SUMMARY OF RESEARCH AND EVALUATION OF THE SENIORS SUPPORT SERVICES FOR SOUTH ASIAN COMMUNITY PROJECT Sanzida Habib, Sharon Koehn, and Syeda Bukhari (July 8th, 2013) Full reports on the ‘Achieving Self-Management Supports for Immigrant Seniors team: South Asian Seniors Project’ research or the ‘Seniors Support Services for South Asian Community (S4AC) Project: Process Evaluation’ can be obtained from Dr. Sharon Koehn at skoehn@sfu.ca or 778-7829467. The evaluation report is also accessible from DIVERSEcity Community Resources Society. We are grateful to the United Way of the Lower Mainland and Simon Fraser University Community Trust Endowment Fund (LiVWELL group) for their support of these projects.
Background Research has found that South Asians, especially senior women, have low physical activity rates, and they face more barriers to accessing health promotion programs in the community. A large number of South Asian seniors live in the Newton area of Surrey, but they were not using recreation and seniors’ facilities in this neighborhood. In 2008, DIVERSEcity Community Services Society and the City of Surrey decided to work together to solve this problem. They started the Seniors Support Services for South Asian Community Project. Now the project has grown into two exercise programs. One is held at Newton Seniors Center and Wave Pool, and the other is at Bear Creek Park (North Surrey). Both programs are funded by the United Way of the Lower Mainland (UWLM). The City provides space and instructors, and DIVERSEcity staff bring South Asian seniors into the program. They also provide interpretation, childcare and snacks, and tell seniors about other programs and services in the neighborhood.
What we wanted to know We wanted to find out if the two partner agencies have been successful in delivering these programs. We also wanted to see how the programs have helped those seniors with ongoing (or chronic) health problems to live well with those conditions.
How we did the research We spent eight hours at the Bear Creek Park and Newton Seniors’ Centre and Wave Pool sites to see first-hand how the program runs. Most Bear Creek seniors are Punjabi-speaking Sikhs from India, but non-South Asians are also welcome there. They attend chair exercise classes twice a week and yoga once a week. At the Newton site, seniors can go to two exercise classes a twice a week: chair exercises are held in the Seniors Centre and Aquacize classes are held at the Newton Wave Pool next door. Seniors who are not South Asian also participate in these classes. We interviewed fifteen immigrant South Asian seniors who attended the exercise programs in both sites. Their ages ranged from 53 to 87 years, but most were between 65 and 74. Most of the seniors in the two programs, particularly Bear Creek, were women, so we interviewed thirteen women and two men. All of these seniors had two or more chronic health conditions such as diabetes, hypertension, high cholesterol, arthritis, asthma, thyroid problems, anxiety and depression. We also talked to five staff from DIVERSEcity, and three from the City of Surrey. All were involved in planning or delivering the project. We spoke to another 25 people in three focus groups. At the Newton site, we held two focus groups: one in English (with 7 non-South Asian women) and one in Punjabi (11 South Asian men and women). At Bear Creek, we only held one Punjabi-language focus group with 7 South Asian women because we had already interviewed so many of the women there. Focus group participants 1
did not need to have any chronic conditions. We asked current senior participants to help us find people that used to attend the program at any of the sites so that we could understand why they stopped coming to this program.
Making sure we got it right At the end of our project, we held a special event to report back to the seniors what they told us about the programs. A total of 42 seniors and 7 staff came. Seniors were from both sites and staff were from the City of Surrey and DIVERSEcity. The Research Assistant who did the interviews presented research highlights in Punjabi. Findings from the focus groups were not included. Overall, the seniors agreed with the main ideas. Everyone enjoyed a Punjabi lunch at the end of the session.
Two groups of seniors Bear Creek Park: Most of the women interviewees in the Bear Creek Park program said they came from farming families in India. Seniors were usually sponsored by a son who came to Canada before them. They lived with the sponsoring child and their grand-children, and generally helped their older children with household chores. Most were currently or had previously been taking care of young children. Some of the seniors were previously or currently involved in part-time or seasonal farming work in Canada. Newton Seniors Centre and Wave Pool: There were 6-8 South Asian men and women attending the Newton sites. All were from cities in India. Most of them came to the program with their husbands or wives. Compared to the Bear Creek group, they were well-educated, professional and, could speak English well. The non-South Asian seniors were from Canada and other countries and they were mostly women. Many had difficulty getting around, so few attended the Aquacize classes.
What we found Seniors and staff talked about different aspects and benefits of attending the exercise program. They also gave suggestions about how to improve it (see the bolded blue font).
Health benefits of regular exercise Seniors at both sites said that the main skill they learned from the program is exercise. Some South Asian women at the Newton Centre said they learned how to do pool exercise or Aquacize, something they never did before. Most were happy with the quality of the program, especially the instructors. They liked how the instructor showed them how to adapt the exercise moves, depending on their ability. Staff also tried to make the exercise program culturally suitable and comfortable for South Asian seniors. For example, they allowed them to wear traditional clothes (shalwar-kamiz) for exercise, and tights and T-shirts for Aquacize. Some of the staff told us that, over time, some South Asian seniors slowly started wearing track suits and runners during exercise and even swim-suits for the Aquacize. Some of the seniors at the Bear Creek Park suggested that the instructors 2
should explain to them the benefits of the exercise moves. The seniors would like printed handouts or videos of some of the moves to help them to remember and practice those moves at home. All the seniors that we interviewed said that both their physical and mental health improved, especially through chair exercise and yoga. They said exercise helps them to stay active, fit, healthy and happy. Coming to the exercise program gives them an opportunity to meet friends, and remove their isolation. This benefits their mental health. Some said that their blood pressure medication dosage went down. Others said they are now able to move better, their muscles are more flexible or stronger. One woman said that she overcame her fear of falling. Another woman said that coming to the program helped her relieve mental stress. The staff told us that they had heard many similar stories about the benefits of the program from the seniors.
Old friends and new friends Seniors in the exercise program also benefited from the opportunity to meet regularly with other seniors. This improved their mental health and increased their awareness about health and self-care, especially the need to exercise. All of the South Asian interviewees said that they had a ‘good time’ coming to the program because they met with their old friends and family members, and also made new friends. The DIVERSEcity staff encouraged seniors to introduce their neighbors, friends and family members to the program, and many of them did, especially at the Bear Creek site. This was a good way to get new South Asian members into the program. The non-South Asian seniors also enjoyed chatting with friends over snacks after the exercise at the Newton Centre. Some of them said, this gets them out of the house and encourages them to come to the Centre even when the weather is bad or they have problems getting there. There have only been a couple of field trips (to the Sikh temple and a South Asian grocery store) that brought seniors from the Bear Creek and Newton sites together.
Health and other information Staff told us that they also gave information to the seniors about health and other topics. Healthrelated topics included fall prevention, nutrition and healthy eating, diabetes, healthy heart, and healthy eyes. The information was passed on verbally and in written formats, such as handouts, in Punjabi. Sometimes the staff invited doctors and nurses to the program to run group workshops on health issues. If no Punjabi speaking expert was available, DIVERSEcity staff provided interpretation. The mental health counsellor also organized a workshop on taking care of mental health and emotional self-care (e.g. talking with friends, exercising). By contrast, most of the seniors that we interviewed said they had not received much information on health or other topics. Seniors in the Newton focus groups told us that they received information regularly after the exercise classes when the program first started up, but not recently. Most seniors were interested in receiving such information, but in more informal ways. They thought field 3
trips and tours to different places with other seniors would give them new information and knowledge about Canadian society in a manner they could enjoy and remember.
Understanding the importance of self-care Staff told us that an important goal of the project was to teach the seniors the importance of selfcare, which is often ignored among South Asian elderly women. They usually put the care of their family members before their own needs. Program staff tried to increase seniors’ confidence and independence, making them aware of their rights, access to services, and connecting them with other programs at the Centres. Staff have also encouraged the seniors to participate in special events outside the program such as International Women’s Day. South Asian senior interviewees said that after coming to this program they could better understand the importance of taking care of themselves and their health. They also told us that their morale and confidence has increased. When they are able to do their own chores at home and help other family members, they feel they have become independent and self-sufficient. In other words, South Asian seniors do not view self-care or taking care of themselves as separate from taking care of their families. Overall, the program improved their confidence, social skills and sense of being connected, and this can help them find and use other community resources and health services. The seniors thought that there should be more opportunities for learning new skills as well as for having fun so that they can live and enjoy life more independently. Linking with other programs and services We wanted to know if coming to this exercise program created more chances for the seniors to access other programs and to learn about other events. The staff seemed to think that it did. One staff who ran the programs at Bear Creek said that when the program first began, she partnered with another DIVERSEcity program for seniors at the same site to organize some workshops for seniors in both programs. Some of the seniors told us that they had attended these programs. They learned English language, basic computer skills, and cooking. Some of the staff told us that many of the seniors at the Newton Centre were attending other programs and events (such as healthy eating, healthy breakfast program and the computer club) at that site. After visiting the sites and talking to the focus group participants, we found that a few well-educated South Asian seniors at the Newton Senior Center were already connected with other programs before starting the current exercise program. They were able to attend those without any help from the program staff. Most senior interviewees said that they were just doing exercise at their own sites. The Newton seniors would like to be invited to the Bear Creek site for yoga and other activities and they are able to attend because they drive their own cars. The Bear Creek seniors would like to try Aquacize, but they cannot easily get over to the Newton Wave Pool, and the timing of the North Surrey classes conflicts with their chair exercise class. 4
Removing barriers to participation The programs are offered at convenient locations and times, at a lower cost and in culturally appropriate ways so that it can attract more South Asian seniors. The Punjabi speaking staff went to connect with South Asian seniors in the temples and school grounds where they take their grandchildren. They also offered free try-out sessions, and tried to convince family members to support their elders to participate. DIVERSEcity staff members participate in the classes to interpret what the instructor is saying and to model the best type of clothes and shoes to wear. They also provide healthy snacks and sometimes Indian tea (chai ) after the exercise classes. Some of the seniors at the Bear Creek site said they would like the staff to give them water bottles and fresh fruits, not granola and dried fruit bars as snacks. All of the South Asian seniors agreed that many older women, and even some men, could not come to the program without childcare because they have to look after young grandchildren. Free on-site childcare services have been provided at the Bear Creek site where it is needed the most, but when we visited, we learned that the funding for childcare had expired, so seniors were asked not to bring grandchildren for safety reasons. Happily, the childcare service was brought back (and was well-used) by the time we completed our research. Transportation difficulties prevent both South Asian and non-South Asian seniors from participating in the program. Seniors who live close to the Bear Creek Park area can walk to the program, although they may experience difficulty getting there if the weather is bad. Those who live further away often have to depend on family members for a ride to drop them off. The program staff gave bus tickets to the seniors and showed them how to use them on a bus. But this is not enough for seniors who find it difficult to walk or wait at a bus stop and for those who lack confidence because they do not speak or read English. They would like a bus that can pick them up and take them on field trips.
Summing Up Educated South Asians from cities, such as the Newton seniors, may not need the ongoing assistance of a linking organization such as DIVERSEcity to be successfully connected to existing services, but the lower fees and a safe introduction to new things, such as the pool, was welcomed. For the Bear Creek seniors, the involvement of DIVERSEcity was much more important. Many of the South Asian seniors at this location were registered in an exercise program for the first time in their lives. Thus by taking programs to where seniors naturally gather (e.g., parks, temples), by reducing language and cultural barriers, and by providing childcare for grandchildren, the project has succeeded in build the capacity of isolated seniors to take care of their health needs. All of the seniors said that they want the program to continue. In fact, they would like more classes, in more locations and throughout the summer months. Services could also be targeted at the many other South Asian groups besides Punjabi Sikhs from India who live in Surrey. 5