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Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A Phenomenographic Study

Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A... Hindawi Journal of Aging Research Volume 2018, Article ID 3734645, 9 pages https://doi.org/10.1155/2018/3734645 Research Article Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A Phenomenographic Study 1 2,3 4 Pornpun Manasatchakun , Asa Roxberg, and Margareta Asp Boromarajonani College of Nursing, Udon ani, ailand School of Health and Welfare, Halmstad University, Halmstad, Sweden VID Specialized University, Bergen, Norway School of Health, Care and Social Welfare, Ma ¨lardalen University, Eskilstuna, Va ¨stera˚s, Sweden Correspondence should be addressed to Pornpun Manasatchakun; pornpun.manasatchakun@gmail.com Received 26 August 2017; Revised 1 November 2017; Accepted 21 November 2017; Published 14 January 2018 Academic Editor: Arshad Jahangir Copyright © 2018 Pornpun Manasatchakun et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In (ailand, family nurses are expected to provide support for older persons and their family members to promote healthy aging. Family bonds are strong, and relatives are expected to take care of their older family members. However, there is limited research on how older persons’ family members perceive healthy aging. (is study aimed to describe the conceptions of healthy aging held by the children and grandchildren of older persons in northeast (ailand. In a phenomenographic study, 14 interviews were performed to qualitatively analyze different conceptions of healthy aging. Four descriptive categories emerged: being independent, not being afflicted by diseases or illnesses, being a giver and a receiver, and being wise. (e conceptions of healthy aging entail both autonomy and interdependence. (e relative’s perspective needs to be considered when policies relating to healthy aging are implemented in the community and when family nurses provide support to families to promote healthy aging. engaging older persons in their care. With a growing aging 1.Introduction population, the (ai government has developed health pol- (ailand’s healthcare system emphasizes the importance of icies to maintain the older population’s health and improve family participation in care for older persons [1]. A family their quality of life [3]. (e promotion of healthy aging is one nurse is the key person who works with older clients and their of the key strategies adopted in the national agenda for family members to provide care and support those people’s meeting the challenges of caring for the older population [4]. health. In (ailand, a family nurse is defined as a person who (e concept of healthy aging is adopted and studied takes responsibility for public health, holistic healthcare, and throughout the world [5, 6]. In (ailand, studies of healthy enhancing the quality of life among the population [2]. (e aging have focused on older persons’ perspectives [7–9]. (e roles of a family nurse include not only identifying health literature indicates that healthy aging is facilitated not only problems and managing chronic and acute medical condi- by older persons themselves but also by their families and tions but also collaborating with families and providing health culture [6, 10]. To promote healthy aging and encourage services [2]. (ese tasks encompass preventing diseases and family members to work together with healthcare providers, promoting health for families [2]. Family nurses have tra- family nurses must consider the relatives’ perspective, as ditionally been expected to provide support for older persons relatives contribute to the improvement of health among and their family members. Family members play a key role as older persons. Understanding what healthy aging means to the primary caregivers of older persons in (ai society, es- family members of older persons may be helpful when pecially in the northeastern region of (ailand, also known as collaborating with them and their families in the promotion Isan. (us, family nurses should value the role of family when of health among people in the northeast of (ailand. 2 Journal of Aging Research persons’ lives. In Isan, similar to other regions in (ailand, 1.1. Healthy Aging: Positive Outcomes of Old Age and Policies for Responding to the Aging Situation in ailand. (ere are the family structure has shifted from the extended family to the nuclear family. Older persons and young persons have become many terms that can be used to explain the maintenance of well-being in older persons [6], such as successful aging [11], separated. Young adults tend to move to larger cities featuring active aging [12], and healthy aging [6]. Healthy aging is centers of commerce to seek economic opportunities [24, 25]. a concept that covers the multidimensional aspects of older Some adults in Isan leave their own children with their parents persons’ lives and may help incorporate the overlapping and emigrate to the capital city or to other countries to work concepts of active aging and successful aging [6]. Moreover, [21]. A previous study [26] showed that, compared with earlier healthy aging is viewed as a complex concept that involves generations, the current younger generation in the Isan region has fewer opportunities to stay with their older relatives. multiple dimensions and relates to physical, mental, and social well-being [8]. Previous studies have shown that Sudnongbua et al. [26] reported that older persons in the Isan region felt abandoned because their children had migrated to healthy aging entails achieving positive health outcomes, maintaining well-being throughout one’s life, and pre- other areas to work. (e consequence of social change is a challenge for family nurses and provides an opportunity for venting long-term health conditions [6, 10]. Healthy aging has become a major consideration for family nurses to improve health among older persons and global policy-makers aiming to preserve the health and support their families who live in the northeast of (ailand. improve the quality of life of the older population [13]. As in many countries worldwide, (ailand is currently facing the 1.3. Family Members of Older Persons and Healthy Aging in problem of an aging population [14]. Older persons, their Northeast ailand. A previous study of healthy aging in the families, and the government need to be aware of the in- Isan region showed that older persons’ perspectives on healthy creased risks of chronic diseases and disabilities associated aging are related to the support that they receive from family with old age [15]. (e (ai government is concerned about members [7]. However, no studies focusing on the conceptions the aging of the (ai population. (erefore, healthy aging is of healthy aging held by the relatives of older persons in the one of the goals of the national plan for older persons, which Isan region have been conducted. (e understanding of aims to provide support for older individuals to enable them healthy aging that is held by the relatives of older persons in to maintain a healthy lifestyle and to reduce long-term care Isan-(ai culture needs to be expanded. Such studies may costs [3]. Implementation of this plan challenges family enable family nurses to broaden their views regarding the nurses to achieve the goal of promoting healthy aging. meaning of healthy aging and provide a foundation for de- veloping care practices consistent with healthcare policies. (erefore, the aim of this study was to describe the conceptions 1.2. Family: e Unit Responsible for the Informal Care of of healthy aging held by children and grandchildren caring Older Persons in Northeast ailand. Family is viewed as a for older persons in northeast (ailand. unit of care [16] and represents the context for individual de- velopment, according to one dimension of family nurses [17]. 2. Methodology (e family has the primary responsibility for advocating the development of family members. (e family serves as the 2.1. Study Design. (is study has a descriptive and phe- context for a client’s health, which means that the focus is on nomenographic design with an epistemological basis in the client, and the family is viewed in the background of the lifeworld theory, as suggested by Ashworth and Lucas [27, 28]. client [17]. (e individual’s health influences the family, and (is methodology was used because phenomenography and the capability of the family has an impact on the health of lifeworld theory aim to explain how human beings derive individual members [17]. When caring for older persons and meaning from their connections with the world around them promoting their health, the family nurse should be con- [29, 30]. One’s lifeworld is the everyday life that he or she cerned with both the older person and the family members. experiences [29, 31], and each individual experiences things in In (ai society, family is highly valued [2]. (e northeast of his or her lifeworld as different phenomena [29]. Phenom- (ailand, also referred to as Isan, has a large population of older enography uncovers different qualitative conceptions of persons [18] and is afflicted by poverty, especially among the specific phenomena [30, 32]. (e phenomenon of interest in older population [19]. (e children of the current generation of this study was the notion of healthy aging. older persons remain an important support group in the northeast of (ailand [20, 21]. (is importance may stem from the Isan culture’s long tradition of paying respect to older 2.2. Study Setting and Participants. (is study was set in persons and the cultural belief in the concept of repaying one’s Udon (ani Province, which is located in northeast (ailand parents [20]. According to Isan cultural values, children are and features a growing population of people aged 60 years or obliged to care for their parents based on Buddhist customs older. We selected this province as the setting because it [20–23]. Children and other family members serve as informal exhibits both rural and urban characteristics and is an ex- caregivers who play an important role in supporting their ample of an area undergoing modernization and growth parents both socially and financially [21]. Older persons still [33]. A purposive sampling technique was used to select the receive support from their family members (e.g., daughters, participants from a list of family members caring for 17 older sons, and grandchildren) to fulfill their needs [21]. However, persons from 17 families who participated in a previous societal changes in Isan are affecting families and older study on healthy aging in the northeast region of (ailand [7]. Journal of Aging Research 3 Table 1: Participants’ characteristics (n � 14). Number Sex Age Relation with older person Education Marital status Occupation Religion 1 F 16 Granddaughter High school Single Student Buddhism 2 F 42 Daughter Elementary Married Housewife Buddhism 3 F 45 Daughter Elementary Married Farmer Buddhism 4 F 34 Daughter High school Married Housewife Buddhism 5 M 41 Son High school Married Employee Buddhism 6 M 24 Grandson High school Single Self-employed Buddhism 7 M 46 Son High school Single Self-employed Buddhism 8 F 41 Daughter Master degree Single Teacher Buddhism 9 F 56 Daughter Bachelor degree Married Teacher Buddhism 10 F 40 Daughter Master degree Single Teacher Buddhism 11 F 54 Daughter High school Single Employee Buddhism 12 F 48 Daughter Elementary Married Self-employed Buddhism 13 F 40 Daughter Elementary Married Farmer Buddhism 14 F 42 Daughter Elementary Married Employee Buddhism Fallsberg [35]. First, in the familiarization step, the first Various background characteristics, such as age, sex, marital status, and educational level, were used as inclusion criteria. author read the transcriptions several times in both (ai and English to gain an overview of the relatives’ conceptions of To ensure that the conceptions of healthy aging were not drawn from older persons, this study included older persons’ healthy aging. (is step was necessary to verify the accuracy children and grandchildren aged< 60 years. (ree family of the transcriptions in (ai and English. (e first author members were excluded because they were the spouses of confirmed that the transcriptions completely retained the the participants in a previous study on healthy aging who meaning of the responses. (e English transcripts were then were aged> 60 years. used throughout the analysis process. (e other authors read Twelve children and two grandchildren of older persons the English transcripts several times to familiarize them- (11 women and three men) participated in this study, and the selves with the content. In the second step, the meaning units age range varied from 16 to 56 years. Five participants had an associated with healthy aging were condensed into short statements. In the third step, called the comparison step, elementary school education, six had a high school educa- tion, one had a bachelor’s degree, and two had a master’s similarities and differences in the dialogue excerpts were identified. (en, similar statements were grouped into degree. Eight participants were married, and six participants were single. All participants were Buddhists. (e partici- descriptive categories in the fourth step. In the fifth step, or pants’ characteristics are described in Table 1. the articulating step, embedded conceptions in each group of meaning units were identified. (e sixth step was the labeling step, in which the authors named the various 2.3. Data Collection. (e first author collected all data from categories. (e final step was the contrasting step, in which September to October 2013 using semistructured, in-depth the differences and similarities between categories were interviews and recorded the interviews to produce verbatim considered. transcripts of each conversation. All the participants agreed to have their conversations recorded. (e interviews were initiated using open-ended questions, such as “What is 2.5. Ethical Approval. We followed the guidelines of the meant by healthy aging, in your opinion?,” “Could you tell principles outlined in the Declaration of Helsinki [36], me about healthy aging?,” and “What makes older persons which emphasize showing respect for all participants and healthy?” (en, the first author asked specific follow-up protecting their rights. (e first author orally informed questions to prompt the participants to reflect on the the participants about the study and then provided them meaning of the phrase “healthy aging” and on their own with written information detailing the purpose of the thoughts, such as “What do you mean when you say ...?” or study and its possible benefits. (e participants could “Please give me an example of ....” (e lengths of the in- choose the time and place of the interview and were terviews varied, depending on the participants’ responses, allowed to withdraw from the study at any time. (e between 45 and 90 minutes. Each interview was transcribed participants were also ensured that their information verbatim, and each transcript was then translated from (ai would remain confidential. Permission to conduct this to English by a professional (ai-English translator to ensure study was granted by the Udon (ani Provincial Public that the translations were accurate [34]. Health Office Committee Board in (ailand and the Ethical Review Board of Research Involving Humans. (is study was registered with the Research Ethical Re- 2.4. Data Analysis. (e authors analyzed the transcribed interviews according to the steps suggested by Dahlgren and view Board of Uppsala, Sweden (Dnr 2013/019). 4 Journal of Aging Research one has the ability to maintain the functions of his or her 3.Results body and mind. Healthy aging means having a considerably (e participants’ conceptions of healthy aging consisted of strong, age-appropriate body and mind, the strength of four qualitatively different descriptive categories: being in- which is visually apparent to oneself and to others. (is dependent, not being afflicted by diseases or illnesses, being category encompassed the subcategories “living with dis- a giver and a receiver, and being wise. Each descriptive eases or illnesses” and “exhibiting physical and mental category is presented and described in detail below. strength.” 3.1. Being Independent. Healthy aging means having a desire 3.2.1. Living with Diseases or Illnesses. Healthy aging means to do everything by oneself and to avoid relinquishing having the ability to live with serious diseases or illnesses and control or seeking assistance from family members. (is to continue performing daily life activities. One relative category comprised the following two subcategories: “per- noted the following: forming activities without the assistance of others” and “not being a burden to others.” My mother is free from illness. Older persons can have some diseases, but not many. Although they have diseases, they effectively live with them. As long as they can simply 3.1.1. Performing Activities without the Assistance of live according to their routine, they are fine. (12) Others. Healthy aging means being able to care for oneself, to be free, and to participate in activities considered ap- (e participants stated that even individuals who have propriate for one’s age without needing assistance from some chronic diseases can exhibit healthy aging, although relatives. Healthy aging also means having the ability to work these individuals must find a way to live with their health after retirement to earn an adequate income as a means of conditions and thus live an ordinary life. supporting oneself financially. One participant described healthy aging as follows: 3.2.2. Exhibiting Physical and Mental Strength. Healthy My mother is expected to do things by herself. Older aging means being in good physical and mental conditions persons should work and earn their own income. ey can and free of diseases or illnesses that can limit one’s ability to choose what they want to do. Some choose to eat vege- perform daily life activities. Healthy aging also means having tables or fish. Some like chili paste. You just live on your a good memory, which is particularly desirable among older own. (6) persons. Such individuals are able to manage their emotions and are as strong as others of the same age. Healthy aging means having the ability to adjust to different circumstances and having autonomy, which fosters ey must be healthy, both physically and mentally, and a sense of freedom that prevents individuals from being free of diseases or illnesses. If you have a strong body, you forced to perform unwanted activities. also have a good mind. If you are well on the inside, your physical body is also well. If you are healthy physically, everything is healthy. When you have a positive state of 3.1.2. Not Being a Burden to Others. According to the psychological health, everything is fine. If you are calm participants, healthy aging means not being dependent on people around you feel cool. (9) family members. Specifically, healthy aging means that one’s needs are sufficiently met such that he or she demands Healthy aging means being strong and being a psycho- nothing. (us, one who ages healthily lives a sufficient life logically healthy person. Healthy individuals’ bodily func- and does not strive for unnecessary things, offend anyone, or tions are clearly connected to their mental functions, linking interfere in others’ business. One participant described this their inner and outer states. idea as follows: She does what she can and doesn’t impose a burden on her 3.3. Being a Giver and a Receiver. (e participants conceived children and grandchildren. Someone always expresses of healthy aging as giving and receiving help from others and concern that our family spoils her. But my mother isn’t stated that happiness and satisfaction derive from these like that. We don’t have to worry about her. (2) exchanges. Furthermore, healthy aging means being gen- erous and performing good deeds in accordance with (is statement indicates that healthy aging means not Buddhist beliefs, resulting in satisfaction, and delight from being a burden to others and that one should not impose Buddhist practices. (is category comprised the following oneself on one’s children or grandchildren. two subcategories: “giving assistance and receiving support” and “devoting oneself to and being delighted by Buddhist practices.” 3.2. Not Being Afflicted by Diseases or Illnesses. Healthy aging was described as a lack of degeneration of the body and 3.3.1. Giving Assistance and Receiving Support. Healthy mind. (is concept means that one does not suffer or worry about living with chronic diseases or illnesses. In this state, aging means having family members available to provide Journal of Aging Research 5 She understands what she needs to do because her life help, as well as helping children and others by acting as a giver. In this context, healthy individuals are good parents experience helps her. She learns from what she does. If it is good for her, she will continue to do it. She learns from her who have raised and provided for their family members but who also receive help from their children and grandchildren. behavior. My mother has lived long enough to have ex- perienced good and bad events in her life. (12) She makes bamboo sticks for grilled sticky rice for her son. He sells grilled sticky rice in town, and she helps him. (e participants stated that healthy aging means having She is happy to do it. I help take care of her bed and the ability to learn through life experiences and to experience her mosquito net. My aunt sells grilled eggs in town. She life as a journey. always buys delicious food for my grandmother when she visits. (4) 3.4.2. Preparing for Aging. Healthy aging means preparing oneself for growing old, which includes being satisfied with In this context, healthy aging means providing cooking one’s present life and focusing on the moment. Preparing for materials for family members and receiving support from aging involves practicing what is beneficial for one’s health family members. It means asking for help, for example, to to continue feeling young. meet one’s daily needs. Healthy aging also means helping family members in their work to support them. People should prepare for what they have to confront when they get old. ey have prepared themselves since 3.3.2. Devoting Oneself to and Being Delighted by Buddhist they were young, that is, our age. My mother has been doing this. She does aerobic dance and jumps rope, for Practices. Healthy aging means devoting oneself to the beliefs of Buddhism and attaining peace as a result of example. (10) Buddhist practices. Healthy individuals live virtuous and positive lives, and perform noble deeds. In return, these Healthy aging is conceived of as preparing oneself to face the process of growing old. Preparing for aging includes individuals experience happy lives and good health. Dedi- cating oneself to Buddhism involves making merit and preventing a decline in functions, for instance, by exercising and maintaining proper nutrition and hygiene. practicing the Buddhist doctrine. She likes to go to temple. e temple is her society. 4. Discussion Sometimes, she cuts the grass for the abbot and the monks. e monks support her, and my mother supports them. (is study is the first to examine how the children and She offers to make merit in religious ceremonies. My grandchildren of older persons in northeast (ailand con- mother lives in the community and adheres to Dharmic ceive of healthy aging. (e participants determined the principles. Making merit is a sign that one’s mind is meaning of healthy aging based on their lived experience of peaceful and that one’s health is also good. (9) connecting to older persons they lived with and took care of in everyday life. (e meaning of healthy aging consists of Healthy aging means that one is dedicated to the act of four descriptive categories: “being independent,” “not being making merit in accordance with Buddhist teachings. afflicted by diseases or illnesses,” “being a giver and a re- Making merit entails not only doing something good for ceiver,” and “being wise.” (e findings of this study reveal others but also receiving merit in return, such as happiness, existential aspects of healthy aging. Additionally, the current positive energy, peace, and enjoyment. study elucidates different conceptions of healthy aging that family nurses should consider when working together with the family members of older persons. 3.4. Being Wise. Healthy aging means being wise, which (e family is viewed as the context, according to the entails understanding one’s own life and life situations that focus of the family nursing perspective [17], which means occur. In particular, being wise means having the inner that the older person is in the foreground and the family is in strength to address life’s challenges and the knowledge to the background. Although the older person is the main focus prevent diseases and take care of oneself. (is category of the promotion of healthy aging, family nurses should also consisted of the following two subcategories: “experiencing consider the perspectives of older persons’ family members. life as a journey” and “preparing for old age.” (e family is an important unit since the family supports and provides for the older family member. Family nurses 3.4.1. Experiencing Life as a Journey. Healthy aging means therefore need to integrate the conceptions of healthy aging having sufficient knowledge—although not necessarily educa- held by the family members of older persons in their care. tional knowledge or an educational degree—to address prob- (is does not mean changing their way of thinking but lems in life. In the context of healthy aging, this subcategory involves being aware that there is not only one conception of refers to life experiences, which are derived from one’s lifestyle. healthy aging when participating with the family members of Healthy individuals regularly engage in positive practices in older persons. To work with the family members of older their everyday life to gain experiences that can help them persons, family nurses should respect and try to understand make necessary decisions. their conceptions of healthy aging. (e challenge for family 6 Journal of Aging Research consistent with the ideas expressed by healthcare pro- nurses and policy-makers is to find strategies to handle the different ways in which the relatives experience healthy fessionals in earlier studies of healthy aging in Western countries [5, 6]. We observed that being independent was aging. It is obvious that the family members of older persons conceive of healthy aging differently. As the results show, a criterion for healthy aging, which may indicate that (ai family nurses should equally emphasize the importance of cultural values have been influenced by Western traditions, in being autonomous and depending on others. Moreover, which individualism plays a prominent role [24, 41]. (us, healthy aging is related to disease and illness but is also fo- modern society may have an impact on people’s beliefs and cused on wisdom in old age. (erefore, family nurses should normative contexts. A previous study showed that, according apply these perceptions when promoting healthy aging. to the perspective of older persons in the Isan region, healthy aging still depends on one’s relatives [7]. Furthermore, older Another challenge is to integrate the differences between the perspectives of older persons and family members when persons are dependent on caregivers [21, 42], whereas their younger relatives may value independence. While older working with these groups of people. (is practice may be useful for supporting good relationships among older per- persons still need assistance [21] because of changes in their bodily functions [43], the children and grandchildren of older sons, family members, and healthcare providers when implementing a plan to promote healthy aging. persons conceptualize healthy aging with respect to the A comparison of healthy aging from the perspectives functional capacity of older persons and not being a burden of the children and grandchildren of older persons reveals on relatives. (ese conceptions may be partly related to similarities between healthy aging, successful aging, and active ageism, the belief that older persons are inferior to younger aging. (ese similarities demonstrate that the meaning of people because of their age [44]. Children and grandchildren healthy aging relates to the ability to remain active and to view older persons as being different from themselves, which may result in negative attitudes toward older persons. (is maintain the overall functioning. (is is in line with the definition of successful aging, which emphasizes healthy study indicates that family nurses should be aware of these conceptions when collaborating with the children and grand- cognitive function and focuses on the state of functioning that makes an active life possible [11, 37]. When comparing the children of older persons to promote healthy aging. Considering these aspects, policies should be developed according to the findings of this study with the concept of active aging, we found that both healthy aging and active aging refer to the conception of healthy aging with respect to the burden of ability to maintain autonomy as well as the importance of older persons on family members and the roles of older independence for the older person [12]. (ere is little dif- persons in society. Another suggestion is to support older ference between the concepts of healthy aging found in this persons when they lack the capacity to increase the value of study and a previous study [38]. (at previous study on their lives. Policy-makers and family nurses should emphasize healthy aging also showed that healthy aging was defined as the value of older persons to younger people. Healthy aging is also defined as “being a giver and freedom from chronic illness and impairment [38]. However, in the present study, healthy aging is defined not only as the a receiver.” (is category is related to the second dimension of the ontological health concept, in which health is viewed absence of disease or illness but also the importance of the ability to live with disease or illness. as “being health” [39]. Health is characterized as the Our results indicate the diversity of meanings of healthy achievement of balance and harmony, whether between the aging, which is consistent with the characteristics of the body and soul; between physiological, psychological, and ontological health concept [39], which is perceived as social factors; or between internal and external elements a movement toward wholeness and holiness [40]. (e four [39, 45]. When comparing that conception of healthy aging descriptive categories are consistent with the three health to the meaning found in this study, there are differences levels in the ontological health concept: health as behavior, between the categories “being independent” and “being health as being, and health as becoming [39]. Herberts and a giver and a receiver.” Surprisingly, “being independent” and “being a giver and a receiver” seem to be contradictory. Eriksson [39] described the first dimension of health as having health, which is a way of achieving health through (e meaning of healthy aging that focuses on healthy aging as a state characterized by independence may reflect the certain behaviors that are considered healthy by the indi- vidual or society. (e conceptions of healthy aging as being influence of the Western perspective [5]. In contrast, “being independent and not being afflicted by diseases or illnesses a giver and a receiver” stresses the importance of the re- are related to the first dimension of health, that is, having lationships between older persons and their family members health. Healthy aging also entails being independent, having as an influential factor in healthy aging, which may be due to the ability to care for oneself, being free from diseases or ill- the values of Isan culture. Being a giver and a receiver is nesses, and maintaining strong bodily and cognitive functions. related to the dynamics of the relationships between children and grandchildren and older persons in Isan culture. (is Healthy aging is consistent with the idea of evaluating health using external objective criteria and focusing on illness-related relationship reflects the idea that children are indebted to their parents because their parents raised them from birth problems [39]. A comparison of the meaning of healthy aging found in [22, 42]. (us, these relationships may be related to the concept of intersubjectivity, which is defined in phenome- this study and that reported in other studies reveals explicit differences and similarities. Regarding the description of the nological theory [29, 46, 47] as the idea that everyone relies nature of each category, the conceptions of healthy aging as on and exists in relation to others [48]. (e children and being independent and not afflicted by diseases or illnesses are grandchildren of older persons interact with older persons Journal of Aging Research 7 perspectives of young adults regarding healthy aging. For the throughout their lives and use their own bodies to un- derstand how the concept of healthy aging relates to the future challenges of supporting healthy aging, we suggest that family nurses plan for the promotion of healthy aging with older persons with whom they live. Parents provide for their children, love them, and take care of them from early adults in parallel with the current older population, according childhood, and children are taught that they should live with to the findings of this study. For example, family nurses and repay their parents until the parents die [22]. (is should serve the workforce and programs for preparing connection may be described as an obligation and a social healthy aging in middle adulthood. (ese programs should be norm in Isan-(ai culture, which is based on Buddhism. related to the prevention of health problems. Moreover, the Although the Isan lifestyle has been changed by moderni- promotion of healthy aging should be relevant to the different conceptions of healthy aging. (e family members of older zation [24], people in this region continue to have a strong belief in Buddhism [49]. Isan customs and Buddhist beliefs persons should be encouraged to brainstorm a list of the key determinant factors in supporting their health and advance are passed down from generation to generation [50], and the cultural values tied to these customs and beliefs determine care planning to promote healthy aging. the individual person’s thoughts and ideas [51]. Isan people cling to their culture through local customs [49]. Buddhists 4.1. Methodological Considerations. Rigor in phenomeno- believe in the concept of karma [22, 52], which means that graphic research is based on the study’s validity and re- one receives what he or she gives to others; this means that liability [61]. (e participants of this study were carefully whatever one does to others may also be done to him/herself selected using a strategy intended to obtain a varied and in the future. (is belief is illustrated by the practice of broad picture regarding the focus of the study—the con- making merit, which, according to Buddha’s teachings, brings ceptions of healthy aging held by the relatives of older happiness and peace [9]. Isan values are rooted in the in- persons. (e number of participants recruited for this study teractions between an individual and others. (us, this category was considered reasonable, but the participants included is related to the interdependence [8, 53] that characterizes Isan more women than men. (us, the conceptions of healthy society. (is finding indicates that family nurses should en- aging held by the men who participated in this study may not deavor to enhance the relationships between older people and be fully representative. In-depth interviews exploring the their children and grandchildren to promote healthy aging. conceptions of healthy aging were conducted by one person In the final category, healthy aging is conceived of as (the first author), which allowed probing for deeper elab- “being wise.” Comparisons between our results and those of oration and ensuring that all information was considered. previous studies regarding healthy aging [5, 6] indicate that Specific quotations were used to clarify the meaning of the domains of one’s experience, adaptation, and prepara- healthy aging. (e rigorous approach used in this study also tion are related to wisdom. Being wise is related to the last yielded findings that are transferable [62]. (is study focused dimension of health, in which health is perceived as “be- on the conceptions of healthy aging held only by the children coming” [39], meaning that human beings are becoming and grandchildren of older persons who live in the Isan something greater than themselves and/or becoming whole region of (ailand. (is restriction may have influenced our at a deeper level [39]. In this context, wholeness refers to findings, as cultural backgrounds may impact people’s be- physical, mental, and spiritual wholeness [39]. Furthermore, liefs. However, the findings of this study may be used to Eriksson [54] noted that health as becoming means that “the transfer to the relatives of older persons with similar person strives to reconcile himself with the circumstances of backgrounds, such as the children and grandchildren of life and to become whole in a deeper dimension of in- older persons who live in the northeast of (ailand. Al- tegration” (p. 76). Our findings indicate that being wise is though the results of the present study can be related to the linked to self-adjustment and to one’s ability to face his or Western perspective on the meaning of healthy aging, data her problems and the changes associated with the aging were drawn from the relatives of older persons in only one process. People in society believe that older persons have region of (ailand. (e information about the meaning of gained important life experiences that enable them to face healthy aging gathered from this group of family members of life’s problems and thus consider these life experiences as older persons cannot be applied to the entire world. (e valuable sources of wisdom [55]. Wisdom is believed to purposive sampling method may also limit the generaliz- benefit older persons in facing life situations and is corre- ability of our results. Moreover, all the participants were lated with older age [56, 57]. Wisdom also underlies the Buddhists. Although Buddhism is a main religion in respect shown to older persons by children and other rel- (ailand, the conceptions of healthy aging held by Buddhists atives who greatly admire them [58]. Another explanation may differ from those held by members of other religions. for this behavior is consistent with the idea of ego integrity [59, 60]. (is category may be associated with the ability to integrate one’s life experiences. (is finding suggests that the 5. Conclusions life experiences and wisdom of older persons should be revealed in order to promote positive attitudes toward older (e key findings of this study are the conceptions of healthy persons. We observed that participants also defined healthy aging represented as a set of categories: “being independent,” aging as preparation for aging. “not being afflicted by diseases or illnesses,” “being a giver (e findings of this study represent a starting point for and a receiver,” and “being wise.” Furthermore, the meaning family nurses and/or policy-makers when considering the of healthy aging is linked to older persons, their relatives, 8 Journal of Aging Research [13] World Health Organization, “Multisectoral action for a life and the Buddhist religion, which emphasizes the importance course approach to healthy aging: draft global strategy and plan of a holistic view of healthy aging. Although some relatives’ of action on aging and health,” May 2016. http://apps.who.int/ conceptions of healthy aging were consistent with Western gb/ebwha/pdf_files/WHA69/A69_17-en.pdf?ua�1. perspectives, traditional Isan-(ai cultural values still in- [14] J. Knodel, B. Teerawichitchainan, V. 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Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A Phenomenographic Study

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Hindawi Journal of Aging Research Volume 2018, Article ID 3734645, 9 pages https://doi.org/10.1155/2018/3734645 Research Article Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A Phenomenographic Study 1 2,3 4 Pornpun Manasatchakun , Asa Roxberg, and Margareta Asp Boromarajonani College of Nursing, Udon ani, ailand School of Health and Welfare, Halmstad University, Halmstad, Sweden VID Specialized University, Bergen, Norway School of Health, Care and Social Welfare, Ma ¨lardalen University, Eskilstuna, Va ¨stera˚s, Sweden Correspondence should be addressed to Pornpun Manasatchakun; pornpun.manasatchakun@gmail.com Received 26 August 2017; Revised 1 November 2017; Accepted 21 November 2017; Published 14 January 2018 Academic Editor: Arshad Jahangir Copyright © 2018 Pornpun Manasatchakun et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In (ailand, family nurses are expected to provide support for older persons and their family members to promote healthy aging. Family bonds are strong, and relatives are expected to take care of their older family members. However, there is limited research on how older persons’ family members perceive healthy aging. (is study aimed to describe the conceptions of healthy aging held by the children and grandchildren of older persons in northeast (ailand. In a phenomenographic study, 14 interviews were performed to qualitatively analyze different conceptions of healthy aging. Four descriptive categories emerged: being independent, not being afflicted by diseases or illnesses, being a giver and a receiver, and being wise. (e conceptions of healthy aging entail both autonomy and interdependence. (e relative’s perspective needs to be considered when policies relating to healthy aging are implemented in the community and when family nurses provide support to families to promote healthy aging. engaging older persons in their care. With a growing aging 1.Introduction population, the (ai government has developed health pol- (ailand’s healthcare system emphasizes the importance of icies to maintain the older population’s health and improve family participation in care for older persons [1]. A family their quality of life [3]. (e promotion of healthy aging is one nurse is the key person who works with older clients and their of the key strategies adopted in the national agenda for family members to provide care and support those people’s meeting the challenges of caring for the older population [4]. health. In (ailand, a family nurse is defined as a person who (e concept of healthy aging is adopted and studied takes responsibility for public health, holistic healthcare, and throughout the world [5, 6]. In (ailand, studies of healthy enhancing the quality of life among the population [2]. (e aging have focused on older persons’ perspectives [7–9]. (e roles of a family nurse include not only identifying health literature indicates that healthy aging is facilitated not only problems and managing chronic and acute medical condi- by older persons themselves but also by their families and tions but also collaborating with families and providing health culture [6, 10]. To promote healthy aging and encourage services [2]. (ese tasks encompass preventing diseases and family members to work together with healthcare providers, promoting health for families [2]. Family nurses have tra- family nurses must consider the relatives’ perspective, as ditionally been expected to provide support for older persons relatives contribute to the improvement of health among and their family members. Family members play a key role as older persons. Understanding what healthy aging means to the primary caregivers of older persons in (ai society, es- family members of older persons may be helpful when pecially in the northeastern region of (ailand, also known as collaborating with them and their families in the promotion Isan. (us, family nurses should value the role of family when of health among people in the northeast of (ailand. 2 Journal of Aging Research persons’ lives. In Isan, similar to other regions in (ailand, 1.1. Healthy Aging: Positive Outcomes of Old Age and Policies for Responding to the Aging Situation in ailand. (ere are the family structure has shifted from the extended family to the nuclear family. Older persons and young persons have become many terms that can be used to explain the maintenance of well-being in older persons [6], such as successful aging [11], separated. Young adults tend to move to larger cities featuring active aging [12], and healthy aging [6]. Healthy aging is centers of commerce to seek economic opportunities [24, 25]. a concept that covers the multidimensional aspects of older Some adults in Isan leave their own children with their parents persons’ lives and may help incorporate the overlapping and emigrate to the capital city or to other countries to work concepts of active aging and successful aging [6]. Moreover, [21]. A previous study [26] showed that, compared with earlier healthy aging is viewed as a complex concept that involves generations, the current younger generation in the Isan region has fewer opportunities to stay with their older relatives. multiple dimensions and relates to physical, mental, and social well-being [8]. Previous studies have shown that Sudnongbua et al. [26] reported that older persons in the Isan region felt abandoned because their children had migrated to healthy aging entails achieving positive health outcomes, maintaining well-being throughout one’s life, and pre- other areas to work. (e consequence of social change is a challenge for family nurses and provides an opportunity for venting long-term health conditions [6, 10]. Healthy aging has become a major consideration for family nurses to improve health among older persons and global policy-makers aiming to preserve the health and support their families who live in the northeast of (ailand. improve the quality of life of the older population [13]. As in many countries worldwide, (ailand is currently facing the 1.3. Family Members of Older Persons and Healthy Aging in problem of an aging population [14]. Older persons, their Northeast ailand. A previous study of healthy aging in the families, and the government need to be aware of the in- Isan region showed that older persons’ perspectives on healthy creased risks of chronic diseases and disabilities associated aging are related to the support that they receive from family with old age [15]. (e (ai government is concerned about members [7]. However, no studies focusing on the conceptions the aging of the (ai population. (erefore, healthy aging is of healthy aging held by the relatives of older persons in the one of the goals of the national plan for older persons, which Isan region have been conducted. (e understanding of aims to provide support for older individuals to enable them healthy aging that is held by the relatives of older persons in to maintain a healthy lifestyle and to reduce long-term care Isan-(ai culture needs to be expanded. Such studies may costs [3]. Implementation of this plan challenges family enable family nurses to broaden their views regarding the nurses to achieve the goal of promoting healthy aging. meaning of healthy aging and provide a foundation for de- veloping care practices consistent with healthcare policies. (erefore, the aim of this study was to describe the conceptions 1.2. Family: e Unit Responsible for the Informal Care of of healthy aging held by children and grandchildren caring Older Persons in Northeast ailand. Family is viewed as a for older persons in northeast (ailand. unit of care [16] and represents the context for individual de- velopment, according to one dimension of family nurses [17]. 2. Methodology (e family has the primary responsibility for advocating the development of family members. (e family serves as the 2.1. Study Design. (is study has a descriptive and phe- context for a client’s health, which means that the focus is on nomenographic design with an epistemological basis in the client, and the family is viewed in the background of the lifeworld theory, as suggested by Ashworth and Lucas [27, 28]. client [17]. (e individual’s health influences the family, and (is methodology was used because phenomenography and the capability of the family has an impact on the health of lifeworld theory aim to explain how human beings derive individual members [17]. When caring for older persons and meaning from their connections with the world around them promoting their health, the family nurse should be con- [29, 30]. One’s lifeworld is the everyday life that he or she cerned with both the older person and the family members. experiences [29, 31], and each individual experiences things in In (ai society, family is highly valued [2]. (e northeast of his or her lifeworld as different phenomena [29]. Phenom- (ailand, also referred to as Isan, has a large population of older enography uncovers different qualitative conceptions of persons [18] and is afflicted by poverty, especially among the specific phenomena [30, 32]. (e phenomenon of interest in older population [19]. (e children of the current generation of this study was the notion of healthy aging. older persons remain an important support group in the northeast of (ailand [20, 21]. (is importance may stem from the Isan culture’s long tradition of paying respect to older 2.2. Study Setting and Participants. (is study was set in persons and the cultural belief in the concept of repaying one’s Udon (ani Province, which is located in northeast (ailand parents [20]. According to Isan cultural values, children are and features a growing population of people aged 60 years or obliged to care for their parents based on Buddhist customs older. We selected this province as the setting because it [20–23]. Children and other family members serve as informal exhibits both rural and urban characteristics and is an ex- caregivers who play an important role in supporting their ample of an area undergoing modernization and growth parents both socially and financially [21]. Older persons still [33]. A purposive sampling technique was used to select the receive support from their family members (e.g., daughters, participants from a list of family members caring for 17 older sons, and grandchildren) to fulfill their needs [21]. However, persons from 17 families who participated in a previous societal changes in Isan are affecting families and older study on healthy aging in the northeast region of (ailand [7]. Journal of Aging Research 3 Table 1: Participants’ characteristics (n � 14). Number Sex Age Relation with older person Education Marital status Occupation Religion 1 F 16 Granddaughter High school Single Student Buddhism 2 F 42 Daughter Elementary Married Housewife Buddhism 3 F 45 Daughter Elementary Married Farmer Buddhism 4 F 34 Daughter High school Married Housewife Buddhism 5 M 41 Son High school Married Employee Buddhism 6 M 24 Grandson High school Single Self-employed Buddhism 7 M 46 Son High school Single Self-employed Buddhism 8 F 41 Daughter Master degree Single Teacher Buddhism 9 F 56 Daughter Bachelor degree Married Teacher Buddhism 10 F 40 Daughter Master degree Single Teacher Buddhism 11 F 54 Daughter High school Single Employee Buddhism 12 F 48 Daughter Elementary Married Self-employed Buddhism 13 F 40 Daughter Elementary Married Farmer Buddhism 14 F 42 Daughter Elementary Married Employee Buddhism Fallsberg [35]. First, in the familiarization step, the first Various background characteristics, such as age, sex, marital status, and educational level, were used as inclusion criteria. author read the transcriptions several times in both (ai and English to gain an overview of the relatives’ conceptions of To ensure that the conceptions of healthy aging were not drawn from older persons, this study included older persons’ healthy aging. (is step was necessary to verify the accuracy children and grandchildren aged< 60 years. (ree family of the transcriptions in (ai and English. (e first author members were excluded because they were the spouses of confirmed that the transcriptions completely retained the the participants in a previous study on healthy aging who meaning of the responses. (e English transcripts were then were aged> 60 years. used throughout the analysis process. (e other authors read Twelve children and two grandchildren of older persons the English transcripts several times to familiarize them- (11 women and three men) participated in this study, and the selves with the content. In the second step, the meaning units age range varied from 16 to 56 years. Five participants had an associated with healthy aging were condensed into short statements. In the third step, called the comparison step, elementary school education, six had a high school educa- tion, one had a bachelor’s degree, and two had a master’s similarities and differences in the dialogue excerpts were identified. (en, similar statements were grouped into degree. Eight participants were married, and six participants were single. All participants were Buddhists. (e partici- descriptive categories in the fourth step. In the fifth step, or pants’ characteristics are described in Table 1. the articulating step, embedded conceptions in each group of meaning units were identified. (e sixth step was the labeling step, in which the authors named the various 2.3. Data Collection. (e first author collected all data from categories. (e final step was the contrasting step, in which September to October 2013 using semistructured, in-depth the differences and similarities between categories were interviews and recorded the interviews to produce verbatim considered. transcripts of each conversation. All the participants agreed to have their conversations recorded. (e interviews were initiated using open-ended questions, such as “What is 2.5. Ethical Approval. We followed the guidelines of the meant by healthy aging, in your opinion?,” “Could you tell principles outlined in the Declaration of Helsinki [36], me about healthy aging?,” and “What makes older persons which emphasize showing respect for all participants and healthy?” (en, the first author asked specific follow-up protecting their rights. (e first author orally informed questions to prompt the participants to reflect on the the participants about the study and then provided them meaning of the phrase “healthy aging” and on their own with written information detailing the purpose of the thoughts, such as “What do you mean when you say ...?” or study and its possible benefits. (e participants could “Please give me an example of ....” (e lengths of the in- choose the time and place of the interview and were terviews varied, depending on the participants’ responses, allowed to withdraw from the study at any time. (e between 45 and 90 minutes. Each interview was transcribed participants were also ensured that their information verbatim, and each transcript was then translated from (ai would remain confidential. Permission to conduct this to English by a professional (ai-English translator to ensure study was granted by the Udon (ani Provincial Public that the translations were accurate [34]. Health Office Committee Board in (ailand and the Ethical Review Board of Research Involving Humans. (is study was registered with the Research Ethical Re- 2.4. Data Analysis. (e authors analyzed the transcribed interviews according to the steps suggested by Dahlgren and view Board of Uppsala, Sweden (Dnr 2013/019). 4 Journal of Aging Research one has the ability to maintain the functions of his or her 3.Results body and mind. Healthy aging means having a considerably (e participants’ conceptions of healthy aging consisted of strong, age-appropriate body and mind, the strength of four qualitatively different descriptive categories: being in- which is visually apparent to oneself and to others. (is dependent, not being afflicted by diseases or illnesses, being category encompassed the subcategories “living with dis- a giver and a receiver, and being wise. Each descriptive eases or illnesses” and “exhibiting physical and mental category is presented and described in detail below. strength.” 3.1. Being Independent. Healthy aging means having a desire 3.2.1. Living with Diseases or Illnesses. Healthy aging means to do everything by oneself and to avoid relinquishing having the ability to live with serious diseases or illnesses and control or seeking assistance from family members. (is to continue performing daily life activities. One relative category comprised the following two subcategories: “per- noted the following: forming activities without the assistance of others” and “not being a burden to others.” My mother is free from illness. Older persons can have some diseases, but not many. Although they have diseases, they effectively live with them. As long as they can simply 3.1.1. Performing Activities without the Assistance of live according to their routine, they are fine. (12) Others. Healthy aging means being able to care for oneself, to be free, and to participate in activities considered ap- (e participants stated that even individuals who have propriate for one’s age without needing assistance from some chronic diseases can exhibit healthy aging, although relatives. Healthy aging also means having the ability to work these individuals must find a way to live with their health after retirement to earn an adequate income as a means of conditions and thus live an ordinary life. supporting oneself financially. One participant described healthy aging as follows: 3.2.2. Exhibiting Physical and Mental Strength. Healthy My mother is expected to do things by herself. Older aging means being in good physical and mental conditions persons should work and earn their own income. ey can and free of diseases or illnesses that can limit one’s ability to choose what they want to do. Some choose to eat vege- perform daily life activities. Healthy aging also means having tables or fish. Some like chili paste. You just live on your a good memory, which is particularly desirable among older own. (6) persons. Such individuals are able to manage their emotions and are as strong as others of the same age. Healthy aging means having the ability to adjust to different circumstances and having autonomy, which fosters ey must be healthy, both physically and mentally, and a sense of freedom that prevents individuals from being free of diseases or illnesses. If you have a strong body, you forced to perform unwanted activities. also have a good mind. If you are well on the inside, your physical body is also well. If you are healthy physically, everything is healthy. When you have a positive state of 3.1.2. Not Being a Burden to Others. According to the psychological health, everything is fine. If you are calm participants, healthy aging means not being dependent on people around you feel cool. (9) family members. Specifically, healthy aging means that one’s needs are sufficiently met such that he or she demands Healthy aging means being strong and being a psycho- nothing. (us, one who ages healthily lives a sufficient life logically healthy person. Healthy individuals’ bodily func- and does not strive for unnecessary things, offend anyone, or tions are clearly connected to their mental functions, linking interfere in others’ business. One participant described this their inner and outer states. idea as follows: She does what she can and doesn’t impose a burden on her 3.3. Being a Giver and a Receiver. (e participants conceived children and grandchildren. Someone always expresses of healthy aging as giving and receiving help from others and concern that our family spoils her. But my mother isn’t stated that happiness and satisfaction derive from these like that. We don’t have to worry about her. (2) exchanges. Furthermore, healthy aging means being gen- erous and performing good deeds in accordance with (is statement indicates that healthy aging means not Buddhist beliefs, resulting in satisfaction, and delight from being a burden to others and that one should not impose Buddhist practices. (is category comprised the following oneself on one’s children or grandchildren. two subcategories: “giving assistance and receiving support” and “devoting oneself to and being delighted by Buddhist practices.” 3.2. Not Being Afflicted by Diseases or Illnesses. Healthy aging was described as a lack of degeneration of the body and 3.3.1. Giving Assistance and Receiving Support. Healthy mind. (is concept means that one does not suffer or worry about living with chronic diseases or illnesses. In this state, aging means having family members available to provide Journal of Aging Research 5 She understands what she needs to do because her life help, as well as helping children and others by acting as a giver. In this context, healthy individuals are good parents experience helps her. She learns from what she does. If it is good for her, she will continue to do it. She learns from her who have raised and provided for their family members but who also receive help from their children and grandchildren. behavior. My mother has lived long enough to have ex- perienced good and bad events in her life. (12) She makes bamboo sticks for grilled sticky rice for her son. He sells grilled sticky rice in town, and she helps him. (e participants stated that healthy aging means having She is happy to do it. I help take care of her bed and the ability to learn through life experiences and to experience her mosquito net. My aunt sells grilled eggs in town. She life as a journey. always buys delicious food for my grandmother when she visits. (4) 3.4.2. Preparing for Aging. Healthy aging means preparing oneself for growing old, which includes being satisfied with In this context, healthy aging means providing cooking one’s present life and focusing on the moment. Preparing for materials for family members and receiving support from aging involves practicing what is beneficial for one’s health family members. It means asking for help, for example, to to continue feeling young. meet one’s daily needs. Healthy aging also means helping family members in their work to support them. People should prepare for what they have to confront when they get old. ey have prepared themselves since 3.3.2. Devoting Oneself to and Being Delighted by Buddhist they were young, that is, our age. My mother has been doing this. She does aerobic dance and jumps rope, for Practices. Healthy aging means devoting oneself to the beliefs of Buddhism and attaining peace as a result of example. (10) Buddhist practices. Healthy individuals live virtuous and positive lives, and perform noble deeds. In return, these Healthy aging is conceived of as preparing oneself to face the process of growing old. Preparing for aging includes individuals experience happy lives and good health. Dedi- cating oneself to Buddhism involves making merit and preventing a decline in functions, for instance, by exercising and maintaining proper nutrition and hygiene. practicing the Buddhist doctrine. She likes to go to temple. e temple is her society. 4. Discussion Sometimes, she cuts the grass for the abbot and the monks. e monks support her, and my mother supports them. (is study is the first to examine how the children and She offers to make merit in religious ceremonies. My grandchildren of older persons in northeast (ailand con- mother lives in the community and adheres to Dharmic ceive of healthy aging. (e participants determined the principles. Making merit is a sign that one’s mind is meaning of healthy aging based on their lived experience of peaceful and that one’s health is also good. (9) connecting to older persons they lived with and took care of in everyday life. (e meaning of healthy aging consists of Healthy aging means that one is dedicated to the act of four descriptive categories: “being independent,” “not being making merit in accordance with Buddhist teachings. afflicted by diseases or illnesses,” “being a giver and a re- Making merit entails not only doing something good for ceiver,” and “being wise.” (e findings of this study reveal others but also receiving merit in return, such as happiness, existential aspects of healthy aging. Additionally, the current positive energy, peace, and enjoyment. study elucidates different conceptions of healthy aging that family nurses should consider when working together with the family members of older persons. 3.4. Being Wise. Healthy aging means being wise, which (e family is viewed as the context, according to the entails understanding one’s own life and life situations that focus of the family nursing perspective [17], which means occur. In particular, being wise means having the inner that the older person is in the foreground and the family is in strength to address life’s challenges and the knowledge to the background. Although the older person is the main focus prevent diseases and take care of oneself. (is category of the promotion of healthy aging, family nurses should also consisted of the following two subcategories: “experiencing consider the perspectives of older persons’ family members. life as a journey” and “preparing for old age.” (e family is an important unit since the family supports and provides for the older family member. Family nurses 3.4.1. Experiencing Life as a Journey. Healthy aging means therefore need to integrate the conceptions of healthy aging having sufficient knowledge—although not necessarily educa- held by the family members of older persons in their care. tional knowledge or an educational degree—to address prob- (is does not mean changing their way of thinking but lems in life. In the context of healthy aging, this subcategory involves being aware that there is not only one conception of refers to life experiences, which are derived from one’s lifestyle. healthy aging when participating with the family members of Healthy individuals regularly engage in positive practices in older persons. To work with the family members of older their everyday life to gain experiences that can help them persons, family nurses should respect and try to understand make necessary decisions. their conceptions of healthy aging. (e challenge for family 6 Journal of Aging Research consistent with the ideas expressed by healthcare pro- nurses and policy-makers is to find strategies to handle the different ways in which the relatives experience healthy fessionals in earlier studies of healthy aging in Western countries [5, 6]. We observed that being independent was aging. It is obvious that the family members of older persons conceive of healthy aging differently. As the results show, a criterion for healthy aging, which may indicate that (ai family nurses should equally emphasize the importance of cultural values have been influenced by Western traditions, in being autonomous and depending on others. Moreover, which individualism plays a prominent role [24, 41]. (us, healthy aging is related to disease and illness but is also fo- modern society may have an impact on people’s beliefs and cused on wisdom in old age. (erefore, family nurses should normative contexts. A previous study showed that, according apply these perceptions when promoting healthy aging. to the perspective of older persons in the Isan region, healthy aging still depends on one’s relatives [7]. Furthermore, older Another challenge is to integrate the differences between the perspectives of older persons and family members when persons are dependent on caregivers [21, 42], whereas their younger relatives may value independence. While older working with these groups of people. (is practice may be useful for supporting good relationships among older per- persons still need assistance [21] because of changes in their bodily functions [43], the children and grandchildren of older sons, family members, and healthcare providers when implementing a plan to promote healthy aging. persons conceptualize healthy aging with respect to the A comparison of healthy aging from the perspectives functional capacity of older persons and not being a burden of the children and grandchildren of older persons reveals on relatives. (ese conceptions may be partly related to similarities between healthy aging, successful aging, and active ageism, the belief that older persons are inferior to younger aging. (ese similarities demonstrate that the meaning of people because of their age [44]. Children and grandchildren healthy aging relates to the ability to remain active and to view older persons as being different from themselves, which may result in negative attitudes toward older persons. (is maintain the overall functioning. (is is in line with the definition of successful aging, which emphasizes healthy study indicates that family nurses should be aware of these conceptions when collaborating with the children and grand- cognitive function and focuses on the state of functioning that makes an active life possible [11, 37]. When comparing the children of older persons to promote healthy aging. Considering these aspects, policies should be developed according to the findings of this study with the concept of active aging, we found that both healthy aging and active aging refer to the conception of healthy aging with respect to the burden of ability to maintain autonomy as well as the importance of older persons on family members and the roles of older independence for the older person [12]. (ere is little dif- persons in society. Another suggestion is to support older ference between the concepts of healthy aging found in this persons when they lack the capacity to increase the value of study and a previous study [38]. (at previous study on their lives. Policy-makers and family nurses should emphasize healthy aging also showed that healthy aging was defined as the value of older persons to younger people. Healthy aging is also defined as “being a giver and freedom from chronic illness and impairment [38]. However, in the present study, healthy aging is defined not only as the a receiver.” (is category is related to the second dimension of the ontological health concept, in which health is viewed absence of disease or illness but also the importance of the ability to live with disease or illness. as “being health” [39]. Health is characterized as the Our results indicate the diversity of meanings of healthy achievement of balance and harmony, whether between the aging, which is consistent with the characteristics of the body and soul; between physiological, psychological, and ontological health concept [39], which is perceived as social factors; or between internal and external elements a movement toward wholeness and holiness [40]. (e four [39, 45]. When comparing that conception of healthy aging descriptive categories are consistent with the three health to the meaning found in this study, there are differences levels in the ontological health concept: health as behavior, between the categories “being independent” and “being health as being, and health as becoming [39]. Herberts and a giver and a receiver.” Surprisingly, “being independent” and “being a giver and a receiver” seem to be contradictory. Eriksson [39] described the first dimension of health as having health, which is a way of achieving health through (e meaning of healthy aging that focuses on healthy aging as a state characterized by independence may reflect the certain behaviors that are considered healthy by the indi- vidual or society. (e conceptions of healthy aging as being influence of the Western perspective [5]. In contrast, “being independent and not being afflicted by diseases or illnesses a giver and a receiver” stresses the importance of the re- are related to the first dimension of health, that is, having lationships between older persons and their family members health. Healthy aging also entails being independent, having as an influential factor in healthy aging, which may be due to the ability to care for oneself, being free from diseases or ill- the values of Isan culture. Being a giver and a receiver is nesses, and maintaining strong bodily and cognitive functions. related to the dynamics of the relationships between children and grandchildren and older persons in Isan culture. (is Healthy aging is consistent with the idea of evaluating health using external objective criteria and focusing on illness-related relationship reflects the idea that children are indebted to their parents because their parents raised them from birth problems [39]. A comparison of the meaning of healthy aging found in [22, 42]. (us, these relationships may be related to the concept of intersubjectivity, which is defined in phenome- this study and that reported in other studies reveals explicit differences and similarities. Regarding the description of the nological theory [29, 46, 47] as the idea that everyone relies nature of each category, the conceptions of healthy aging as on and exists in relation to others [48]. (e children and being independent and not afflicted by diseases or illnesses are grandchildren of older persons interact with older persons Journal of Aging Research 7 perspectives of young adults regarding healthy aging. For the throughout their lives and use their own bodies to un- derstand how the concept of healthy aging relates to the future challenges of supporting healthy aging, we suggest that family nurses plan for the promotion of healthy aging with older persons with whom they live. Parents provide for their children, love them, and take care of them from early adults in parallel with the current older population, according childhood, and children are taught that they should live with to the findings of this study. For example, family nurses and repay their parents until the parents die [22]. (is should serve the workforce and programs for preparing connection may be described as an obligation and a social healthy aging in middle adulthood. (ese programs should be norm in Isan-(ai culture, which is based on Buddhism. related to the prevention of health problems. Moreover, the Although the Isan lifestyle has been changed by moderni- promotion of healthy aging should be relevant to the different conceptions of healthy aging. (e family members of older zation [24], people in this region continue to have a strong belief in Buddhism [49]. Isan customs and Buddhist beliefs persons should be encouraged to brainstorm a list of the key determinant factors in supporting their health and advance are passed down from generation to generation [50], and the cultural values tied to these customs and beliefs determine care planning to promote healthy aging. the individual person’s thoughts and ideas [51]. Isan people cling to their culture through local customs [49]. Buddhists 4.1. Methodological Considerations. Rigor in phenomeno- believe in the concept of karma [22, 52], which means that graphic research is based on the study’s validity and re- one receives what he or she gives to others; this means that liability [61]. (e participants of this study were carefully whatever one does to others may also be done to him/herself selected using a strategy intended to obtain a varied and in the future. (is belief is illustrated by the practice of broad picture regarding the focus of the study—the con- making merit, which, according to Buddha’s teachings, brings ceptions of healthy aging held by the relatives of older happiness and peace [9]. Isan values are rooted in the in- persons. (e number of participants recruited for this study teractions between an individual and others. (us, this category was considered reasonable, but the participants included is related to the interdependence [8, 53] that characterizes Isan more women than men. (us, the conceptions of healthy society. (is finding indicates that family nurses should en- aging held by the men who participated in this study may not deavor to enhance the relationships between older people and be fully representative. In-depth interviews exploring the their children and grandchildren to promote healthy aging. conceptions of healthy aging were conducted by one person In the final category, healthy aging is conceived of as (the first author), which allowed probing for deeper elab- “being wise.” Comparisons between our results and those of oration and ensuring that all information was considered. previous studies regarding healthy aging [5, 6] indicate that Specific quotations were used to clarify the meaning of the domains of one’s experience, adaptation, and prepara- healthy aging. (e rigorous approach used in this study also tion are related to wisdom. Being wise is related to the last yielded findings that are transferable [62]. (is study focused dimension of health, in which health is perceived as “be- on the conceptions of healthy aging held only by the children coming” [39], meaning that human beings are becoming and grandchildren of older persons who live in the Isan something greater than themselves and/or becoming whole region of (ailand. (is restriction may have influenced our at a deeper level [39]. In this context, wholeness refers to findings, as cultural backgrounds may impact people’s be- physical, mental, and spiritual wholeness [39]. Furthermore, liefs. However, the findings of this study may be used to Eriksson [54] noted that health as becoming means that “the transfer to the relatives of older persons with similar person strives to reconcile himself with the circumstances of backgrounds, such as the children and grandchildren of life and to become whole in a deeper dimension of in- older persons who live in the northeast of (ailand. Al- tegration” (p. 76). Our findings indicate that being wise is though the results of the present study can be related to the linked to self-adjustment and to one’s ability to face his or Western perspective on the meaning of healthy aging, data her problems and the changes associated with the aging were drawn from the relatives of older persons in only one process. People in society believe that older persons have region of (ailand. (e information about the meaning of gained important life experiences that enable them to face healthy aging gathered from this group of family members of life’s problems and thus consider these life experiences as older persons cannot be applied to the entire world. (e valuable sources of wisdom [55]. Wisdom is believed to purposive sampling method may also limit the generaliz- benefit older persons in facing life situations and is corre- ability of our results. Moreover, all the participants were lated with older age [56, 57]. Wisdom also underlies the Buddhists. Although Buddhism is a main religion in respect shown to older persons by children and other rel- (ailand, the conceptions of healthy aging held by Buddhists atives who greatly admire them [58]. Another explanation may differ from those held by members of other religions. for this behavior is consistent with the idea of ego integrity [59, 60]. (is category may be associated with the ability to integrate one’s life experiences. (is finding suggests that the 5. Conclusions life experiences and wisdom of older persons should be revealed in order to promote positive attitudes toward older (e key findings of this study are the conceptions of healthy persons. We observed that participants also defined healthy aging represented as a set of categories: “being independent,” aging as preparation for aging. “not being afflicted by diseases or illnesses,” “being a giver (e findings of this study represent a starting point for and a receiver,” and “being wise.” Furthermore, the meaning family nurses and/or policy-makers when considering the of healthy aging is linked to older persons, their relatives, 8 Journal of Aging Research [13] World Health Organization, “Multisectoral action for a life and the Buddhist religion, which emphasizes the importance course approach to healthy aging: draft global strategy and plan of a holistic view of healthy aging. Although some relatives’ of action on aging and health,” May 2016. http://apps.who.int/ conceptions of healthy aging were consistent with Western gb/ebwha/pdf_files/WHA69/A69_17-en.pdf?ua�1. perspectives, traditional Isan-(ai cultural values still in- [14] J. Knodel, B. Teerawichitchainan, V. 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