1. Health beliefs of older employees as the basis for focusing on their education The National Centre for Workplace Health Promotion – The Nofer Institute of Occupational Medicine – Lodz / Poland Polish NCO of EN WHP The authors: Elzbieta Korzeniowska Jacek Pyzalski Eliza Iwanowicz

2. Ageing as a growing problem WORLD According to the “Active Ageing: A Policy Framework” - WHO, 2002: n The percentage of people to be 60 – year old and more is growing much more rapidly than in other age groups n According to the estimations, there will be a 223 - percentage growth in the amount of older people around the world between year 1970 and 2020. POLAND The percentage of 65- year old people in the whole population is changing in the following way: F 1986r. - 9,5% F 1995r. - 11,2% F 2020r. - 15,9%* * According to „The Prognosis of Polish Population in Voivodships for years 1996- 2020”, Bolesławski L., Marciniak G., Warsaw 1997.

3. Ageing as a consequence of: n a decrease in the birth-rate n and a increase in the life expectancy

4. How can we cope with this challenge? n One way of coping with such a challenge is prolonging older people’s work ability It means that they should be supported in increasing their overall abilities and enhancing their good health n It is in accordance with the Parson’s way of perceiving health: Health is an optimal ability to perform everyday duties and fulfil social roles, whereas disease means decreasing such abilities.

5. How can we do this? n By health promotion programmes Why? n Because, according to the Ottawa Charter for Health Promotion, 1986, such programmes aim at developing conditions helping people to improve their control over issues influencing their health, which in consequence leads to the improvements in its state. Where? n In workplaces

6. The survey of the Polish National Centre for Workplace Health Promotion n It was aimed at checking if there are differences between younger and older employees’ health behaviours and attitudes, and if YES, what is their character. n On this basis we wanted to answer the following question: Does the group of Polish employees at the age of 45 or older require particularly for them prepared and implemented health promotion programmes?

7. The survey n The National Centre for Workplace Health Promotion (NIOM, Poland) n 2002 n a random sample of 1138 employees of two age groups: 45-55 years old (the researched group) and 25-35 years old (the control group) n 250 Polish big and medium-sized enterprises (employing at least 100 workers) n The sample consisted of: u 50,2% older respondents (researched group) and 49,8% younger ones (control group) u 48,0% women and 52,0% men

8. n understanding and self-assessment of health status n health locus of control n perceiving the influence of selected behaviours on health status n motives for: undertaking healthy or unhealthy behaviours or being passive in this field n beliefs concerning relations between health and work n the state of particular healthy and unhealthy behaviours The survey- areas of analysis

9. The survey showed that: n In general, there is no basis for recommending health promoters to plan and implement at workplaces separate health promotion programmes aiming at different age groups of employees. Why? n Firstly, older employees (age 45 –55) did not basically differ from younger ones (age 25 – 35) in their health behaviours and awareness. n Secondly, older employees felt that they are treated worse than younger ones in their enterprises (so implementing separate whp programmes for them could be perceived as a sign of labelling).

10. However, there are some health beliefs of older employees (different from those diagnosed among younger ones) that are the basis for focusing on older employees’ health education. These minor differences point out to some directions of health education which should be taken into consideration while planning and implementing whp programmes.

11. Older employees’ ‘medically oriented fatalism’ n On one hand, older employees very often regard maintaining health as a basic condition for achieving their life goals. u Health was perceived in this way by one in five older employees (21,1%) and by one in seven younger ones (13,8%) (χ²P =10,71, df = 2, p < 0,005, N=1132) n On the other hand, they were narrow – minded in perceiving the opportunity to improve health. u Older employees more often than younger ones (38 % to 25 %) thought that the longer they live, the more their health deteriorates (it is hard to maintain or enhance it) (χ²P=11,66, df = 3, p <0,05) u 35% of older respondents thought pessimistically that their health would decrease in the future. This answer was chosen only by 18% of younger ones (χ²P = 9,51, df = 2, p < 0,0001, N = 1114)

12. n According to older employees, health status depends on the organism that was inherited. Then, health gradually deteriorates during the life span and people can’t do much to change this unfavourable process. u Older employees more often than younger ones were convinced that: F they had inherited such kind of organisms which can’t be changed under the influence of their lifestyles (χ²P=48,47, df=3, p< 0,0001, N=1118) F access to medical service is more important than healthy lifestyle (χ²P=21,79, df=3, p< 0,0001, N=1119)

13. n This way of thinking had a bearing on kinds of factors which older employees perceived as the most detrimental to their health. These were (in an open question): ageing (50,5% of older respondents), diseases (21,0%) and stress (19,0%); u Younger employees mostly pointed out: stress (26,5%), ageing (25,5%), work (14,0%), unhealthy behaviours (mainly an unreasonable diet, 12,0%) and diseases (11,5%). Only few older respondents (1,5%) chose here unhealthy behaviours!!! Correlation between age and perceived factors diminishing health were statistically significant at the level of p < 0,0001 (χ²P = 82,21, df = 9, N = 282).

14. n Therefore, older employees, in comparison to the younger ones, u more often associated healthy behaviours with: F making check-ups (41,9% of older respondents to 25,9% of younger ones) (χ²P =32,16, df=1, p< 0,00001) F and conforming to medical advice (respectively: 15,8% & 7,5%) (χ²P = 32,16, df = 1, p < 0,00001) u less frequently associated healthy behaviours with: F physical activities (respectively: 35,9% & 57,4%) u more often pointed out the following motives for undertaking healthy behaviours: F being convinced that it is better than later treatment (χ²P = 18,74, df = 1, p < 0,0001, N = 1100) F being afraid of the bad state of health care service in Poland (χ²P = 8,19, df = 1, p < 0,05, N = 1104)

15. n These health beliefs of older employees influenced the way they behaved. They were a bit worse, in comparison to the younger respondents, in smoking, physical activities and coping with stress. u close on 40% of older employees were smokers, whereas in the younger group there were 29% of smokers. Among those smoking at least 20 cigarettes per day there were two times more older employees than younger ones (χ²P=50,85, df= 3, p < 0,0001, N = 1090). u one in four older and one in six younger employees did not take up physical activities at all (χ²P = 12,84, df = 4, p < 0,01, N = 1110) u with regard to stress, older employees, in comparison with the younger ones, less often expressed an opinion that they coped with stress well (46,2% of older employees to 60,1% of younger ones) and more often thought that the way they coped with stress was going to be worse (respectively: 44,8% and 29,1%). There were similar numbers of those not coping with stress at all (respectively: 10,0% & 11,1%) (χ²P = 27,44, df = 2, p < 0,0001, N = 1099).

16. n Among all classic healthy behaviours older employees were better only at diet. Besides, they more often controlled their health on their own initiative. u As far as diet is concerned, cutting down on sugar was this kind of healthy behaviour which was considerably more common among older employees than younger ones (χ²P =15,47, df = 1, p < 0,0001, N = 1115). The difference in the frequency of other diet behaviours (cutting down on fats and increasing fruit and vegetable intake) among both age groups of employees was considerably smaller (it was the difference of only few %, p < 0,05). u Older employees more often (48,0%) than younger ones (36,1%) had check-ups done on their own initiative during two years before the survey).

17. n Health beliefs of older employees had an impact on their expectations from their employers: u they mostly expected from their employers a guarantee of access to medical service at their workplaces (which means compensating shortages of Polish health care system) F older employees more often (24,5%) than younger ones (15%) thought that an ideal enterprise taking care of employees’ health ought to create for its employees opportunities to be treated by an enterprise’s doctor (χ²P = 16,53, df = 2, p < 0,001, N = 1123). u they wanted their managers to reduce nerve – racking situations at the worksites F This opinion was expressed by 38, 5% of older employees and 30,4% of younger ones (χ²P = 8,88, df=2, p < 0,01, N = 1123).

18. Younger employees... more often realised that health deteriorates not only because of ageing and stress but also under the influence of work and peoples’ own unhealthy behaviours. They associated taking care of their own health with i.e. physical activities and expected support in this matter from their enterprises.

19. Health education in whp programmes: n Firstly, since older employees’ “medically oriented fatalism” is a source of cognitive dissonance (that stems from the fact that although they realised the importance of health, they simultaneously had conviction about their helplessness with regard to improving their own health or even they disrespected it) health educators in whp programmes should make older employees realise that:

20. u Health can and ought to be maintained / even improved and it doesn’t have to diminish in future. u There are other than ageing and diseases factors being injurious to our health, such as unhealthy behaviours or work-related behaviours, on which we have a considerable impact. u Health depends to a great degree on our lifestyle. Hence, health education has to be focused on showing older employees, other than check-ups or conforming to medical advice, ways of healthy behaviours (e.g. healthy diet, physical activities, obeying safety regulations at workplaces). Furthermore, since many older employees were smokers, health education ought to be devoted to helping them quit this addition.

21. n Secondly, older employees more often than younger ones complained that they coped with stress with much difficulty and expected other people to resolve this problem (i.e. according to older employees managers ought to make efforts to make work less stressful) u That is why, health education in whp programmes should be focused on explaining employees the essence and inevitability of stress and more importantly teaching them easy and proven ways of combating pressure connected with stress. Health education in whp programmes:

22. n Lastly, since the survey showed that for both groups of respondents the most common explanation of not taking up activities for improving health is the ambiguity of health experts’ opinions on healthy lifestyles. u That is why, health education messages have to be understandable and coherent for ordinary people. It is advisable for health educators to refer to various authorities but simultaneously it is worth revealing those areas of health-related knowledge that haven’t been completely explored and proved by researchers yet (so they are not certain), which gives promoters and employees the opportunity to search for their own solutions. Health education in whp programmes:

23. Thank you for your attention!!!