Research Accomplishment Reports 2009

Mental Healthiness Aging Initiative (MHAI)

D. Murray
Department of Human Environmental Sciences

 

Non-Technical Summary

19% of Kentucky's rural elders are living at or below the poverty level, which is much higher than the 13% rate across the US (United States Census Bureau, 2006). Approximately 27% of the population in Kentucky residents report poor mental health (Centers for Disease Control and Prevention, 2004). There is very little research evaluating residential variation in mental health disorders and health behaviors/outcomes associated with such disorders. It is well known that rural residents compared to urban residents have significantly poorer health status, including the Appalachian area of Kentucky.

There is a need for a culturally-sensitive population level approach to health management of rural residents that expands on the chronic-care model. The rural population has already been targeted as a segment of the population in need of health interventions. However, before blanket interventions can be developed, further understanding is needed to appropriately educate and address the needs of the community. MHAI can reduce the burden of mental health conditions for elders, families, and the community and create a greater understanding of normal and pathological mental health status as part of the aging processes. Further, a strong social marketing campaign can influence organizations, such as policy makers, by increasing the awareness of mental health issues among their constituents.

2009 Project Description

From the formative research process emerged key messages that were delivered in an integrated approach, one that coordinated the many communication channels to deliver clear and consistent messages in the 11 full-intervention counties through a Train the Trainer Curriculum utilizing a community awareness system called PALS (Pay Attention, Ask Questions, Listen Actively, Show Support) for promoting mental health among older adults; Real Life Stories included seven fictional accounts of older adults with various mental health concerns as well as describing the context in which they experienced those issues. Participants were asked to identify and discuss the resources available to the people in each case and to decide how they would assist the older adult in the story; Social advertising through local radio spots and newspaper releases promoting PALS and featuring local FCS agents and community members.

Social advertising through a television advertising campaign was conducted in 27 counties in central and eastern Kentucky. A twelve-month, full-color calendar communicating the key messages derived from the formative research. The partial-intervention counties only received the social advertising 17 television campaign featuring the PALS key messages. 15,000 calendars were distributed in 11 counties. Agents reported using the radio spots with a total listening audience of 196,000. Agents used the newspaper and local advertising circulars to reach 91,000 households. One county newspaper devoted an entire health circular to Mental Healthiness in Aging using the MHAI resources for the circular. Agents reported training 82 leaders who trained others. 4,724 people received face to face contact. 47 community partners were involved in the diffusion of the materials. Partners included a Community Wellness Network, Community Action Programs, ministers, and interagency committees.

Programs were presented at senior citizen centers, nursing homes, foster grandparent meetings, churches, extension homemaker club meetings, adult education, and community education programs. One county reported forming a local committee to be proactive with mental healthiness and aging issues. Another county reported monthly community forums with speakers on mental health issues related to aging.

2009 Impact

Pretest research established the effectiveness of the Aging in Kentucky: A Healthy State of Mind curriculum to improve knowledge and beliefs about mental health and aging. The materials were evaluated again for appeal by both FCS Extension agents and a team of mental health experts on faculty at the University of Kentucky. Suggested revisions were made, and the educational curriculum was released for distribution through the Extension Diffusion System in the pilot counties.

MHAI utilized the Extension System as the mechanism to supplement mass communication campaigns with face-to-face interventions found to be successful in early research in social marketing and in more recent research in diffusion of innovation theory and social marketing. A random telephone survey (N=774) was conducted to compare the control counties (n = 29), to the partial-intervention counties (n = 27); those receiving just the "social advertising" television campaign, and to the full-intervention counties (n = 11). The random telephone survey resulted in a total of N=774 (mean age = 54.35; age range = 18-88 years; 67% female) respondents. There were n=223 responses from the control group, n=252 responses from the intervention group, and n=299 response from the partial-intervention group. A series of questions regarding mental health knowledge and attitudes were asked, with one question on the survey directly relating to the social marketing program and the PALS Systems for community intervention. When comparing the three groups, results indicated that the full-intervention counties agreed more with believing that they were able to assist older adults who may have a potential mental illness when necessary (p=.0472).

2009 Publications

Murray, D., Zanjani, F. 2009, Evaluation of the Diffusion of a Mental Health in Aging Initiative (MHAI) Utilizing Family and Consumer Science Agents as Community Change Agents and Mental Health Gatekeepers, Journal(submitted)

Zanjani, F., Kruger, T., Murray, D., 2009, Evaluation of the Mental Healthiness Aging Initiative: Community Program to Promote Awareness about Mental Health and Aging Issues, Community Mental Health Journal(submitted)

Kruger, T., Murray, D. 2009, The Mental Healthiness and Aging Initiative: Lessons from a Social Marketing Research Campaign in Kentucky, Cases in Public Health Communication and Marketing, George Washing University(submitted)

Kruger, T., Newsham, P., Hughes, T., Zanjani, F., Murray, D. 2009, Mental Healthiness and Aging Initiative Training: Assessing the Effectiveness of a Community-informed Mental Health Curriculum, Journal of Extension (submitted)