An Integrated 5I Health Promotion Model for Enhancing Independence and Quality of Life Among Older Adults in...

Population aging poses a growing public health challenge in low- and middle-income countries, including Indonesia. Functional independence is a key determinant of older adults' quality of life, yet integrated community-based health promotion Models addressing this issue remain limited. This study developed and empirically validated an Integrated 5I Health Promotion Model (Identify, Inspire, Initiate, Integrate, and Impact) to enhance independence and quality of life among older adults in an urban Indonesian setting. A community-based cross-sectional survey was conducted among 240 older adults in Surakarta, Indonesia, using proportional cluster sampling from community activity groups. The integrated 5I Model was constructed based on the Health Belief Model, the Logic Model, and a pentahelix approach. The data were collected using a structured questionnaire comprising the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the modified PASE (including religious activities), and an expanded WHOQOL-BREF (incorporating spirituality, freedom, and happiness). The data were analyzed using path analysis to examine direct and indirect relationships among internal and external factors, perceptions, participation, independence, and quality of life. The model demonstrated good structural fit and explained a substantial proportion of variance in independence and quality of life. Perception and participation played significant mediating roles between the internal and external factors and independence. Increased independence was significantly associated with improved quality of life among older adults. Participation showed the most substantial direct effect with physical independence (β = 3.018, p < 0.001), while independence was significantly associated with quality of life (β = 0.599, p < 0.001). Participation was also found to have a significant direct impact on the quality of life (β = 2.376, p = 0.003). The model demonstrated excellent fit (CFI = 1.000; RMSEA = 0.000; SRMR = 0.012). The Integrated 5I Health Promotion Model offers a pragmatic, scalable framework for community-based interventions to promote independence and quality of life among aging populations in urban low- and middle-income settings. This model has important implications for public health programs and policies targeting healthy and active aging.