Product Details

Author Information

Corresponding Author
Heidi Lauckner
School of Occupational Therapy, Dalhousie University
5869 University Avenue
PO BOX 15000
Halifax,, NS B3H 4R
Canada
p: 902-494 2608
Heidi.Lauckner@dal.ca

Authors (listed in order of authorship):
Heidi Lauckner
School of Occupational Therapy, Dalhousie Universi

Robin Stadnyk
Dalhousie University

Lisa Purcell
Town of Mahone Bay

Tillie Biebesheimer
Mahone Bay Lions Club

Ruth Brown
Mahone Bay Inter-Church Council

David Devenne
Town of Mahone Bay

Martha Dolliver
Kinburn Pharmasave

Lila O'Connor
Town of Mahone Bay

Ted Hobson
Mahone Bay Centre

Robin James
RCMP-Mahone Bay

Annette St. Onge
Economic Development

Schelene Swinemar
South Shore Health

Leslie Taylor
Victorian Order of Nurses

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Allied Health, Nursing, Public Health, Social & Behavioral Sciences, Social Work

What specific topics does your product address?

Access to health care, Built environment, Chronic disease, Community assessment, Community development, Community health , Housing, Partnership building , Rural health, Social determinants of health, Community-based participatory research

Does your product focus on a specific population(s)?

Seniors

What methodological approaches were used in the development of your product, or are discussed in your product?

Community-based participatory research , Focus group , Qualitative research, Interview

What resource type(s) best describe(s) your product?

Report

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

This community-based consultative process aimed to gather the perspectives of older adults in a rural Canadian town on what constitutes an age-friendly community in order to identify key priorities for community action. In age-friendly communities, the policies, services, settings and structures related to the physical and social environment are designed to help seniors "age actively;" that is, to be safe, healthy, and involved (1). Based on guidelines developed by the Public Health Agency of Canada (2), a community steering committee, which included local researchers, directed this action research process. Focus groups with older citizens were conducted, along with individual and key informant interviews (n=50). Two key features of this community were identified as promoting its age friendliness: 1) being a small town and 2) diverse opportunities for participation. The key barriers were: 1) inaccessibility of housing, public spaces, transportation, 2) limited health services and businesses, and 3) challenges sharing information about community events, particularly for people who did not use the internet. The Age-Friendly Mahone Bay Report summarize the consultative process and findings. This report is intended as a resource for other communities and community-based researchers embarking on a similar age-friendly community consultation process by describing the community partners involved, consultation steps followed, the data collection tools used and the key findings.

2. What are the goals of the product?

The Age-Friendly Mahone Bay Project report aims to clearly describe the collaborative community consultation process undertaken by a community-based partnership between university-based researchers, a local municipality, and a local community centre in order to create a more age-friendly community. The report illustrates a practical application of the age-friendly guidelines provided by the Public Health Agency of Canada (2) and therefore can provide direction to other rural communities embarking on a similar age-friendly consultation process. The initial objectives of the consulation process were to gather the perspectives of older adults and those involved in senior services/resources to 1) identify what existing aspects of the town and area are considered age-friendly, 2) identify and prioritize what aspects of the town and area were not considered age-friendly and 3) generate a list of ways of further promoting age-friendliness in this community. In the report, the following consultation steps are described: formation of a steering committee representing diverse sectors; creation of community profile based on existing resources and data; recruitment of participants; gathering community perspectives through focus groups, key informant interviews and confirming findings with the community; and action planning. The results of the consultation are described, providing examples of issues faced by older adults in a rural community.

3. Who are the intended audiences or expected users of the product?

This report would be of interest to: a) community-based researchers interested in working collaboratively with community partners to promote age-friendly communities and identify strategies for promoting active aging; b) municipalities who are seeking an example of how they might partner with researchers to engage in an age-friendly consultation process; and, c) community partners who are similarly interested in such a partnership. This report may also be used by any of these audiences as background information to support their own efforts to engage in an age-friendly consultation.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

This report is intended to provide an example of how one community-based partnership engaged in an age-friendly consultation process. Such a process is unique to each community, so each community is encouraged to adapt the steps outlined by the Public Health Agency of Canada (2) to the specific circumstance of their community. The formation of a steering committee with diverse representation from the community can assist with this process. Further information about the consultation process and how it relates to occupational therapy practice processes can be found in the following related article:

Lauckner, H. & Stadnyk, R (in press 2014). Examining an Occupational Perspective in a Rural Canadian Age-friendly Consultation Process. Australian Occupational Therapy Journal.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Although older adults make up 13% of the Canadian population, they account for 44% of our the total health care costs (3). Given that the proportion of older adults is expected to double between 2006 and 2036 (3), there is concern about how best to promote the health of older adults, encourage their continued contributions to communities, and reduce reliance on health care services. The creation of age-friendly communities is one approach to promoting the health of seniors that has national and international support (1;2) . According to the Public Health Agency of Canada (PHAC), in age-friendly communities, the policies, services, settings and structures related to the physical and social environment are designed to help seniors "age actively," that is to be safe, healthy, and involved (1;2).

The age-friendly communities movement began with the World Health Organization (WHO) working in partnership with 33 cities worldwide to conduct focus groups with seniors, caregivers and service providers that identified the key features of communities that are supportive of participation, health, and security (1). In turn, this led to policy and research focused on age-friendly elements of the physical environment of neighborhoods and inclusive design while simultaneously retaining the diversity that exists within each unique community (5).

Inherent in the age-friendly communities movement is the recognition that physical and social environments can either facilitate or impede people’s abilities to actively engage in their communities. Also inherent in this approach is a commitment to bottom-up participatory approaches where seniors are recognized as experts in their experiences who are vital in identifying age-friendly features of their communities (1;6). Innovation and collaborative planning are essential to the process of becoming age-friendly (7) and a number of international studies have concentrated on helping communities identify priority areas (8-11). In 2009, the Public Health Agency of Canada developed guidelines for applying these key features to rural and remote communities based on community consultations completed in communities from different regions in Canada (2).

The Age-Friendly Mahone Bay Project drew upon this previous research and the PHAC guidelines (2) to inform our methodology.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. World Health Organization. Global age-friendly cities project. Geneva Switzerland; 2007. Available from www.phac-aspc.gc.ca/.../pdf/publications/public/healthy-sante/age/age_friendly_e.pdf

2. Public Health Agency of Canada. Age-friendly rural and remote communities project: A guide. Ottawa: Division of Aging Seniors; 2009.

3. Turcotte M, Schellenberg G. A portrait of seniors in Canada. Ottawa, ON: Minister of Industry; 2007. Available from http://www.statcan.gc.ca/pub/89-519-x/89-519-x2006001-eng.pdf

4. Sandelowski, M. (2000). Focus on Research Methods. Whatever happened to Qualitative Description? Research in Nursing and Health, 23, 334-340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G

5. Lui, C,Everingham, J, Warburton, J, Cuthil, M & Bartlett, H. What makes a community age-friendly: A review of international literature. Australian Journal of Aging, 2009; 26: 116-121.

6. Scharlach, AE. Creating age-friendly communities. Journal of the American Society on Aging, 2009; 33: 5-11

7. Harding, E. Towards lifetime neighborhoods: Designing sustainable communities for all. A discussion paper. London, UK: Communications and Local Government Publications, 2007. Available from http://www.agingsociety.org/agingsociety/publications/public_policy/ilclifetime.pdf

8. Austin, C, McClelland, R, Perrault, E, & Sieppert, J. The elder-friendly communities program. Generations – Journal of the American Society on Aging, 2009; 33: 87-90.

9. Bronstein, L, McCallion, P., Kramer, E. . Developing and age prepared community: Collaboration among counties, consumers, professionals, and organizations. Journal of Gerontological Social Work, 2006; 48: 193-202.

10. Everingham, J, Petriwskyj, A, Warburton, J, Cuthill, M, & Bartlett, H. Information provision for an age-friendly community. Aging International, 2009; 34: 79-98.

11. Hanson, D, Emlet, CA. Assessing a community’s elder friendliness: A case example of the AdvantAge initiative. Family & Community Health, 2006; 29: 266-278.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

OBJECTIVES
The objectives of this project were to
1. Identify what aspects of Mahone Bay were considered age-friendly, primarily from the perspective of older adult residents.
2. Identify aspects of Mahone Bay that were not considered age-friendly.
3. Develop an action plan for Mahone Bay to become more age-friendly.
4. Communicate and confirm findings with the citizens of the Mahone Bay area.
PARTNERS, FUNDING and ETHICAL APPROVAL
There were three community partners involved in this project: the Town of Mahone Bay (applicant for and recipient of the project grant), the Mahone Bay Centre (a community centre which has expertise in programming for older adults), and Dalhousie University’s School of Occupational Therapy (providing research expertise). The Town of Mahone Bay, in collaboration with the other partners, applied for and received an Age-Friendly Communities grant in November, 2011 from the Nova Scotia Department of Seniors. Research ethics approval for this study was received from Dalhousie University in the spring of 2011 .
DESIGN
This project was a community-based action research project in that major decisions were made collaboratively with the steering committee. At the request of the Nova Scotia Department of Seniors, the project design was informed by guidelines developed by the Public Health Agency of Canada (2). The key steps of this project were:
1. Bring together a steering committee
2. Raise awareness about project
3. Gather information for a community profile
4. Recruit older adults and service providers to share their perspectives on the age-
friendliness of the community
5. Conduct focus groups and interviews
6. Interpret results
7. Confirm findings with the community
8. Plan future actions with the steering committee
RECRUITMENT and PARTICIPANTS
Older adults were invited to participate in this project through local advertisements and word of mouth. Those interested in participating in the project were asked demographic information to ensure diverse perspectives were included. All those who volunteered to participate in the study were invited to participate in a focus group or individual interview. Thirty-five (35) older adults from the community participated in focus groups or interviews. The majority were 80 years of age or younger (80%), female (65%), living in the town for more than 10 years (62%), married and living with a partner (60%), active in their community, educated, healthy and financially secure. Key informants who work with older adults were also recruited to share their perspectives on the community. 20 key informants participated in this study, representing local government, businesses and banks, community services, health services, faith communities, and local media.
DATA COLLECTION and ANALYSIS
Older adults and key informants were asked questions derived from previous age-friendly studies conducted internationally and in Canada pertaining to the eight topics identified as relevant to age-friendly communities: outdoor spaces and buildings, transportation, housing, respect and social inclusion, social participation, communication and information, civic participation and employment, and community support and health services (2;1). The steering committee reviewed the questions and made minor wording changes to ensure relevance. The note taker recorded key aspects of the interaction and audio transcripts were reviewed to gather further detail about the discussion. The researchers used qualitative content analysis (4) to identify key issues identified by the community members.
TRUSTWORTHINESS
The steering committee reviewed and discussed preliminary findings as a form of confirming and deepening understanding of the issues raised by the participants. The compiled findings were shared at a community forum with a group of 30 community members who responded to a pubic invitation to review the findings and set priorities.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The Age-friendly Mahone Bay report was compiled with the input of the community steering committee throughout. The researchers and project assistant compiled a draft community profile based on resources identified by the steering committee members. One steering committee member with experience in the business sector contributed information about that sector. The responses from the community consultations (e.g., focus group and key informant notes and transcripts) were compiled into a draft summary, which was then circulated to steering committee members to review and comment on. At monthly meetings, steering committee members discussed the findings to ensure the report accurately captured the Mahone Bay context. If points were not clear, they were discussed and further clarified. The key ideas from the analysis were summarized in chart form and shared at a community forum with a group of 30 community members who responded to a public invitation to review the findings and set priorities. At this community forum, small groups of community members choose one of the age-friendly topics from the summary to review. They were invited to confirm, correct or add to the information gathered and to generate potential actions to address the issues identified and prioritized these. Each small group reported back to the the larger group and together, the large group priorities the topics that they felt the community, guided by the steering committee, should address. These priorities informed the subsequent actions taken by the steering committee. Steering committee members, each representing a community agency or sector, then identified actions they would lead. Top priorities identified at the community forum (e.g., side walk markings, benches, delivery services, information about transportation services, housing options, a community radio station and health care professional recruitment) were addressed first.
Lessons learned through this project include the following:
1. Having diverse groups represented in committee membership facilitated meeting project goals. Committee members brought a variety of viewpoints and community connections to the table. The connections proved valuable in disseminating information about the project and subsequent events.
2. Respecting committee members’ time facilitated their participation. A commitment was made to members that meetings would be of a set length each month, and that the committee members’ roles were primarily to steer the project, rather than to follow up with procedural details. Meetings were surprisingly well attended, even in the face of competing demands.
3. Honouring committee member expertise and preferred communication styles yielded richer contributions. While committee members communicated primarily through email, one member did not. The project coordinator met this member several times individually to make sure she got the appropriate information. There were many instances when strategic one-on-one meetings with committee members between meetings helped the project coordinator to understand various facets of community organization that proved helpful to the project.
4. Funding application and management processes helped create community ownership of the project. The project required the municipal government to make the project application and provide matching funds. This created community ownership from the application submission onwards. Ownership was further reinforced by having the municipality house the funds. This meant that the research team had to give up more traditional methods of controlling research funds through a university account. In essence, the requirements of both the application process and the financial management process resulted in the project being considered as a part of the work of the Town, which strengthened the municipal government’s interest in the project outcomes.
5. Researcher membership in the community was helpful in moving the project forwards. In this research the project coordinator could actively draw on connections previously made in the community to facilitate the project. These relationships helped the project to get established relatively quickly and fostered information dissemination. Community knowledge went beyond knowing individuals to having an understanding of the way that the various organizations in the community worked and intersected.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The Age-Friendly Mahone Bay Report details the community consultation process and findings. It records the perspectives and priorities of community members and directs the actions to be taking by the steering committee members and the town. To date, the following action plans have been completed: a Lifetime Housing Expo was held in May 2012 to share housing options and services for older adults, sidewalks have been painted, locations for benches in the downtown area have been identified, information about transportation services have been distributed in a local mailed publication, town committees have been re-instated who can use the report to guide their further actions and a local radio station has been identified who is willing to host a weekly update of events in the area. Copies of the report were forwarded to the town, steering committee members and key informants. From the body of the Age-Friendly Mahone Bay report, the executive summary was developed into a pamphlet which was distributed to all households in the Mahone Bay area. An update on the project was provided at a community meeting in June 2013. At this meeting, the steps of the Age-friendly Mahone Bay project, and the key findings and subsequent actions were reviewed. Those in attendance confirmed that the issues identified through this process were still important to the community. Some of those in attendance had been consulted early on in the age-friendly process and reported that they valued having the opportunity to provide their input. The steering committee is in the process of securing further funds to address accessibility issues identified. Although impact evaluation data has not been gathered, key outcomes of the projects have been achieved and the Age-friendly steering committee continues to meet as a committee of the Town Council, indicating that age-friendly issues remain on the agenda of the Town's planning. The results of this project are clearly relevant to the community members of Mahone Bay and area as specific recommendations for this area are currently being implemented. The report serves to document the concerns and priorities of the community and thus acts as a resource for steering committee members and other decision-makers in the area. Beyond the local area, the report can serve as a template that can guide similar communities in undertaking a similar community consultation. The steps of the consultation process are outlined and could be adapted to the context of other communities, thus providing a general framework for engaging in an age-friendly community consultation.

10. Please describe why you chose the presentation format you did.

As a committee of the Town, the Age-friendly Mahone Bay steering committee was required to document the process and results of the community consultation. Recognizing that such a detailed report may not be appropriate for informing the general public of the project, a summary pamphlet was created and distributed widely (containing the contents from the executive summary). These two formats served to create general awareness about the project outcomes (pamphlet) and provide more detailing information which can inform future actions (report).

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Attempts were made to ensure diverse perspectives were included during the consultation process through various recruitment methods, however the majority of participants were well, active seniors. Upon reflection, we wonder if the project's focus on ways of promoting community participation may have unintentionally excluded those who are not involved in the community - such individuals may not have felt their experiences of marginalization or limited participation were being sought. Although the issues of marginalized community members were often at the forefront of participant and key informant comments, it is not the same as hearing from these citizens themselves. Consequently, this report does not include the perspectives of more marginalized community members and additional efforts in the future would be required to ensure their experiences, perspectives and suggestions are included.

Research indicates that it is challenging to recruit marginalized people for focus groups and surveys. In order to address this, steering committee members, who represented a range of community agencies (some of whom served marginalized populations) were asked to assist with recruitment. A more targeted ask of the steering committee members with more deliberate effort to recruit marginalized individuals and a focus on finding ways that are comfortable for them to participate might have resulted in greater diversity of experiences gathered. Specific discussion questions that focused more explicitly on barriers may have assisted in recruitment, particularly for those individuals who feel they experience barriers more than they experience age-friendliness.

It is also possible that some people within the included age range did not view themselves as “seniors” and thus excluded themselves, assuming that “seniors” referred to people older than themselves.

The report is too detailed for wide spread public distribution which we attempted to address through the mailing of a summary pamphlet.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Steering committee members were selected by Mayor, committee chair, and project coordinator to ensure representation of key organizations including project partners, police, faith communities, service organizations, health sector, and Town Council. This steering committee with diverse community membership provided consultation and advice on all aspects of the project including marketing, recruitment, questionnaire design, interpretation of results and the final project report. All steering committee members were invited to comment on all major project decisions and monthly meetings allowed for ongoing discussion and information sharing. The meetings were chaired by a town councilor and the project coordinator (a university researcher) faciliated discussions such that all steering committee members' perspectives were included. The project coordinator led the research steps of the project and guided the steering committee through a series of questions that needed to be addressed as the project progressed. The project cooredinator, another researcher and a grant-paid project assistant completed the majority of the research tasks (e.g., conducted interviews, summarized findings) under the direction of the steering committee who reviewed the findings and draft report. Prioritization of the action plans and the follow up on the identified priorities from this project have been led by steering committee members. From the start of steering committee meetings, members made a comitment to meet on a monthly basis (except in December and the summer months) during which time steering committee input would be gathered. Because all members had other significant responsibilities in the community beyond this committee, it was agreed (and appreciated) that the researchers would take on the research and operational tasks, with the steering committee serving to guide the process.

Study findings were based on interviews and focus groups with citizens - older adults and those working with older adults. Findings were shared at a community meeting (all participants plus other community members were invited). At this meeting we received feedback and priorities for action were set. A community information session was also provided in June 2013 to summarize the work of the committee and to gather community members' input on the progress of the project and if the priorities identified and the actions taken are still of importance to the community. Such regular engagement with the community (e.g., through steering committee members, interactions with citizens and on going community consultaitons), directed the project based on mutual respect for diverse perspectives, shared work and shared credit.

The Age-Friendly Mahone Bay Project received Dalhousie University's Social Sciences Research Ethic Board approval in April 2011.

The current chair of the steering committee was consulted regarding this submission to CES4Health.info and town mayor was consulted to confirm the council's agreement with sharing the report more widely. The steering committee members were informed of this process and invited to share any comments. Earlier discussions had taken place in the steering committee and were approved regarding the researchers' commitment to writing about and sharing the results of this project through publications.