title: Mental health and aging initiative: intervention component effects.
abstract: BACKGROUND
  The objective of this investigation is to evaluate the Mental Healthiness and Aging Initiative (MHAI) intervention. The MHAI was created to promote awareness and knowledge about mental health/substance (MH/SA) use and aging issues in rural Kentucky, USA, due to limitations in formal and informal mental health care and treatment resources as a result of multilevel barriers in rural regions and effects on health, wellbeing and quality of life.
  
  
  METHODS
  This investigation took place between 2010 and 2011 in two rural counties in Kentucky. Participants from two counties were recruited through an email solicitation sent to Kentucky cooperative extension agents (university-affiliated community liaisons). Individuals participated in a two-hour intervention session covering facts and information, application exercises, and community tools for addressing late-life mental health and substance abuse. Effectiveness was evaluated by examining changes in attitudes and knowledge about MH/SA and aging from pre-test to post-test and again 3 months and 6 months later. The evaluation survey examined mental health and substance abuse awareness (six questions) and knowledge (13 questions) and was previously piloted and designed for the current study ensuring face validity. Seven individual linear mixed models were analyzed using each of the six awareness questions and an additional model using an aggregate score across the knowledge questions representing the total percent correct for knowledge questions.
  
  
  RESULTS
  The participating sample (n=55) was 65.35 years of age on average, with the majority being female (85%), white (100%), married (69%), living with a spouse/partner only (68%), high school educated (57%) and having a total household income averaging US$44,199. The findings indicated sustained improvement in awareness and knowledge about MH/SA and aging. Results also indicated that there is a need to improve maintenance of knowledge regarding older adult alcohol consumption risk, clinical provider communication about mental health, identifying/recognizing mental health problems, and older adult retention of their mental abilities based on long-term retention rates. These indicators had below 90% correctness at 6 months, despite having 90%+ accuracy at post-assessment, immediately after the intervention administration.
  
  
  CONCLUSIONS
  This study demonstrates that community interventions for MH/SA awareness and knowledge are effective within majority rural regions. As currently designed, implementing the MHAI intervention program is feasible. Evidence from the current study indicates that community residents (including rural individuals) can be recruited to participate in a program about MH/SA and aging, and as an outcome have increased awareness and knowledge about MH/SA and aging. Future research will need to explore how to utilize MHAI-type intervention programs to a point where the mental health of rural adults can be improved. Specifically, further investigation is needed to examine whether community mental health awareness interventions, such as the MHAI intervention program, can lead to earlier detection of MH/SA issues among older adults and increase treatment rates. If so, community mental health workers and facilities can expect such interventions to increase local residents' awareness of their services and likelihood of utilizing mental health services. Future research needs to enhance generalizability and ensure that improved knowledge and awareness translates into improved mental health in rural regions.
authors.affiliation: Gerontology, University of Kentucky, Lexington, Kentucky, USA. f.zanjani@uky.edu
authors.forename: Faika
authors.initials: F
authors.lastname: Zanjani
authors.forename: Tracy
authors.initials: T
authors.lastname: Davis
authors.forename: Tina
authors.initials: T
authors.lastname: Kruger
authors.forename: Deborah
authors.initials: D
authors.lastname: Murray
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D003153:Community Health Services; D005260:Female; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007629:Kentucky; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology; D015397:Program Evaluation; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000628:therapy