Construction Of Health Empowerment Theoretical Framework For The Chinese Elderly With Chronic Illness

BackgroundChina is currently facing a massive demographic change and will soon become acountry with the most serious challenge of growth of an aging population. The elderlyusually have higher prevalence of chronic illness and need effective self-management whichshould empower patients and attach importance to patients' experience. Healthprofessionals may be expert in illness and treatment, but patients with long-term healthproblems are the experts in their own life and illness rhythm, they are more familiar withown priorities and choice in health management and should be the most importantcaregiver for themselves. While health within illness and health empowerment providenew perspective interpreting the dialectical unifying of illness and health, healthmanagement for the elderly should focus on understanding life meaning and how to initiatepotential to live a new normal life within illness to realize empowerment. However, limitedresearch has done to reveal meaning of life and health experience for Chinese elderly as a result ofaffecting the understanding of health empowerment in Chinese culture.ObjectiveThe aims of the study are to construct a health empowerment framework for Chineseelderly with chronic illness by exploring the meaning of life and illness experience to get aglance of self-management resource and influencing factors. We propose the followingquestions: what's the life experience in illness? What are the adopted measures to managetheir health? Did they have identified inner strength or potential to improve self-adjustingand reorientation? What are the factors improving or affecting this transition of self andpositive self management? What are the elements necessary for Chinese elderly healthempowerment?MethodsTheory research and qualitative grounded theory method were used to deeply exploreand construct the model of health empowerment for Chinese elderly with chronic illness.Such theories as health within illness, inner strength, and health as expandingconsciousness, health empowerment and so on were reviewed and analyzed.40olderadults with chronic illness living in three cities, Shanghai, Nanjing and Bengbu in EasternChina were interviewed and observed by convenient sampling, purposive sampling andtheory sampling. After tape-recorder and transcribed verbatim, data were analyzed by Nivivo7version by the process of constant comparative method, coding and memos. Thecore themes and the relationship between categories were obtained and constructed todevelop the theory framework of health empowerment.Results"responsibility endowing power" as the core theme of the framework covers such sixcategories as "health responsibility initiation","health responsibility performance","healthresponsibility realization","self","family" and "society". The connotation of healthempowerment for Chinese elderly is the process of initiating, performing and realizinghealth responsibility by the interaction of self, family and society. Sense of healthresponsibility could be initiated depending on the interaction of self, family and societyrather than self alone. Simultaneously, health responsibility has three parts including"responsibility for self care","responsibility for family members" and" responsibility forsociety" which were congruent with power from self, family and society respectively. Soself, family and society as the important influencing factors and motivation were givendouble attributes including power and responsibility and ran through the whole framework.Five strategies and one requirement were identified for responsibility performance. Theywere "letting the nature take its course","proactive self-control","self-transcendence","finding joy in life","self escape" and "self-requirement for health". Health responsibilityrealization as the outcome meant "happiness lies in contentment"DiscussionThe theory framework were interpreted and supported by the perspective of geometryprinciple, force of inertia principle, Traditional Chinese cultural philosophy and symbolisminteraction and compared with Shearer's health empowerment theory and inner strengththeory.Some suggestion were also proposed.ConclusionThe constructed health empowerment framework for Chinese elderly with chronicillness should enrich the meaning of health empowerment and have implication for healthintervention practice for older adults.