Health promotion in later life: public and professional perspectives on an expert system for health risk appraisal

Aim: To explore the perspectives of both professionals and older people on modifiable health behaviours and risks in later life. Background: Promotion of health and prevention of disability in later life are major health policy priorities across Europe. A system for health risk appraisal in later life, health risk appraisal in older people (HRA-O) permits a population-wide assessment to be carried out. The HRA-O technology is a single assessment process-based questionnaire, which generates a computer decision support system, to offer tailored advice about modifying health risks and behaviours. Method: Qualitative study using nominal groups and interviews. Setting: General practices, National Health Service and local government social services, and voluntary organisations in two London boroughs. Recruitment: Nominal groups were recruited from general practice, older people’s forums, voluntary organisations and social services departments, and individual interviews were carried out with health and social care commissioners, clinicians, professionals and public health practitioners, which discussed the HRA-O questionnaire. Results: Public and professional evaluation identified necessary refinements of the HRA-O technology, the need for greater insight into the social psychology of ageing on the part of those engaged in health promotion, and the necessary and appropriate involvement of professionals in reinforcing health promotion advice. Discussion: This study discusses the findings from the nominal groups and interviews in the light of the technology’s failure to change self-reported behaviour and places them in the context of current approaches to health promotion for older populations.