Intergenerational interaction, social capital and health: Results from a randomised controlled trial in Brazil

Abstract

Recent years have seen a burgeoning of intergenerational programmes aiming to improve the well being of participants. However, very few programmes have been formally evaluated. In this paper we report results from a randomised controlled trial of a school-based intergenerational intervention undertaken in Brazil. Randomly selected samples of 253 adolescents and 266 elders aged 60 and over resident in the school's catchment area were administered a questionnaire including questions on cognitive components of social capital, family relationships, and self-rated health. Participants were then randomly allocated to control and intervention groups. The intervention comprised participation in a 4 month programme of intergenerational activities in which the elders shared their memories with the students. At the end of the intervention the questionnaire was re-administered to the samples. High proportions (85–95%) of both samples completed the questionnaires but compliance with the intervention was low in the elderly group. In the analysis of results from the elderly sample, we therefore compared the control group with the group assigned to the intervention (intention to treat analysis). Results showed that adolescents in the intervention group were nearly three times more likely to rate their health as good than those in the control group, but also more likely to judge that most people were selfish. In the elderly sample, those from the intervention group were over twice as likely as those from the control group to report positively on the helpfulness of neighbours; judge most people to be honest or consider their family relationships as good. There were no significant differences between groups on other outcome measures. These results suggest that structured intergenerational activities may have positive effects on some aspects of social capital for both adolescents and elderly people, although further research is needed to elucidate the processes involved and the extent to which the findings are context specific. This study is the first to use a controlled trial design to evaluate this type of intervention and is valuable in showing that this design can be used in interventions of this kind, and also the difficulties involved.

Introduction

The concept of social capital refers to features of social relationships that facilitate co-operation for mutual benefit. Features of social capital such as feelings of interpersonal trust and norms of reciprocity have been termed cognitive components and are distinguished in the literature from civic engagement which is considered a structural component (Baum, & Ziersch, 2003; Berkman, Glass, Brissette, & Seeman, 2000; Harpham, 2003; Kawachi, 1999; Macinko & Starfield, 2001; Winter, 2000). Social capital, it has been argued, is associated with better government performance, economic growth, the functioning of democracy and the prevention of delinquency (Coleman, 1990; Putman, 1993; Putnam, 1995). Additionally, a wide range of studies have suggested that aspects of social capital might influence indicators of health including mortality, self-rated health, and mental health (De Silva, McKenzie, Huttly, & Harpham, 2005; Kawachi, 1999; Kawachi & Kennedy,1997; Kawachi, Kennedy, & Glass, 1999; Skrabski, Kopp, & Kawachi, 2003). This association has also been hypothesised to reflect psychosocial pathways linking the social environment and health, although such a link has not yet been clearly established. There is a general paucity of rigorous information on the health effects of social interventions and few studies have tested interventions designed to improve social capital, and so health (Harpham, Grant, & Thomas, 2002; Thomson, Hoskins, Petticrew, Ogilvie, Craig, & Quinn, 2004). Of the few studies that have been undertaken, most have focussed on developed countries and few consider particular groups, such as older people or adolescents, for whom social capital may be particularly important because of their greater risk of social exclusion and potentially higher needs for social support (Morrow, 1999; Morrow, 2000; Souza, 2004b). The challenges faced by poor people living in developing countries, which frequently have undeveloped state organised systems of collective support for vulnerable groups, suggest that social capital is likely to be a potentially particularly important influence on well being in these settings.

This paper reports results from a randomised controlled intervention, involving a structured programme of intergenerational interaction, on perceived health status and cognitive components of social capital among older people and adolescents in a low income area of the Distrito Federal (DF) of Brazil.

Brazil faces a number of major public health challenges arising from social and demographic changes and extreme socio-economic inequalities (Casas, Dochs, & Bambas, 2001). Such inequalities, it has been argued, are associated with low levels of social capital (Wilkinson, 1996). In Brazil, there are growing signs of social stress in the adolescent population including high rates of death from violence (Gawryszwski, Latorre, & Jorge,1997; Magalhães, 2001). In the DF of Brazil, comprising Brasilia and its satellite cities, homicide and suicide accounted for 55% of all adolescent deaths in 2003–2005 and in Ceilandia, the satellite township chosen for this study, this proportion was 59% (SES, DF, 2005). A number of studies have also highlighted the extent to which the health and well being of older people, a growing segment of the Brazilian population, may be challenged by social and demographic stresses, a lack of understanding and awareness of issues related to ageing and a generally poor social environment (Guerra, Barreto, & Uchôa, 2000; Sherlock, 2000; Veras, 1992). These findings suggest that older people and adolescents in Brazil may be particularly vulnerable to low levels of social capital.

Intergenerational programmes are increasingly viewed as a mechanism whereby links can be forged between young and old with benefits for both. Programmes of this kind were recommended in the World Assembly on Ageing held in Madrid in 2002 (Newman, 2003; UN, 2002). Numbers of such programmes, many school based, have been launched in a variety of settings and several have been described in observational accounts of their operation: however, very few have been formally evaluated (Bernard & Ellis, 2004; Kuehne & Collin, 1997; Kuehne, 2003; Souza (2003a), Souza (2004a); Ward, 1997).

The study was undertaken in Ceilândia, one of the satellite cities of Brasilia, in the DF of Brazil. Ceilândia is a low income area which was established in the 1960s with the founding of Brasilia. In 2000, the city had a population of some 379,500 people of whom 4% were aged 60 and over while adolescents, aged 10–19 years old constituted 21% of the population. All people aged 42 and over, 55% of the population in 2002, came from elsewhere in Brazil (CODEPLAN, 2000). Thus, Ceilândia, like a number of similar areas, has a range of characteristics which may predispose to poor levels of social cohesion which suggests a need to develop interventions to promote social integration.

It was hypothesised that levels of social capital among older people in Ceilândia would be low and that participation in an intergenerational programme might serve to increase cognitive elements of social capital and self-rated health. It was also hypothesised that there would be similar benefits for the adolescents involved. These hypotheses were supported by findings from previous small scale qualitative studies which suggested that older people who participated in intergenerational programmes reported increases in feelings of trust and solidarity, improvements in self-rated health and family relationships (Souza (2003a), Souza (2003b)). The aim of the study was to see whether participants in the programme had better scores on relevant indictors of the cognitive components of social capital, and on self-rated health, at the end of the intervention. A secondary aim was to see whether a controlled trial was appropriate to evaluate this kind of intervention and to contribute to methodological improvements in the evaluation of intergenerational programmes.