Cross-Sectional Study of Health Promotion and Recreation Effectiveness on Quality of Life Among Rural Older Adults

Abstract

Older adults in rural areas often face barriers to accessing formal health services. Community-based programs serve as alternative models for delivering preventive care and psychosocial support. However, the effectiveness of specific program types on well-being outcomes remains underexplored. This cross-sectional study analyzed secondary data from 1033 older adults across 44 rural communities in Taiwan. Participants were involved in 5 types of community-based programs. Subjective well-being was assessed using the WHO-5 index. Associations between participation hours and well-being were examined using ANOVA, OLS regression, and linear mixed models, with community-level clustering and individual demographics controlled. Health promotion and recreational activities were positively associated with well-being, while horticultural therapy and social participation showed negative associations. Food and agricultural education was positively associated with well-being only after controlling for community context. Neither age nor gender significantly predicted outcomes. Community context moderated several program effects. Community-based programs impact rural older adults’ well-being in diverse ways depending on program type and local implementation. Tailored, context-sensitive interventions and ongoing program evaluation are essential for optimizing care outcomes in aging rural populations.