| Backgrouds and ObjectivesToday, the global population is facing a tendency of aging and China is becoming the country with the largest older population in the world. In 2000, the older population aged 60 and more reached 129.98 million in China, it was near 10.46% of the whole population. Moreover, the older population in China is increasing in a rate of 5.96 million per year, and it is estimated that the number of older population will reach 437 million by the year 2051. With the development of aging in China, the quality of life (QoL) is becoming the focus in the fields of aging study.Physical health, mental health, and social status should be combined together to assess the QoL among the older population, and the MOS 36-item short-form heath survey (SF-36) was widely used to assess the QoL because of its comprehensiveness, brevity and high standard of reliability and validity. A few literatures around the world explored the differences of the QoL and its possible influence factors between the older populations in urban and rural areas. Compared with the older population in urban area, the older population in rural area usually had poorer lifestyle and QoL due to their poorer social and economic status. The key factors of the QoL included social-demographic factor, lifestyle, and the chronic diseases, and health interventions aimed to these factors may help to improve the QoL of the older population. In recent years, although the older population in Zhejiang province can get more and more medical services through the health service center in the community, they rarely can get the health interventions which were aimed to their behavioral changes. Thus, developing and assessing an effective and feasible health intervention project for older population will be a very important direction of health intervention study in futureThis study was conducted in the study fields of Gongshu district in urban area and Wuyi County in rural area, methods combined with quantitative analysis and qualitative analysis were used to explore the basic social-demographic status and chronic diseases in the intervention and control groups between the urban and rural areas. Meanwhile, focusing on the QoL, we used the SF-36 questionnaire to analyze the QoL and its influence factors in the older urban and rural populations, to explore the common and special factors which influence the QoL of the older urban and rural populations. After diagnosing the main health problems and its influence factors in both areas, we put forward the individualized health intervention project which was guided by the TTM theory, and conducted a 9-month intervention trial. Finally, we assessed the individualized health intervention through the behavioral changes and the changes of SF-36 scale scores. Study shows that individualized health interventions are a feasible method of changing the health behaviors and improving the QoL in the older rural population of China. Study provides scientific evidences for the QoL of the older people, and also provides useful experiences for the health aging study in future.Materials and MethodsThis study was based on a multistage cluster sampling at two stages, the intervention and control groups were selected in both urban and rural areas. Questionnaire was administered by face-to-face interviews to survey the health of the older people in a cross-sectional study from October to November 2007. The correlation analysis, reliability analysis, factor analysis, t-test and one-way ANOVA were used to evaluate the reliability and validity of the SF-36. With scale scores of the SF-36 were fitted as the dependent variable, statistic methods such as multiple linear regression models were used to discover the main influential factors of the QoL in urban and rural areas.From December 1st 2007 to August 31st 2008, individualized health interventions guided by the TTM theory were conducted in both urban and rural areas, and the outcome survey of the intervention was conducted in September 2008. Ordinal logistic regression models were fitted with behavior change as the dependent variable and intervention type and confounding factors as the independent variable to calculate the odds ratio of the intervention group versus the control group. Multiple linear regression models were fitted with paired changes (outcome minus baseline) of each scale score as the dependent variable. Intervention type and other confounding factors were set as independent variables to investigate the effect of intervention on SF-36 scale scores after controlling the influences of other factors.ResultsAfter the baseline survey,4230 finished the questionnaire in both urban and rural areas,2157 in urban area while 2073 in rural area. Significant differences were existed in social-demographic factors, lifestyle, and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The unmarried older people were less in urban than rural area (1.5% vs.6.8% P<0.001), illiterate people were more in rural area (17.1% vs.70.0% P<0.001), living alone people were more in rural area (10.7% vs.25.1% P<0.001), older people earned more in urban area (P<0.001), older people ate more brined vegetables in rural area (57.4% vs.37.6%, P<0.001), more current smoking older people in rural area (12.1% vs.35.1%, P<0.001), more current drinking older people in rural area (19.1% vs.32.7%, P<0.001), more tea consumption older people in urban area (56.2% vs.23.4%, P<0.001), more physical exercise older people in urban area (66.6% vs.2.2% P<0.001), meanwhile more diabetes in urban area, and more arthritis in rural area.Study revealed that all scale scores of SF-36 in rural areas were significantly lower than that in urban areas except general health (GH) (P< 0.001), especially in RE and RP scales. In both rural and urban populations, age was negatively related with PF, RP, VT, and SF scale scores (P<0.05). Gender (male) was positively related with PF and BP scale scores (P< 0.05), and income was positively related with PF, BP, and RE scale scores (P<0.05). Tea consumption was positively associated with all scale scores, except for RP and BP (P<0.05), and alcohol consumption was positively associated with PF, GH, and SF scale scores in rural and urban populations (P<0.05). The number of diseases was a factor negatively related to all scale scores in both populations (P<0.001). In the rural population, ex-drinking was negatively associated with GH, VT, SF, and MH scale scores (P<0.05); ex-smoking was negatively associated with PF, GH, and VT scale scores (P<0.05); and current smoking was positively associated with GH scale score (P<0.05). In the urban population, living alone was negatively associated with PF, GH, VT, and MH scale scores (P<0.05), and educational level was positively associated with PF, VT, RE, and MH scale scores (P<0.05). Regular exercise was a health-related behavior factor positively associated with all scale scores (P<0.01).In urban area, the intervention results were contrary with the assumption. Brined vegetable intake, salt intake, and smoking increased while fresh vegetable and fresh fruit intake decreased within the intervention group (P<0.05) after adjusting for confounding factors. Moreover, the scale scores in intervention group were significantly lower except MH (P<0.05) after adjusting for confounding factors. In rural area, the intervention results were consistent with the assumption. Brined vegetable intake, salt intake, and smoking decreased (P<0.001) while fresh vegetable and fresh fruit intake increased within the intervention group (P<0.01) after adjusting for confounding factors. The intervention group improved significantly in role-physical, role-emotional, mental health, and mental component summary scale scores (P<0.05) after adjusting for confounding factors.ConclusionsSignificant differences were existed in social-demographic factors, economic status, lifestyle, psychological status, medical services and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The SF-36 Chinese version has good reliability and validity; it is acceptable for the evaluation of quality of life in the older population. However, the reliability and validity of MH is relative low and the items such as 9-2,9-8 in MH and 3-1 in PF are not suitable for Chinese older population.The older rural population scored lower than the older urban population on QoL. Common factors that were positively associated with the QoL in both the older rural and urban populations were gender (male), tea consumption, income, and current alcohol consumption. Age and the number of chronic diseases an individual experienced were negatively associated with the QoL. Ex-smoking and ex-drinking were special factors negatively associated with the QoL of participants living in rural areas, whereas educational level and regular exercise were special factors positively associated with QoL of participants living in urban areas.The individualized health intervention (IHI) has proved unsuccessful in urban area, however, IHI is feasible in rural areas of China and it has obvious effects on health behavior changes in the elderly population, especially on the cessation of smoking and the reduction of salt intake. Moreover, this intervention can improve the mental health scale scores of QoL among the elderly population. This suggests that, through intensive training, community doctors can effectively implement the intervention to the elderly in Chinese rural areas.
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