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Aging & Mental Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/camh20
Leisure education reduces stress among older adults Liang-Chih Chang
a
a
Department of Living Sciences, National Open University, New Taipei City, Taiwan Published online: 31 Jan 2014.
To cite this article: Liang-Chih Chang (2014) Leisure education reduces stress among older adults, Aging & Mental Health, 18:6, 754-758, DOI: 10.1080/13607863.2013.878306 To link to this article: http://dx.doi.org/10.1080/13607863.2013.878306
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Aging & Mental Health, 2014 Vol. 18, No. 6, 754–758, http://dx.doi.org/10.1080/13607863.2013.878306
Leisure education reduces stress among older adults Liang-Chih Chang* Department of Living Sciences, National Open University, New Taipei City, Taiwan
Downloaded by [Umeå University Library] at 13:05 16 November 2014
(Received 25 July 2013; accepted 14 December 2013) Objectives: The objectives of this study were to examine whether a leisure education program could facilitate leisure competence among older adults and whether it could also reduce their stress. Methods: A pre-test–post-test randomized experimental design was conducted. Subjects were randomly assigned to either an experimental group (n ¼ 30) or a control group (n ¼ 30). A leisure education program was used to serve as the intervention. A day before this experiment was carried out, pre-test data were collected using leisure competence and stress scales. Thirty minutes after this experiment ended, post-test data were collected using the same scales. These data were analyzed using an analysis of covariance. Results: The results indicated that the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group and that the average post-test scores of stress in the experimental group were significantly lower than those in the control group. Conclusion: Healthcare practitioners should adopt the provision of leisure education as a priority to facilitate leisure competence and reduce stress among older adults. Keywords: leisure competence; leisure education; stress
Introduction Over 60% of older adults report that they suffer from stress (Bureau of Health Promotion [BHP], 2006). Stress contributes to anxiety, depression, and headaches among older adults (BHP, 2006); therefore, it is necessary for them to develop an effective mechanism to reduce stress in order to maintain optimal health. Self-determination theory (SDT), which has recently been applied in the field of stress studies (Ntoumanis, Edmunds, & Duda, 2009; Weinstein & Ryan, 2011), holds that competence is a basic human need (Deci & Ryan, 2008). Competence refers to one’s capacity to deal with the activities in which one participates (Deci & Ryan, 1985). When satisfied, this need will contribute to overall stress reduction. In particular, feedback generated from displays of competence makes one perceive oneself as generally capable of dealing with negative events and these negative events are thereby hardly considered stressors. This feedback also results in positive emotions that prevent the incursion of stress (Weinstein & Ryan, 2011). Consistent with SDT, empirical studies have confirmed that competence is significantly negatively related to depression and stress (Chou, 2005; Windle, Markland, & Woods, 2008). Thus, enhancing levels of competence may be an effective way to reduce the stress faced by older adults. Previous studies have indicated that leisure activities can provide participants with opportunities to exercise competence (Caldwell, 2005; Trenberth, 2005). Leisure activities are available to most retired adults and provide pleasurable experiences to supplement the routines of
*Email: [email protected] Ó 2014 Taylor & Francis
daily life. Therefore, participation in leisure activities appears to be an ideal opportunity to promote the competence of older adults. The promotion of competence through leisure activities can be defined as leisure competence: a participant’s perception of her/his capacity to deal with leisure activities and control her/his own behaviors within the context of these activities. Chang and Yu (2013) demonstrated that leisure competence was significantly negatively related to stress among older adults; however, they failed to reveal a causal relationship between leisure competence and stress. Thus, the effect of leisure competence on stress requires a further investigation. Leisure education has long been regarded as a modality that strengthens the leisure competence of participants (Datillo & Murphy, 1991). Leisure education refers to an organized program designed to improve the leisure attitudes, leisure knowledge, and leisure capacity/leisure competence of participants, thereby using their leisure time more effectively (Sivan & Stebbins, 2011). One mechanism by which leisure education can facilitate leisure competence has further been proposed. Leisure competence depends on one’s capacity for participation in leisure activities. When leisure capacity increases, leisure competence also increases. Leisure education addresses the leisure capacity of participants through training (Datillo & Murphy, 1991; Sivan & Stebbins, 2011); therefore, it can facilitate an increase in leisure competence by developing the leisure capacity of the participants. Searle, Mahon, Iso-Ahola, Sdrolias, and Dyck (1995) conducted a pre-test–post-test experimental design to
Downloaded by [Umeå University Library] at 13:05 16 November 2014
Aging & Mental Health examine the effect of an individualized leisure education program on leisure competence among older adults. They assigned 13 subjects to an experimental group and 15 subjects to a control group. The average number of weeks spent in this program was 17 (ranged from 14 to 25). After this experiment ended, they used an analysis of covariance to analyze pre-test and post-test data. The results of their study indicated that the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group. It seems that a leisure education program, like Searle et al.’s program, may either facilitate leisure competence or serve as an appropriate intervention to examine the effect of leisure competence on stress. However, the validity of their results needs to be further examined because they did not randomly assign subjects. According to the above, it was hypothesized that a leisure education program could facilitate leisure competence and thereby reduce stress among older adults. The results of this study provide healthcare practitioners with information valuable to the development of strategies for stress reduction. Methods Subjects Subjects had to meet four eligibility criteria: (1) aged 65 years or older, (2) had no previous training in any form of leisure education, (3) demonstrated practical literacy, and (4) were free from mental health problems, such as dementia and suicide attempts. They were excluded if their family told the research assistant that they were judged to have mental problems by the doctor. One hundred potential subjects were randomly selected from a pool of participants in a random sampling study (Chang & Yu, 2013). These subjects received a handbill outlining the purpose of this study and describing the leisure education program. They were then invited to take part in the program with assurance that only statistical data would be reported. Those who agreed to participate were asked to fill out a consent form. Sixty subjects agreed to take part in the program. The 60 subjects in this study were all retired. Many of them experienced mild dexterity problems that might have slightly limited their participation in the activities, and their self-rated health scores of 2.92 were slightly lower than the average scores of 3.00 on a 5-point scale (2.90 in the experimental group and 2.93 in the control group); however, they still could independently participate in leisure activities. The ages of the subjects ranged from 67 to 79 years old, with a mean age of 70.83 years (SD ¼ 4.53) in the experimental group and 70.76 years (SD ¼ 4.43) in the control group. Most of them were married and had completed primary school (Table 1). No statistically significant differences were observed in the demographic variables between experimental group subjects and control group subjects. One subject in the control group moved to a new location and subsequently dropped out. All of the subjects in the experimental group completed the experiment (Figure 1).
755
Table 1. Characteristics of the subjects. Experiment Characteristic Gender Female Male Education Primary-school graduates High-school graduates University degree and above Marital status Unmarried Divorced Widowed Married
Control
n
%
n
%
15 15
50.0 50.0
15 14
51.7 48.3
26 2 2
86.7 6.7 6.7
22 5 2
75.9 17.2 6.9
1 0 6 23
3.3 0.0 20.0 76.7
2 1 7 19
6.9 3.4 24.1 65.5
Design A pre-test–post-test randomized experimental design was adopted in this study. Subjects were randomly assigned to either an experimental group or a control group, and these subjects were not advised of their assignment. All subjects took a pre-test to measure their leisure competence and stress. The subjects in the experimental group then participated in a leisure education program. All subjects also underwent a post-test before the subjects in the control group participated in the same leisure education program. This was done to ensure that all subjects could benefit from the leisure education program, while this study could still determine the net effects of the program on leisure competence and stress.
Intervention Searle et al.’s (1995) leisure education program was adopted as a template for the intervention. As mentioned earlier, leisure competence could be facilitated by the development of leisure capacity. This study addressed leisure capacity in Units 4, 6, 8, and 12 of the leisure education program. Thus, it is believed that the leisure education program can facilitate leisure competence and then reduce stress among the subjects. The intervention consisted of 12 units. Unit 1: What you do for recreation. This unit has the client explore the potential benefits of recreation on physical and mental well-being and his/her personal recreation interests. Unit 2: Why you do what you do. Based on the list of interests identified in unit 1, the therapeutic recreation specialist (TRS) helps the clients decide what motivates them to participate in specific recreation activities. Unit 3: How it’s done. The client learns to conduct an activity analysis of each of his/her recreation interests by analyzing the physical, mental, and social skills required for each activity. Unit 4: Can you do it? Clients are taught to realistically assess current and potential physical and mental capabilities, and how they may affect future recreation involvement. Unit 5: Can/will you adapt? Each of the clients is exposed to the concepts of activity adaptation and equipment modification and taught how to utilize the procedures to facilitate satisfactory leisure participation. Unit
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L.-C. Chang
Figure 1. Flow of subjects.
6: Barriers. Clients explore the variety of barriers they may face, and explore ways and means of overcoming barriers to enable them to participate in their chosen leisure pursuits. Unit 7: Making plans for your future recreation. Clients are taught to make realistic short-range and long-range leisure plans. Unit 8: What else is there? In this unit clients explore other potential recreation pursuits, determine what skills they must learn to participate in such activities, and develop plans to facilitate their participation in these activities. Unit 9: Resources. Clients are taught to identify who may act as a support for them to carry out their leisure goals, and how to make clear and assertive requests for assistance. Unit 10: Personal resources. Each of the clients is taught to assess personal resources including such things as finances, transportation, and equipment as they relate to their leisure plans. Unit 11: Community resources. Clients are exposed to community resources and are taught how to assess such resources as a means of facilitating community-based participation. Unit 12: Before You’re Through With Us. Prior to the end of the intervention clients are asked to reassess and if necessary revise their participation goals. In part, this is to ensure that they are able to continue to reassess their leisure goals in the future (Searle et al., 1995, p. 116). Some of the units were modified to ensure that the leisure education program was appropriate for the subjects living in Taiwan. In Taiwanese society, the relationships among relatives are strongly emphasized; therefore, the subjects were taught that, in addition to leisure companions, relatives also can support them in the pursuit of leisure goals in Unit 9.
Furthermore, Taiwanese people share leisure resources less than Americans do because the population density of Taiwan is substantially higher than that of the United States. Consequently, the subjects were taught how to effectively use public leisure resources near their community during off-peak times in Unit 11. Each of these 12 units comprised a variety of activities, such as discussion exercises, role-playing, and participation in leisure activities. The subjects in the experimental group attended unit lectures and completed all units together. The intervention was conducted twice per week over a period of three months. The subjects spent approximately two hours participating in each unit. This experiment was approved by the Research Ethics Committee, Central Regional Research Ethics Center in Taiwan. Measures Leisure competence was measured using Chang’s (2012) Leisure Competence Scale. The scale comprises six items related to the perception of older adults regarding their ability to participate in leisure activities. Here are two examples of the items: (1) I am skilled at leisure activities and (2) I feel good about my ability to participate in leisure activities. The subjects were asked to rate the degree to which they agreed with each of the items on a 5-point scale, from 1 (not at all) to 5 (completely). Total scores of the scale ranged from 6 to 30. Higher scores indicated greater leisure competence. The reliability of the scale was reassessed by performing a preliminary investigation
Aging & Mental Health
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involving 120 participants. The results indicated that the scale had an acceptable alpha reliability coefficient of 0.88. Stress was measured using Cohen, Kamarck, and Mermelstein’s (1983) Perceived Stress Scale – 14 items, which has widely been used in Taiwan (Gaertner, Sedikides, & Chang, 2008; Lu, 2006). Two examples of the items are listed here: (1) in the last month, how often have you successfully coped with life hassles and (2) in the last month, how often have you felt that you were unable to control the important things in your life? The subjects were asked to rate the degree of stress they felt regarding each of the items on a 5-point scale, from 1 (never) to 5 (always). Total scores of the scale ranged from 14 to 70. Higher scores indicated higher stress. The reliability of the scale was reassessed by the preliminary investigation. The results indicated that the scale had an acceptable alpha reliability coefficient of 0.91. Data collection and analysis A day before the intervention was carried out, the fulltime assistant who worked on this study collected the pretest data of the experimental and control groups. Thirty minutes after the intervention ended, the post-test data of the experimental group were collected by the same person in the same setting in the afternoon. The post-test data of the control group were collected in the morning on the same day they attended their first leisure education class. The pre-test data from the experimental and control groups were used as covariates and then group differences in post-test leisure competence and stress were examined using an analysis of covariance. A correlation analysis was also performed to examine the relationship between leisure competence and stress in order to double check whether a change in stress resulted from an increase in leisure competence. Results The average leisure competence scores of the subjects in the experimental group were 17.10 in the pre-test and 18.83 in the post-test, whereas the subjects in the control group scored 16.97 in the pre-test and 16.59 in the posttest. The average stress scores of the subjects in the experimental group were 45.43 in the pre-test and 41.77 in the post-test, whereas the subjects in the control group scored 44.69 in the pre-test and 46.03 in the post-test. The results derived from the analysis of covariance were as follows: (1) in the experimental group, the average post-test scores of leisure competence were significantly higher than the average pre-test scores of leisure competence (t ¼ 3.79, p < 0.01), whereas the average post-test scores of stress were significantly lower than the average pre-test scores of stress (t ¼ 4.44, p < 0.01) and (2) the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group when the pre-test data from these two groups were used as covariates (F ¼ 18.27, p < 0.01), whereas the average post-test scores of stress in the experimental group were significantly lower than those in
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Table 2. Differences in leisure competence and stress between the pre-test and post-test data.
Variable Leisure competence Experiment Control stress Experiment Control
Pre-test
Post-test
M
M
17.10 16.97
SD
4.05 18.83 4.00 16.59
SD
t
F
4.21 3.79 4.15 2.09
45.43 11.40 41.77 12.08 4.44 44.69 11.89 46.03 10.85 3.23
18.27 28.88
p < 0.01.
the control group when the pre-test data from these two groups were used as covariates (F ¼ 28.88, p < 0.01), as shown in Table 2. The results of the correlation analysis revealed that leisure competence was significantly negatively related to stress in the pre-test (r ¼ 0.36, p < 0.05) and post-test (r ¼ 0.39, p < 0.05).
Discussion The results of this study indicated that the leisure education program could significantly facilitate leisure competence among the subjects, confirming the findings of Searle et al. (1995). The results further demonstrated that the leisure education program could significantly reduce the stress of the subjects and that their leisure competence had a significant negative correlation with their stress. The results are consistent with those of Chang and Yu (2013). It appears that an effective leisure education program can help facilitate leisure competence and thereby decrease stress among older adults. The above results provide healthcare practitioners with important information regarding efforts to reduce the stress experienced by older adults. The leisure education program outlined in the study of Searle et al. (1995) was based on learning activities tailored for each subject. Although individual plans for leisure education worked well in their study, implementing such individualized program is difficult in practice. Nonetheless, the results suggest that a group-based leisure education program can also be effective in the facilitation of leisure competence in order to reduce stress among older adults. Leisure education has been proposed in Taiwan for approximately 60 years (Chu, 1956). During this period, the leisure education programs were typically implemented for children and adolescents, and rarely for older adults (Chuang & Hsu, 2007; Hsieh, Wu, & Hsieh, 2007), which is evidenced by the fact that none of the participants in the study conducted by Chang and Yu (2013) had any previous training in leisure education. Therefore, providing older adults with leisure education programs to help them reduce stress is necessary. This study has several strengths as compared to Searle et al.’s (1995) study. First, the sample size of this study was double bigger than that of their study. Second, more
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importantly, this study used a randomized experimental design, whereas their study did not. This study also has two limitations. First, the results may not directly be generalized to people with mental health problems or illiterate older adults because these groups were excluded. Second, participation in the groupbased leisure education program likely changed the state of the subjects’ social interactions. Because social interactions also have a significant effect on stress, the stress reduction reported in this study cannot necessarily be attributed entirely to changes in leisure competence. If one accepts the underlying premise of this study, however, the results are still valuable in spite of these limitations. The results suggest that providing older adults with a leisure education program should be an effective means to facilitate their leisure competence to reduce their stress.
Funding This study was funded by National Science Council in Taiwan [grant number NSC 98-2410-H-180-001-SS3].
References Bureau of Health Promotion. (2006). Results from the social environment and biomarkers of aging study (Report No. Taiwan Aging Study Series 9). Taiwan: Author. Caldwell, L.L. (2005). Leisure and health: Why is leisure therapeutic? British Journal of Guidance and Counselling, 33(1), 7–26. doi: 10.1080/03069880412331335939 Chang, L. (2012). An interaction effect of leisure self-determination and leisure competence on older adults’ self-rated health. Journal of Health Psychology, 17(3), 324–332. doi: 10.1177/1359105311415727 Chang, L., & Yu, P. (2013). Relationships between leisure factors and health-related stress among older adults. Psychology, Health and Medicine, 18(1), 79–88. doi: 10.1080/ 13548506.2012.686621 Chou, K. (2005). Everyday competence and depressive symptoms: Social support and sense of control as mediators or moderators? Aging and Mental Health, 9(2), 177–183. doi: 10.1080/13607860412331336814 Chu, S. (1956). Leisure education for children. Taiwan Education Review, 70, 13–14 (in Chinese). Chuang, L., & Hsu, Y. (2007). Leisure education experiments to enhance resiliency by using the BBM model. Chinese
Annual Report of Guidance and Counseling, 21, 71–98 (in Chinese). Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. doi: 10.2307/2136404 Datillo, J., & Murphy, W. (1991). Leisure education program planning: A systematic approach. State College, PA: Venture Publishing. Deci, E.L., & Ryan, R.M. (1985). Intrinsic motivation and selfdetermination in human behavior. New York, NY: Plenum Press. Deci, E.L., & Ryan, R.M. (2008). Self-determination theory: A macrotheory of human motivation, development, and health. Canadian Psychology, 49(3), 182–185. doi: 10.1037/ a0012801 Gaertner, L., Sedikides, C., & Chang, K. (2008). On pancultural self-enhancement: Well-adjusted Taiwanese self-enhance on personally valued traits. Journal of Cross-Cultural Psychology, 39(4), 463–477. doi: 10.1177/0022022108318431 Hsieh, C., Wu, C., & Hsieh, Y. (2007). Evaluation of the effects for the experiential learning based leisure education courses. Journal of Sport, Leisure and Hospitality Research, 2(4), 39–50 (in Chinese). Lu, L. (2006). The transition to parenthood: Stress, resources, and gender differences in a Chinese society. Journal of Community Psychology, 34(4), 471–488. doi: 10.1002/ jcop.20110 Ntoumanis, N., Edmunds, J., & Duda, J.L. (2009). Understanding the coping process from a self-determination theory perspective. British Journal of Health Psychology, 14(2), 249– 260. doi: 10.1348/135910708349352 Searle, M.S., Mahon, M.J., Iso-Ahola, S.E., Sdrolias, H.A., & Dyck, J. (1995). Enhancing a sense of independence and psychological well-being among the elderly: A field experiment. Journal of Leisure Research, 27(2), 107–124. Sivan, A., & Stebbins, R.A. (2011). Leisure education: Definition, aims, advocacy, and practices – are we talking about the same thing(s)? World Leisure Journal, 53(1), 27–41. doi: 10.1080/04419057.2011.552216 Trenberth, L. (2005). The role, nature and purpose of leisure and its contribution to individual development and well-being. British Journal of Guidance and Counselling, 33(1), 1–6. doi: 10.1080/03069880412331335849 Weinstein, N., & Ryan, R.M. (2011). A self-determination theory approach to understanding stress incursion and responses. Stress and Health, 27(1), 4–17. doi: 10.1002/ smi.1368 Windle, G., Markland, D.A., & Woods, R.T. (2008). Examination of a theoretical model of psychological resilience in older age. Aging and Mental Health, 12(3), 285–292. doi: 10.1080/13607860802120763
Aging & Mental Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/camh20
Leisure education reduces stress among older adults Liang-Chih Chang
a
a
Department of Living Sciences, National Open University, New Taipei City, Taiwan Published online: 31 Jan 2014.
To cite this article: Liang-Chih Chang (2014) Leisure education reduces stress among older adults, Aging & Mental Health, 18:6, 754-758, DOI: 10.1080/13607863.2013.878306 To link to this article: http://dx.doi.org/10.1080/13607863.2013.878306
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Aging & Mental Health, 2014 Vol. 18, No. 6, 754–758, http://dx.doi.org/10.1080/13607863.2013.878306
Leisure education reduces stress among older adults Liang-Chih Chang* Department of Living Sciences, National Open University, New Taipei City, Taiwan
Downloaded by [Umeå University Library] at 13:05 16 November 2014
(Received 25 July 2013; accepted 14 December 2013) Objectives: The objectives of this study were to examine whether a leisure education program could facilitate leisure competence among older adults and whether it could also reduce their stress. Methods: A pre-test–post-test randomized experimental design was conducted. Subjects were randomly assigned to either an experimental group (n ¼ 30) or a control group (n ¼ 30). A leisure education program was used to serve as the intervention. A day before this experiment was carried out, pre-test data were collected using leisure competence and stress scales. Thirty minutes after this experiment ended, post-test data were collected using the same scales. These data were analyzed using an analysis of covariance. Results: The results indicated that the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group and that the average post-test scores of stress in the experimental group were significantly lower than those in the control group. Conclusion: Healthcare practitioners should adopt the provision of leisure education as a priority to facilitate leisure competence and reduce stress among older adults. Keywords: leisure competence; leisure education; stress
Introduction Over 60% of older adults report that they suffer from stress (Bureau of Health Promotion [BHP], 2006). Stress contributes to anxiety, depression, and headaches among older adults (BHP, 2006); therefore, it is necessary for them to develop an effective mechanism to reduce stress in order to maintain optimal health. Self-determination theory (SDT), which has recently been applied in the field of stress studies (Ntoumanis, Edmunds, & Duda, 2009; Weinstein & Ryan, 2011), holds that competence is a basic human need (Deci & Ryan, 2008). Competence refers to one’s capacity to deal with the activities in which one participates (Deci & Ryan, 1985). When satisfied, this need will contribute to overall stress reduction. In particular, feedback generated from displays of competence makes one perceive oneself as generally capable of dealing with negative events and these negative events are thereby hardly considered stressors. This feedback also results in positive emotions that prevent the incursion of stress (Weinstein & Ryan, 2011). Consistent with SDT, empirical studies have confirmed that competence is significantly negatively related to depression and stress (Chou, 2005; Windle, Markland, & Woods, 2008). Thus, enhancing levels of competence may be an effective way to reduce the stress faced by older adults. Previous studies have indicated that leisure activities can provide participants with opportunities to exercise competence (Caldwell, 2005; Trenberth, 2005). Leisure activities are available to most retired adults and provide pleasurable experiences to supplement the routines of
*Email: [email protected] Ó 2014 Taylor & Francis
daily life. Therefore, participation in leisure activities appears to be an ideal opportunity to promote the competence of older adults. The promotion of competence through leisure activities can be defined as leisure competence: a participant’s perception of her/his capacity to deal with leisure activities and control her/his own behaviors within the context of these activities. Chang and Yu (2013) demonstrated that leisure competence was significantly negatively related to stress among older adults; however, they failed to reveal a causal relationship between leisure competence and stress. Thus, the effect of leisure competence on stress requires a further investigation. Leisure education has long been regarded as a modality that strengthens the leisure competence of participants (Datillo & Murphy, 1991). Leisure education refers to an organized program designed to improve the leisure attitudes, leisure knowledge, and leisure capacity/leisure competence of participants, thereby using their leisure time more effectively (Sivan & Stebbins, 2011). One mechanism by which leisure education can facilitate leisure competence has further been proposed. Leisure competence depends on one’s capacity for participation in leisure activities. When leisure capacity increases, leisure competence also increases. Leisure education addresses the leisure capacity of participants through training (Datillo & Murphy, 1991; Sivan & Stebbins, 2011); therefore, it can facilitate an increase in leisure competence by developing the leisure capacity of the participants. Searle, Mahon, Iso-Ahola, Sdrolias, and Dyck (1995) conducted a pre-test–post-test experimental design to
Downloaded by [Umeå University Library] at 13:05 16 November 2014
Aging & Mental Health examine the effect of an individualized leisure education program on leisure competence among older adults. They assigned 13 subjects to an experimental group and 15 subjects to a control group. The average number of weeks spent in this program was 17 (ranged from 14 to 25). After this experiment ended, they used an analysis of covariance to analyze pre-test and post-test data. The results of their study indicated that the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group. It seems that a leisure education program, like Searle et al.’s program, may either facilitate leisure competence or serve as an appropriate intervention to examine the effect of leisure competence on stress. However, the validity of their results needs to be further examined because they did not randomly assign subjects. According to the above, it was hypothesized that a leisure education program could facilitate leisure competence and thereby reduce stress among older adults. The results of this study provide healthcare practitioners with information valuable to the development of strategies for stress reduction. Methods Subjects Subjects had to meet four eligibility criteria: (1) aged 65 years or older, (2) had no previous training in any form of leisure education, (3) demonstrated practical literacy, and (4) were free from mental health problems, such as dementia and suicide attempts. They were excluded if their family told the research assistant that they were judged to have mental problems by the doctor. One hundred potential subjects were randomly selected from a pool of participants in a random sampling study (Chang & Yu, 2013). These subjects received a handbill outlining the purpose of this study and describing the leisure education program. They were then invited to take part in the program with assurance that only statistical data would be reported. Those who agreed to participate were asked to fill out a consent form. Sixty subjects agreed to take part in the program. The 60 subjects in this study were all retired. Many of them experienced mild dexterity problems that might have slightly limited their participation in the activities, and their self-rated health scores of 2.92 were slightly lower than the average scores of 3.00 on a 5-point scale (2.90 in the experimental group and 2.93 in the control group); however, they still could independently participate in leisure activities. The ages of the subjects ranged from 67 to 79 years old, with a mean age of 70.83 years (SD ¼ 4.53) in the experimental group and 70.76 years (SD ¼ 4.43) in the control group. Most of them were married and had completed primary school (Table 1). No statistically significant differences were observed in the demographic variables between experimental group subjects and control group subjects. One subject in the control group moved to a new location and subsequently dropped out. All of the subjects in the experimental group completed the experiment (Figure 1).
755
Table 1. Characteristics of the subjects. Experiment Characteristic Gender Female Male Education Primary-school graduates High-school graduates University degree and above Marital status Unmarried Divorced Widowed Married
Control
n
%
n
%
15 15
50.0 50.0
15 14
51.7 48.3
26 2 2
86.7 6.7 6.7
22 5 2
75.9 17.2 6.9
1 0 6 23
3.3 0.0 20.0 76.7
2 1 7 19
6.9 3.4 24.1 65.5
Design A pre-test–post-test randomized experimental design was adopted in this study. Subjects were randomly assigned to either an experimental group or a control group, and these subjects were not advised of their assignment. All subjects took a pre-test to measure their leisure competence and stress. The subjects in the experimental group then participated in a leisure education program. All subjects also underwent a post-test before the subjects in the control group participated in the same leisure education program. This was done to ensure that all subjects could benefit from the leisure education program, while this study could still determine the net effects of the program on leisure competence and stress.
Intervention Searle et al.’s (1995) leisure education program was adopted as a template for the intervention. As mentioned earlier, leisure competence could be facilitated by the development of leisure capacity. This study addressed leisure capacity in Units 4, 6, 8, and 12 of the leisure education program. Thus, it is believed that the leisure education program can facilitate leisure competence and then reduce stress among the subjects. The intervention consisted of 12 units. Unit 1: What you do for recreation. This unit has the client explore the potential benefits of recreation on physical and mental well-being and his/her personal recreation interests. Unit 2: Why you do what you do. Based on the list of interests identified in unit 1, the therapeutic recreation specialist (TRS) helps the clients decide what motivates them to participate in specific recreation activities. Unit 3: How it’s done. The client learns to conduct an activity analysis of each of his/her recreation interests by analyzing the physical, mental, and social skills required for each activity. Unit 4: Can you do it? Clients are taught to realistically assess current and potential physical and mental capabilities, and how they may affect future recreation involvement. Unit 5: Can/will you adapt? Each of the clients is exposed to the concepts of activity adaptation and equipment modification and taught how to utilize the procedures to facilitate satisfactory leisure participation. Unit
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Figure 1. Flow of subjects.
6: Barriers. Clients explore the variety of barriers they may face, and explore ways and means of overcoming barriers to enable them to participate in their chosen leisure pursuits. Unit 7: Making plans for your future recreation. Clients are taught to make realistic short-range and long-range leisure plans. Unit 8: What else is there? In this unit clients explore other potential recreation pursuits, determine what skills they must learn to participate in such activities, and develop plans to facilitate their participation in these activities. Unit 9: Resources. Clients are taught to identify who may act as a support for them to carry out their leisure goals, and how to make clear and assertive requests for assistance. Unit 10: Personal resources. Each of the clients is taught to assess personal resources including such things as finances, transportation, and equipment as they relate to their leisure plans. Unit 11: Community resources. Clients are exposed to community resources and are taught how to assess such resources as a means of facilitating community-based participation. Unit 12: Before You’re Through With Us. Prior to the end of the intervention clients are asked to reassess and if necessary revise their participation goals. In part, this is to ensure that they are able to continue to reassess their leisure goals in the future (Searle et al., 1995, p. 116). Some of the units were modified to ensure that the leisure education program was appropriate for the subjects living in Taiwan. In Taiwanese society, the relationships among relatives are strongly emphasized; therefore, the subjects were taught that, in addition to leisure companions, relatives also can support them in the pursuit of leisure goals in Unit 9.
Furthermore, Taiwanese people share leisure resources less than Americans do because the population density of Taiwan is substantially higher than that of the United States. Consequently, the subjects were taught how to effectively use public leisure resources near their community during off-peak times in Unit 11. Each of these 12 units comprised a variety of activities, such as discussion exercises, role-playing, and participation in leisure activities. The subjects in the experimental group attended unit lectures and completed all units together. The intervention was conducted twice per week over a period of three months. The subjects spent approximately two hours participating in each unit. This experiment was approved by the Research Ethics Committee, Central Regional Research Ethics Center in Taiwan. Measures Leisure competence was measured using Chang’s (2012) Leisure Competence Scale. The scale comprises six items related to the perception of older adults regarding their ability to participate in leisure activities. Here are two examples of the items: (1) I am skilled at leisure activities and (2) I feel good about my ability to participate in leisure activities. The subjects were asked to rate the degree to which they agreed with each of the items on a 5-point scale, from 1 (not at all) to 5 (completely). Total scores of the scale ranged from 6 to 30. Higher scores indicated greater leisure competence. The reliability of the scale was reassessed by performing a preliminary investigation
Aging & Mental Health
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involving 120 participants. The results indicated that the scale had an acceptable alpha reliability coefficient of 0.88. Stress was measured using Cohen, Kamarck, and Mermelstein’s (1983) Perceived Stress Scale – 14 items, which has widely been used in Taiwan (Gaertner, Sedikides, & Chang, 2008; Lu, 2006). Two examples of the items are listed here: (1) in the last month, how often have you successfully coped with life hassles and (2) in the last month, how often have you felt that you were unable to control the important things in your life? The subjects were asked to rate the degree of stress they felt regarding each of the items on a 5-point scale, from 1 (never) to 5 (always). Total scores of the scale ranged from 14 to 70. Higher scores indicated higher stress. The reliability of the scale was reassessed by the preliminary investigation. The results indicated that the scale had an acceptable alpha reliability coefficient of 0.91. Data collection and analysis A day before the intervention was carried out, the fulltime assistant who worked on this study collected the pretest data of the experimental and control groups. Thirty minutes after the intervention ended, the post-test data of the experimental group were collected by the same person in the same setting in the afternoon. The post-test data of the control group were collected in the morning on the same day they attended their first leisure education class. The pre-test data from the experimental and control groups were used as covariates and then group differences in post-test leisure competence and stress were examined using an analysis of covariance. A correlation analysis was also performed to examine the relationship between leisure competence and stress in order to double check whether a change in stress resulted from an increase in leisure competence. Results The average leisure competence scores of the subjects in the experimental group were 17.10 in the pre-test and 18.83 in the post-test, whereas the subjects in the control group scored 16.97 in the pre-test and 16.59 in the posttest. The average stress scores of the subjects in the experimental group were 45.43 in the pre-test and 41.77 in the post-test, whereas the subjects in the control group scored 44.69 in the pre-test and 46.03 in the post-test. The results derived from the analysis of covariance were as follows: (1) in the experimental group, the average post-test scores of leisure competence were significantly higher than the average pre-test scores of leisure competence (t ¼ 3.79, p < 0.01), whereas the average post-test scores of stress were significantly lower than the average pre-test scores of stress (t ¼ 4.44, p < 0.01) and (2) the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group when the pre-test data from these two groups were used as covariates (F ¼ 18.27, p < 0.01), whereas the average post-test scores of stress in the experimental group were significantly lower than those in
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Table 2. Differences in leisure competence and stress between the pre-test and post-test data.
Variable Leisure competence Experiment Control stress Experiment Control
Pre-test
Post-test
M
M
17.10 16.97
SD
4.05 18.83 4.00 16.59
SD
t
F
4.21 3.79 4.15 2.09
45.43 11.40 41.77 12.08 4.44 44.69 11.89 46.03 10.85 3.23
18.27 28.88
p < 0.01.
the control group when the pre-test data from these two groups were used as covariates (F ¼ 28.88, p < 0.01), as shown in Table 2. The results of the correlation analysis revealed that leisure competence was significantly negatively related to stress in the pre-test (r ¼ 0.36, p < 0.05) and post-test (r ¼ 0.39, p < 0.05).
Discussion The results of this study indicated that the leisure education program could significantly facilitate leisure competence among the subjects, confirming the findings of Searle et al. (1995). The results further demonstrated that the leisure education program could significantly reduce the stress of the subjects and that their leisure competence had a significant negative correlation with their stress. The results are consistent with those of Chang and Yu (2013). It appears that an effective leisure education program can help facilitate leisure competence and thereby decrease stress among older adults. The above results provide healthcare practitioners with important information regarding efforts to reduce the stress experienced by older adults. The leisure education program outlined in the study of Searle et al. (1995) was based on learning activities tailored for each subject. Although individual plans for leisure education worked well in their study, implementing such individualized program is difficult in practice. Nonetheless, the results suggest that a group-based leisure education program can also be effective in the facilitation of leisure competence in order to reduce stress among older adults. Leisure education has been proposed in Taiwan for approximately 60 years (Chu, 1956). During this period, the leisure education programs were typically implemented for children and adolescents, and rarely for older adults (Chuang & Hsu, 2007; Hsieh, Wu, & Hsieh, 2007), which is evidenced by the fact that none of the participants in the study conducted by Chang and Yu (2013) had any previous training in leisure education. Therefore, providing older adults with leisure education programs to help them reduce stress is necessary. This study has several strengths as compared to Searle et al.’s (1995) study. First, the sample size of this study was double bigger than that of their study. Second, more
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importantly, this study used a randomized experimental design, whereas their study did not. This study also has two limitations. First, the results may not directly be generalized to people with mental health problems or illiterate older adults because these groups were excluded. Second, participation in the groupbased leisure education program likely changed the state of the subjects’ social interactions. Because social interactions also have a significant effect on stress, the stress reduction reported in this study cannot necessarily be attributed entirely to changes in leisure competence. If one accepts the underlying premise of this study, however, the results are still valuable in spite of these limitations. The results suggest that providing older adults with a leisure education program should be an effective means to facilitate their leisure competence to reduce their stress.
Funding This study was funded by National Science Council in Taiwan [grant number NSC 98-2410-H-180-001-SS3].
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