# An Integrated 5I Health Promotion Model for Enhancing Independence and Quality of Life Among Older Adults in Indonesia: A Community-Based Path Analysis Study

## TL;DR

This study introduces a validated health model to improve independence and quality of life for older adults in Indonesia through community-based activities.

## Contribution

The novel 5I Health Promotion Model integrates personal and social factors to enhance aging outcomes in low-resource urban settings.

## Key findings

- Participation in social activities strongly predicts physical independence (β = 3.018, p < 0.001).
- The 5I Model achieved excellent statistical fit (CFI = 1.000) and explained significant variance in quality of life.
- Incorporating spiritual and cultural elements is crucial for effective health promotion in Indonesia.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Population aging in low- and middle-income countries (LMICs) poses a major challenge due to limited health resources and the need for functional independence.There is a lack of integrated community-based health promotion models that address the complex interaction between personal beliefs and social support in urban settings.

Population aging in low- and middle-income countries (LMICs) poses a major challenge due to limited health resources and the need for functional independence.

There is a lack of integrated community-based health promotion models that address the complex interaction between personal beliefs and social support in urban settings.

Public health significance—Why is this work of significance to public health?
The Integrated 5I Model provides an empirically validated framework (Identify, Inspire, Initiate, Integrate, and Impact) that achieves excellent statistical fit (CFI = 1.000).Participation in daily and social activities was found to be the strongest direct predictor of physical independence (β = 3.018, p < 0.001).Participation in social activities was found to have a significant direct impact on the quality of life among the elderly (β = 2.376, p = 0.003), highlighting the importance of psychosocial integration.

The Integrated 5I Model provides an empirically validated framework (Identify, Inspire, Initiate, Integrate, and Impact) that achieves excellent statistical fit (CFI = 1.000).

Participation in daily and social activities was found to be the strongest direct predictor of physical independence (β = 3.018, p < 0.001).

Participation in social activities was found to have a significant direct impact on the quality of life among the elderly (β = 2.376, p = 0.003), highlighting the importance of psychosocial integration.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Health promotion for older adults in Indonesia is most effective when embedded within local spiritual-social structures and cultural social capital.Practitioners and policymakers should utilize the Pentahelix approach (government, academia, community, media, and private sector) to ensure the sustainability of active aging programs.

Health promotion for older adults in Indonesia is most effective when embedded within local spiritual-social structures and cultural social capital.

Practitioners and policymakers should utilize the Pentahelix approach (government, academia, community, media, and private sector) to ensure the sustainability of active aging programs.

Population aging poses a growing public health challenge in low- and middle-income countries, including Indonesia. Functional independence is a key determinant of older adults’ quality of life, yet integrated community-based health promotion Models addressing this issue remain limited. This study developed and empirically validated an Integrated 5I Health Promotion Model (Identify, Inspire, Initiate, Integrate, and Impact) to enhance independence and quality of life among older adults in an urban Indonesian setting. A community-based cross-sectional survey was conducted among 240 older adults in Surakarta, Indonesia, using proportional cluster sampling from community activity groups. The integrated 5I Model was constructed based on the Health Belief Model, the Logic Model, and a pentahelix approach. The data were collected using a structured questionnaire comprising the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the modified PASE (including religious activities), and an expanded WHOQOL-BREF (incorporating spirituality, freedom, and happiness). The data were analyzed using path analysis to examine direct and indirect relationships among internal and external factors, perceptions, participation, independence, and quality of life. The model demonstrated good structural fit and explained a substantial proportion of variance in independence and quality of life. Perception and participation played significant mediating roles between the internal and external factors and independence. Increased independence was significantly associated with improved quality of life among older adults. Participation showed the most substantial direct effect with physical independence (β = 3.018, p < 0.001), while independence was significantly associated with quality of life (β = 0.599, p < 0.001). Participation was also found to have a significant direct impact on the quality of life (β = 2.376, p = 0.003). The model demonstrated excellent fit (CFI = 1.000; RMSEA = 0.000; SRMR = 0.012). The Integrated 5I Health Promotion Model offers a pragmatic, scalable framework for community-based interventions to promote independence and quality of life among aging populations in urban low- and middle-income settings. This model has important implications for public health programs and policies targeting healthy and active aging.