abstract: 'Background: Populations of low and middle-income countries are ageing

  rapidly; there is a need for policies that support an increase in the

  duration of old age lived in good health. There is growing evidence that

  social participation protects against morbidity and mortality, but few

  studies explore patterns of social participation. Analysis of baseline

  quantitative and qualitative data from a trial of the impact of Elders''

  Clubs on health and well-being in the hill country of Sri Lanka provided

  an opportunity to better understand the extent of, and influences on,

  social participation among elders.

  Methods: We analysed data from 1028 baseline survey respondents and from

  12 focus group discussions. Participants were consenting elders, aged

  over 60 years, living in Tamil tea plantation communities or Sinhala

  villages in 40 randomly selected local government divisions. We assessed

  participation in organised social activities using self-reported

  attendance during the previous year. Multivariable regression analyses

  were used to explore associations with community and individual factors.

  The quantitative findings were complemented by thematic analysis of

  focus group discussion transcripts.

  Results: Social participation in these poor, geographically isolated

  communities was low: 63\% reported `no'' or `very low'' engagement with

  organised activities. Plantation community elders reported significantly

  less participation than village elders. Attendance at religious

  activities was common and valued. Individual factors with significant

  positive association with social participation in multivariable analyses

  were being younger, male, Sinhala, married, employed, and satisfied with

  one''s health. Domestic work and cultural constraints often prevented

  older women from attending organised activities.

  Conclusions: Elders likely to benefit most from greater social contact

  are those most likely to face barriers, including older women, the

  oldest old, those living alone and those in poor health. Understanding

  these barriers can inform strategies to overcome them. This might

  include opportunities for both informal and formal social contact close

  to elders'' homes, consulting elders, providing childcare, improving

  physical access, advocating with elders'' families and religious leaders,

  and encouraging mutual support and inter-generational activities.

  Influences on social participation are interrelated and vary with the

  history, culture and community environment. Further study is required in

  other low and middle-income country contexts.'
affiliation: 'Marsh, C (Corresponding Author), Burnet Inst, Melbourne, Vic, Australia.

  Marsh, Celeste; Agius, Paul A.; Durrant, Kelly; Luchters, Stanley; Holmes, Wendy,
  Burnet Inst, Melbourne, Vic, Australia.

  Agius, Paul A.; Durrant, Kelly; Luchters, Stanley, Monash Univ, Dept Epidemiol \&
  Prevent Med, Melbourne, Vic, Australia.

  Agius, Paul A., La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.

  Luchters, Stanley, Univ Ghent, Int Ctr Reprod Hlth, Dept Obstet \& Gynecol, Ghent,
  Belgium.

  Jayakody, Gamini, Cent Prov Hlth Dept, Kandy, Sri Lanka.

  Shajehan, Roshan; Abeywickrema, Chandima, PALM Fdn, Nuwara Eliya, Sri Lanka.'
article-number: '636'
author: Marsh, Celeste and Agius, Paul A. and Jayakody, Gamini and Shajehan, Roshan
  and Abeywickrema, Chandima and Durrant, Kelly and Luchters, Stanley and Holmes,
  Wendy
author-email: celeste.marsh@gmail.com
author_list:
- family: Marsh
  given: Celeste
- family: Agius
  given: Paul A.
- family: Jayakody
  given: Gamini
- family: Shajehan
  given: Roshan
- family: Abeywickrema
  given: Chandima
- family: Durrant
  given: Kelly
- family: Luchters
  given: Stanley
- family: Holmes
  given: Wendy
da: '2023-09-28'
doi: 10.1186/s12889-018-5482-x
eissn: 1471-2458
files: []
journal: BMC PUBLIC HEALTH
keywords: 'Social participation; Organised activities; Older adults; Low and middle

  income countries; Healthy ageing; Active ageing'
keywords-plus: 'OLDER-ADULTS; HEALTH OUTCOMES; LOW-VISION; LATE-LIFE; PEOPLE;

  DETERMINANTS; DEPRESSION; SUPPORT; LONELINESS; VALIDATION'
language: English
month: MAY 16
number-of-cited-references: '67'
orcid-numbers: 'Luchters, Stanley/0000-0001-5235-5629

  Agius, Paul/0000-0002-6075-8548'
papis_id: c33bd2409f5610fb023dcb840463e625
ref: Marsh2018factorsassociated
times-cited: '10'
title: 'Factors associated with social participation amongst elders in rural Sri Lanka:
  a cross-sectional mixed methods analysis'
type: Article
unique-id: WOS:000432721200006
usage-count-last-180-days: '1'
usage-count-since-2013: '27'
volume: '18'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2018'