Razak Gyasi
Urbanization and demographic aging are dramatically occurring in sub-Saharan Africa (SSA). Estimates show that 58% (1.26 billion) of Africans will live in increasingly poor informal urban settings by 2050. Slum areas are characterized by overcrowding, tenure insecurity, food insecurity, and limited access to water/health services. Slum-dwelling older Africans with cumulative disadvantages across the life course are especially vulnerable to these harsh environmental conditions, including social exclusion (SE). Studies have shown that socially excluded older persons are more likely to report physical and mental dysfunction and unmet social care needs, which in turn, may deepen SE. However, these studies have not used the World Health Organization’s Age-Friendly Cities and Communities (AFCC) model to understand the SE and well-being linkages among older adults in SSA. In addition, the dynamics of old age SE in slums and how it interrelates with area effects are poorly characterized in SSA. With the projected expansion in the older population and slum areas in SSA, improving social inclusion among older adults in these settings is an important policy and public health agenda. Using the AFCC model, this exploratory and formative study investigates the micro- and neighborhood-level drivers of SE and how they interrelate with health outcomes among slum- and non-dwelling older adults in Ghana and Kenya. The study will include community-dwelling adults ≥60 years in four slum- and four non-slum communities in Ghana and Kenya. The study objectives will be evaluated via various work packages (WP). WP1 will involve a document review/synthesis of the existing literature/data and social policy documents to provide rich insights into how SE varies for diverse older groups. Stakeholder interviews (10 in each country) will assess the adoption and implementation of the AFCC model and the extent to which SE is being integrated into the model. WP2 will collect representative cross-sectional data (1100 in each country) to explore SE patterns and how it interrelates with micro- and neighborhood-level factors and health outcomes. In WP 3, 60 in-depth interviews (30 in each country) and 10 FGDs (five in each country) will be conducted to explore respondents’ experiences on how SE influences area effects and impacts well-being. WP3 will uniquely apply a co-production and participatory research model to train older adults to interview their peers. WP4 will explore the innovative interventions proposed by prior studies and provide the platform to upscale through piloting and testing these interventions in the next phase of the study. Descriptive and inferential statistics, i.e., χ2/zero-order correlation tests, generalized linear/multivariate mixed models, and unconditional partially acute effects growth curves will analyze quantitative data using R-4.0.0. Qualitative data will be analyzed and reported using NVivo software. Findings may contribute to including older persons in mainstream society toward Sustainable Development Goals with a strong focus on equity and leaving no one behind. This formative study will also provide grounds for upscale interventional studies to improve the social inclusion and well-being of older persons in SSA.