An exploration of the long-term impact of a Health Empowerment Programme on self-care enablement and health outcomes of Hong Kong Chinese adults of low socioeconomic status

Abstract

Introduction: Individuals of low socioeconomic status (SES) experience poorer health. This study aimed to determine whether a community-based health empowerment programme (HEP) could improve self-care and health outcomes among adults of low SES. Methods: This longitudinal study included participants enrolled in the HEP where they received free annual health assessments and health enablement programmes (intervention group) and those with a similar socioeconomic background (control group). Inclusion criteria were: 1) at least one working family member; 2) at least one child studying in grade 1-3; and 3) a monthly household of <75% Hong Kong’s median monthly household income. The primary outcome was selfcare enablement, measured using the Patient Enablement Instrument (PEI). Secondary outcomes included HealthRelated Quality-of-Life (HRQoL) measured by Short-Form 12 Health Survey Version 2(SF-12v2)) and allostatic load assessed by waist-to-hip-ratio (WHR), total-cholesterol to high-density-lipoprotein-cholesterol (TC:HDLC) ratio, triglycerides and blood pressure. Results: 229 intervention adults (mean age: 45.5, 67.0% female) and 167 control adults (mean age: 51.3, 76.6% female) were included (mean follow-up: 4 years). Both intervention and control groups reported increases in mean PEI-total scores between baseline and follow-up, with significantly greater increases in the intervention group than control group (p<0.001). The change in mean SF-12v2 mental component scores were also significantly greater for the intervention group (p<0.001). No statistically significant differences were found between groups for changes in mean SF-12v2 physical component scores. For allostatic load, the intervention group showed significant increases in the proportion achieving optimal TC:HDL-C ratio and blood pressure, whereas significant decreases were found in the control group (all p<0.001). Both groups showed significant increases in WHR and triglycerides, however, such increases were higher among control group participants. Conclusions: Our findings support the implementation of community-based health empowerment programmes to build self-care capacity among individuals of low SES and ultimately improve self-care enablement, mental wellbeing and allostatic load.