Readiness for prevention: health-related quality of life and self-efficacy in urban older people

Background

Health-related quality of life (HRQoL) and self-efficacy (SE) are key patient-reported outcomes in behaviour-change interventions for older people with, or at risk of, non-communicable diseases (NCDs). In the Rijeka pilot of HORUS (GA 101136516), baseline HRQoL and three SE domains were used to characterise the cohort and to identify participants for the personalisation of urban interventions in physical activity, nutrition, and mental health.

Methods

A cross-sectional baseline analysis was conducted within a 9-month pre-post-controlled study involving older urban people at risk of, or living with, NCDs (n = 156 intervention, n = 160 control). HRQoL was measured using the PROMIS-10. Self-efficacy was assessed with three Schwarzer scales: Nutrition, Physical Exercise, and Alcohol Resistance. Group differences were assessed using Welch’s t-tests for continuous variables and χ² tests for sex. Internal consistency ranged from α = 0.68 to 0.94.

Results

Groups differed at baseline in age (71.8±8.1 vs 65.8±16.5 years, p < 0.001) and sex (87.5% vs 45.3% female, p < 0.001). PROMIS-10 T-scores were below the US norm, more so for physical than mental health: GPH 44.0±6.0 vs 42.6±8.7 (p = 0.124); GMH 46.8±7.6 vs 45.1±7.7 (p = 0.048). Behaviour-change self-efficacy was modest: 30% of intervention and 46% of control participants scored low on nutrition SE, and 33% vs 48% low on exercise SE; means were higher in the intervention arm (nutrition 13.2 vs 12.1, p = 0.018; exercise 13.2 vs 11.8, p = 0.006). Alcohol-resistance SE was evenly high (85% vs 79%, p = 0.11).

Conclusions

The cohort is approximately 0.5 standard deviations below the US norm for physical health, with one in three having low nutrition or exercise self-efficacy – precisely the needs targeted by the HORUS personalised pathways. Baseline age and sex imbalances will be addressed at T1 using ANCOVA adjusted for baseline score, age, and sex.

Key messages

• Thirty per cent of intervention participants entered with low nutrition or exercise self-efficacy; alcohol resistance was already high in 85% — personalization should match support to actual needs.

• PROMIS-10 and self-efficacy scales are feasible tools for stratifying older urban people into NCD-prevention pathways and will anchor the T0–T1 evaluation in HORUS.