amp; Midwifery, Aga Khan University. Pakistan.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiddiqui M, Ansari MA, Ks S. M I. Public Health and Community Medicine2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteves CJ, Spector TD, Jackson SH. Ageing, genes, environment and epigenetics: what twin studies tell us now, and in the future. Age Ageing. 2012;41(5):581\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVasto S, Scapagnini G, Bulati M, Candore G, Castiglia L, Colonna-Romano G, et al. Biomarkes of aging. Front Biosci (Schol Ed). 2010;2(1):392\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarma G, Kusuma Y, Babu B. Health-related quality of life of elderly living in the rural community and homes for the elderly in a district of India. Zeitschrift f\u0026uuml;r Gerontologie und Geriatrie. 2010;43(4):259\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQidwai W. Ageing Population: Status, Challenges and Opportunities for Health Care Providers in Pakistan. J Coll Physicians Surg Pakistan. 2009;19(7):399\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTourani S, Behzadifar M, Martini M, Aryankhesal A, Taheri Mirghaed M, Salemi M, et al. Health-related quality of life among healthy elderly Iranians: a systematic review and meta-analysis of the literature. Health Qual Life Outcomes. 2018;16(1):18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsad UAAZ. The Rising Old Age Problem In Pakistan. J Res Soc Pakistan. 2017;54(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJalal S, Younis MZ. Aging and elderly in Pakistan. Ageing Int. 2014;39:4\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshiq U, Asad AZ. The rising old age problem in Pakistan. J Res Soc Pakistan\u0026ndash;Vol. 2017;54(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZafar SN, Ganatra HA, Tehseen S, Qidwai W. Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi. J Pakistan Med Association. 2006;56(10):470\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQidwai W, Ashfaq T. Elderly Patients and their health in Pakistan: Current Status, Issues, Challenges and Opportunities. J Liaquat Univ Med Health Sci. 2011;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSabzwari S, Azhar G. Ageing in Pakistan\u0026mdash;A New Challenge. Ageing Int. 2011;36:423\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolinowska S, Groot W, Baji P, Pavlova M. Health promotion targeting older people. BMC Health Serv Res. 2016;16(5):345.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026aacute; GGM, Silva FL, Santos A, Nol\u0026ecirc;to JDS, Gouveia MTO, Nogueira LT. Technologies that promote health education for the community elderly: integrative review. Rev Lat Am Enfermagem. 2019;27:e3186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRana AKMM, Wahlin \u0026Aring;, Lundborg CS, Kabir ZN. Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh. Health Promot Int. 2009;24(1):36\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolit DF, Beck CT. Essentials of nursing research. 9th ed. Lippincott Williams and Wilkins; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu C-J, Hu J-C, Lo Y-H, Chang E-Y. Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015\u0026ndash;2019. Int J Environ Res Public Health. 2020;17(15):5335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmenn GS. Prevention and the elderly: appropriate policies. Health Aff (Millwood). 1990;9(2):80\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Hoa H, Giang HT, Vu PT, Van Tuyen D, Khue PM. Factors Associated with Health Literacy among the Elderly People in Vietnam. Biomed Res Int. 2020;2020:3490635.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuong T-V, S\u0026oslash;rensen K, Pelikan JM, Van den Broucke S, Lin I-F, Lin Y-C, et al. Health-related behaviors moderate the association between age and self-reported health literacy among Taiwanese women. Women Health. 2018;58(6):632\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee MK, Oh J, editors. Health-related quality of life in older adults: Its association with health literacy, self-efficacy, social support, and health-promoting behavior. Healthcare: MDPI; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKayupova G, Turdaliyeva B, Tulebayev K, Van Duong T, Chang PW, Zagulova D. Health literacy among visitors of district polyclinics in Almaty. Kaz Iran J public health. 2017;46(8):1062.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilford DM. The aging population in the twenty-first century: Statistics for health policy. 1988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGomes M, Figueiredo D, Teixeira L, Poveda V, Paul C, Santos-Silva A, et al. Physical inactivity among older adults across Europe based on the SHARE database. Age Ageing. 2017;46(1):71\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarimi N, Saadat-Gharin S, Tol A, Sadeghi R, Yaseri M, Mohebbi B. A problem-based learning health literacy intervention program on improving health-promoting behaviors among girl students. J Educ health promotion. 2019;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuddal MH, Stensland S\u0026Oslash;, Sm\u0026aring;stuen MC, Johnsen MB, Zwart J-A, Storheim K. Physical activity and sport participation among adolescents: associations with mental health in different age groups. Results from the Young-HUNT study: a cross-sectional survey. BMJ open. 2019;9(9):e028555.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institute of Population Studies (NIPS). [Pakistan] and ICF. Pakistan Demographic and Health Survey 2017-18 Islamabad, Pakistan, and Rockville. Maryland, USA: NIPS and ICF; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZainab S, Khoso A, Siddiqui M, Ashraf K, Mumtaz MA, Awan M. Healthy ageing: Assessment of health-promoting lifestyle among the elderly population in Karachi Pakistan. J Educ Health Promot. 2021;10:389.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaikh B, Rabbani F, Safi N, Dawar Z. Contracting of primary health care services in Pakistan: is up-scaling a pragmatic thinking. J Pak Med Assoc. 2010;60(5):387.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSabzwari SR, Azhar G. Ageing in Pakistan\u0026mdash;A New Challenge. Ageing Int. 2011;36(4):423\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeed YSM, Ilyas R. Discrimination and health status of elderly people in Chakwal: Pakistan. Acad Res Int. 2011;1:149\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003eKhan ATA TR, Amjad Q \u0026nbsp;Assessment and Management of Geriatric Care in Pakistan. . Journal of Gerontology and Geriatric Research. 2018;;7(488).\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh B, Kiran UV. Recreational Activities for Senior Citizens. Int J Humanit Social Sci. 2014;19:2279\u0026ndash;837.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarquet O, Maciejewska M, Delcl\u0026ograve;s-Ali\u0026oacute; X, Vich G, Schipperijn J, Miralles-Guasch C. Physical activity benefits of attending a senior center depend largely on age and gender: a study using GPS and accelerometry data. BMC Geriatr. 2020;20(1):134.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health-related Quality (HRQoL), geriatrics, health promotion, healthy aging, Low-Middle Income Countries (LMIC), elderly, older adults","lastPublishedDoi":"10.21203/rs.3.rs-3886928/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3886928/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDemographic transition has resulted in increased life expectancy among older adults that will lead to the emergence of new illnesses, long-term impairments, and alterations in social attitudes. The need to prioritize actions for this population, with a focus on enhancing the quality of life, fostering autonomy and independence, and promoting active and healthy aging, has made health education for the elderly a topic of global interest due to current demographic and epidemiological changes. The purpose of this study is to assess the impact of health promotion on enhancing health-related quality of life among elderly people in Karachi, Pakistan.\u003c/p\u003e\u003ch2\u003eStudy Setting \u0026amp; Design:\u003c/h2\u003e \u003cp\u003eData was collected at a Senior Citizen \u0026amp; Recreation center, located near the participants' residence in Karachi, Pakistan. A well-structured generic HRQoL instrument (SF-36) short form was used.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOne-group pre-test and post-test interventional (Quasi-experimental) research design using a mixed method approach (Qualitative and Quantitative). Inferential statistics are drawn through paired sample t-test to compare the mean of pre-test HRQoL scores with post-test HRQoL scores. The qualitative analysis was made through a thematic categorical method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eRevealed significant impact of health-promoting activities on 3 sub-scales of HRQoL. However, on other subscales of HRQoL, health-promoting interventions produced little impact.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHealth promotion can play a significant role in improving health-related quality of life.\u003c/p\u003e","manuscriptTitle":"“Impact of Health Promotion Practices on Health-Related Quality of Life (HRQoL) among Geriatric population in Karachi, Pakistan.”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-09 17:02:48","doi":"10.21203/rs.3.rs-3886928/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-18T11:29:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-29T17:35:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-29T02:55:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47756885639875377017363206338661896254","date":"2024-06-21T13:35:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-21T10:31:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-20T06:05:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220418039448071222509524673436956028905","date":"2024-06-19T09:59:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-18T21:50:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297637606635068055637880178705360371979","date":"2024-06-18T05:15:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121612160597482737607727879856957580215","date":"2024-06-17T19:14:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268867661532127140683264080531763980442","date":"2024-06-17T10:27:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-09T17:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89203658762564881667977540948136822561","date":"2024-06-07T13:50:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262645006578632181383771042360213902887","date":"2024-05-27T05:40:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310708139848530501164089229248553377687","date":"2024-05-24T00:25:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-23T05:29:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-16T07:41:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-06T12:14:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-06T09:27:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-01-22T04:38:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8aa358e2-ad8a-4301-b380-7059bbc8404d","owner":[],"postedDate":"February 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-11-19T13:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-09 17:02:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3886928","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3886928","identity":"rs-3886928","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}