What older adults say about participating in health-promoting activities to prevent frailty: a qualitative study

Health-promoting programs have been implemented to prevent frailty amongst older adults in Singapore which has a rapidly aging society. However, participation rate in such programs seemed lower than expected, despite the programs being physically and financially accessible. There is little local research about older adults' personal health beliefs and attitudes towards participating in health-promoting activities to prevent frailty, as well as external influences on their perceptions. Therefore, a qualitative study was conducted to explore older adults' lived experiences and perceptions of health-promoting activities.

Semi-structured one-on-one interviews were conducted with 20 older adults (65-80 years) in a primary care setting from March through May 2023. In-person interviews were guided by a multi-level conceptual framework adapted from the Socioecological model and data were analyzed using framework analysis.

Analysis revealed three themes and associated sub-themes: 1. Personal health beliefs (personal interests, perceived benefits, perceived needs to change, self-efficacy, from awareness to action, perceived difficulties, protection of personal resources); 2. Interpersonal interactions and influences (observations of people becoming frail, family responsibilities, opinion of other people); and 3. Physical, social and policy environment (shared spaces and facilities, social environment, community support and services, nationwide initiatives and recommendations).

Older adults' perceptions of health-promoting activities were influenced by personal, inter-personal and environmental factors. Contextualizing lifestyle modification programs that address their preferences and real-life situations may facilitate engagement. Older adults may also benefit from future initiatives that empower them to choose among feasible options to increase their self-efficacy for preventing frailty.