Citation • Zajac, I. T., Duncan, A., Flight, I., Wilson, C., Wittert, G., & Turnbull, D (2015). The Relationship of Self-Rated Health and Health Priorities to Health-Protective Behaviours in Older Australian Men. Paper presented at the Australasian Society for Behavioural Health and Medicine, Perth, Western Australia. [email protected] 1 |
Citation Zajac, I. T., Duncan, A., Flight, I., Wilson, C., Wittert, G., & Turnbull, D (2015). The Relationship of Self-Rated Health and Health Priorities.
Dec 28, 2015
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• Zajac, I. T., Duncan, A., Flight, I., Wilson, C., Wittert, G., & Turnbull, D (2015). The Relationship of Self-Rated Health and Health Priorities to Health-Protective Behaviours in Older Australian Men. Paper presented at the Australasian Society for Behavioural Health and Medicine, Perth, Western Australia.
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NUTRITION & HEALTH PROGRAM
THE RELATIONSHIP OF SELF-RATED HEALTH AND HEALTH PRIORITIES TO HEALTH-PROTECTIVE BEHAVIOURS IN OLDER AUSTRALIAN MEN
Overview of Presentation
• Health disparities for Australian men
• Self-rated health as theoretical construct
• Self-rated health as a predictor of past behaviours in Men
• Self-rated health as a predictor of future behaviours in Men
• Conclusions
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Health disparities in Australia
• Despite progress towards reducing disparities, men continue to have lower levels of overall health and poorer health outcomes than women.
• Men’s poorer health outcomes are present across all socioeconomic groups • Men of least disadvantage commonly have poorer outcomes than the most
disadvantaged women.
• Men have fewer interactions with the health system than women overall, but a higher proportion of these visits reflect chronic disease than for women
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• Aboriginal men experience substantially lower life expectancy and poorer health than all other Victorian men and women, including higher rates of most chronic diseases, depression and suicide.
• Young men (15–34 years) have the highest rates of health-risk behaviours of any men and have avoidable mortality rates two to three times higher than women in this age group.
• Men of lower socioeconomic status have lower life expectancy than men of higher socioeconomic status, and higher levels of injury and many chronic diseases.
• Rural men experience higher rates of suicide, mortality due to road-traffic injuries and many chronic diseases, as well as higher levels of social isolation and depression.
• Male prisoners and ex-prisoners experience high rates of many health conditions and have a death rate four times higher than men without a prison history.
• Gay, bisexual, transgender and intersex men experience negative health impacts due to discrimination, and have higher rates of depression, anxiety, suicide, and violence.
• Older men face an increased risk (varying with age) of a range of health conditions, and health risks relating to leaving paid work, social isolation and poor access to health information.
• Refugee men can experience physical, emotional and sometimes sexual trauma prior to arriving in Australia, and can face barriers accessing health services.
• Men with disabilities have higher rates of premature mortality and comorbid conditions. The evidence is unclear about the extent to which these are sex and gender specific.
Source: http://www.health.vic.gov.au/diversity/men/focus.htm
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Health disparities: Fast Facts
All Cancers in Australia
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Source: http://www.aihw.gov.au/cancer/cancer-in-australia-overview-2012/appendixb/
Major Coronary Events
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Source: http://www.aihw.gov.au/cardiovascular-health/trends/
Melanoma Rates
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Source: http://www.environment.gov.au/node/22250
Self-rated Health
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• Popular measure of subjective health
• Used by a variety of scientific disciplines most commonly in relation to health events (i.e., cardiovascular disease) and mortality outcomes
• Used as a sociological indicator of health status
• Poorly understood!
– Self-rated health is an individual and subjective conception that is related to the strongest biological indicator, death, and constitutes a cross-road between the social world and psychological experiences on the one hand, and the biological world, on the other. Most empirical studies on self-rated health come from the epidemiological tradition that focuses on the statistical associations of variables rather than on the processes from which the variables emerge. There is an obvious need for more comprehensive approaches to understanding this concept
Adapted from M. Jylha, 2009, doi:10.1016/j.socscimed.2009.05.013
• The Spontaneous Assessment View: SRH is a subjective assessment of a variety of health states (physical, mental, emotional etc...) and as such, is a kind of ‘dependent’ or ‘outcome’ variable.
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Self-rated Health
Source: Hirve et al., 2014 DOI 10.1007/s11205-013-0334-7
• Alternate theory is that SRH is a kind of ‘enduring self-concept’
• Self-rated health is not only a spontaneous assessment of one's health status. Like a self-concept, self-rated health may be regulated by efforts to achieve one's relatively important health-related goals
• A relatively stable trait over time, (i.e., highly correlated)
• Primarily predicted by prior SRH, rather than changes in health
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Self-rated Health
Study Aims• Purpose:
To examine the extent to which previous screening behaviours predict SRH, and to assess whether SRH predicts future behaviour, consistent with the enduring self-concept view.
To explore whether men’s self-health priorities relate to their behaviours in a similar way to SRH
• Participants: BASELINE: N=908 community dwelling older men who were participating in a larger,
randomised controlled trial of FOBT screening. INTERVENTION: 3 months after baseline participants offered free screening test for Bowel
Cancer ENDPOINT: N=574 complete endpoint measures, 3 months after intervention Sample characteristics:
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AGE RANGE 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74
% 21.2 23.3 23.9 20.0 11.7
STATE NSW QLD SA VIC WA
% 30.1 12.6 14.5 30.7 12.1
Results: SRH• At baseline, most men rated their health as ‘Average’ to ‘Good’
• The relationship between SRH at baseline and endpoint was strong (r=.69)
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N Minimum Maximum Mean Std. Deviation
SRH – BASELINEALL PARTICIPANTS 908 1 5 3.25 .919
Reduced Sample Time 1* 574 1 5 3.31 .902
Reduced Sample Time 2* 574 1 5 3.45 .836
* Only those completing baseline + endpoint measures
• How would you rate the importance of your own health?
• How do you rank the importance of your health in comparison to finances, relationship, health of significant others, etc?
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Results: Health Priorities
Not very important
Not important Neutral ImportantVery
important
All Participants % .2 .5 2.9 29.5 65.6
Reduced Sample % .2 .5 2.1 29.6 67.4
ASSIGNED RANK
1 2 3 4 5 6 7 8 10
All Participants 29.4 32.3 17.6 6.7 2.9 1.1 1.1 1.0 3.8
Reduced Sample 30.5 33.3 16.6 7.5 3.0 1.0 1.0 1.2 3.8
Results: Past Behaviours
• Those with higher SRH were more likely to have used PSA testing previously, and not to have smoked in the past
• Health Priority Rank was not associated with prior health behaviours
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GROUP I.V. Prior Use of FOBT
Prior Use of PSA
Prior DRE Use
Prior or Current Smoker
All Participants
%No 34% 28% 39% 50%
Yes 66% 72% 61% 50%
SRHβ 1.10 1.35** 1.15 0.70**
p 0.263 <.001 0.067 <.001
HPβ 1.03 1.02 1.03 0.95
p 0.401 0.422 0.373 0.166
Reduced Sample
%No 28% 26% 39% 53%
Yes 72% 74% 61% 47%
SRHΒ 1.16 1.34* 1.18 0.77*
p 0.2 0.008 0.07 0.006
HPRΒ 1.03 0.99 0.93 0.955
p 0.589 0.877 0.095 0.251SRH = Self Rated HealthHPR = Health Priority Ranking (reversed so higher = better)
Results: Future Behaviours
All Baseline Participants Both Survey Participants
FOBT Return at 6 weeks
FOBT Return at 12 weeks
FOBT Return at 6 weeks
FOBT Return at 12 weeks
% Yes 40% 55% 55% 74%
No 60% 45% 45% 26%
SRH at Baseline β 1.09 1.18 1.04 1.16
p 0.27 0.02 0.65 0.16
HPR at Baseline β 1.01 1.02 1.01 1.01
p 0.65 0.42 0.92 0.91
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• SRH measured at baseline predicts subsequent participation in screening for bowel cancer. Statistically speaking, the result is not significant in the reduced sample
• Health Priorities did not predict participation in subsequent screening offer
Results: Impact of Behaviour on SRH
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No Yes3
3.5
4
FOBT Participant
Mea
n SR
H At
End
poin
t
• Those who participated in screening offer had higher SRH at endpoint (measured after FOBT participation).
• Those who completed the FOBT were 28% more likely (B=1.28, p=.03) to report higher SRH scores than those who did not screen
Conclusions
• Self rated health appears to be a reflection of past behaviours, but also predicts participation in future health behaviours
• Rating one’s health as ‘important’ was not related to either past or future behaviours
• As per the enduring self-concept model, Self-Rate Health measures may reflect a feedback loop
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Self Rated Health
Healthy Behaviours
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