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Community Readiness for 
Increasing Older Adult Physical 
Activity Levels in Kazakhstan 

 

Aniyar Izguttinov1*, Assel 
Ainabekova2, Miruna Petrescu-
Prahova3, Suzanne J. Wood3 
 
1Department of Health Policy and 
Management, University of North 
Carolina at Chapel Hill, Chapel Hill, North 
Carolina, USA;  
2Center for Global Health, Republican 
Center for Health Development, Ministry 
of Healthcare of the Republic of 
Kazakhstan, Nur-Sultan, Kazakhstan; 
3Department of Health Services, 
University of Washington, Seattle, 
Washington, USA 
*Corresponding author email: 
aniyar@email.unc.edu 

 
Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2020.447   |   http://cajgh.pitt.edu 



 
 
IZGUTTINOV 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.447 | http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: Physical activity is proven to be a significant element of successful aging, but many seniors worldwide fail to achieve 
the recommended levels. This study aimed to assess the readiness of the community in Nur-Sultan, Kazakhstan, to act on the issue 
of physical inactivity among older adults. 
Methods: In order to achieve this purpose, we conducted qualitative interviews with key informants in the community and applied 
a validated community readiness tool. 
Results: The results suggest that the local community is at early stages of readiness to act on the issue of older adult physical 
inactivity. We identified a number of barriers that prevented seniors from leading active lifestyles, which included community 
misconceptions about older adult physical activity, family centeredness in older adulthood, scarcity of resources, passive support 
from the leadership, and lack of efforts in the community. Research findings also highlighted the importance of conducting in-
depth analysis of key informant responses in addition to calculating readiness scores, when using the community readiness tool. 
Conclusion: Community-specific strategies for enhancing the level of physical activity among seniors are required to offset the 
disease burden associated with aging and to prolong life expectancy in Kazakhstan, and it is of paramount importance to tailor 
potential efforts as to address the current readiness of the community and its needs. 

Keywords: Community readiness; Physical activity; Older adults; Healthy aging

Community Readiness for Increasing 
Older Adult Physical Activity Levels  
in Kazakhstan 
 

Aniyar Izguttinov1*, Assel 
Ainabekova2, Miruna Petrescu-
Prahova3, Suzanne J. Wood3 

 
 
1Department of Health Policy and 
Management, University of North Carolina at 
Chapel Hill, Chapel Hill, North Carolina, USA;  
2Center for Global Health, Republican Center 
for Health Development, Ministry of 
Healthcare of the Republic of Kazakhstan, 
Nur-Sultan, Kazakhstan; 3Department of 
Health Services, University of Washington, 
Seattle, Washington, USA 
*Corresponding author email: 
aniyar@email.unc.edu 
 

Research 

Physical activity is proven to be a significant 
element of successful aging.1 Apparent benefits of 
physical activity for older adults include an increase in 
functional ability and reduction in the risk of cognitive 
decline.2 Scientific evidence also suggests that physical 
activity prevents onset of diabetes and stroke, improves 
sleep and life satisfaction, and helps to build social 
networks in older adulthood.3 Despite these benefits, 
many seniors fail to achieve the recommended levels of 
physical activity.4-6 One clear finding in the literature is 
that inactivity increases substantially with age across 
nations.3,7 

The Kazakhstan of today has improved in many 
health status measures relative to the 1990s, when the 
country obtained its independence. In 2017, the average 
life expectancy was 72.9 years, which indicates a three-
and-a-half-year gain compared to the 1980s.8 However, 
cardiovascular diseases in particular place the greatest 
burden on the population of Kazakhstan, accounting for 
53% of mortality in the nation.9 An analysis across age 



 
 

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groups demonstrates an even more alarming picture, with 
cardiovascular diseases estimated to be the single leading 
cause of deaths for the age groups of 45-59 and 60-74 
years.9  

Given the high prevalence of cardiovascular 
diseases, especially in older age, and relatively short life 
expectancy in Kazakhstan, increasing physical activity 
levels among older adults in the country appears to be a 
very promising public health measure.3 However, little is 
known about the readiness of communities in Kazakhstan 
to implement older adult physical activity initiatives, and 
the design of successful programs will have to consider 
current community norms and activities. Therefore, the 
purpose of this study was to systematically assess the 
community readiness to act on the issue of physical 
inactivity among older adults aged 60 and over in the city 
of Nur-Sultan (formerly Astana), Kazakhstan. We 
believe the study findings will help inform locally 
tailored initiatives to enhance older adult physical 
activity levels and will facilitate the adoption of 
evidence-based public health programs in the region. 

 

Methods 

A cross-sectional community readiness 
assessment was carried out to achieve the purpose of the 
study. The community was defined by the geographical 
area of the city of Nur-Sultan. 

Community Readiness Tool 

Community readiness (CR) is defined as the 
degree to which a certain community is willing and 
prepared to take action on a specific health problem.10 
We chose the Community Readiness Tool (CRT) 
developed by Edwards et al.11 as the assessment tool for 
our study because it (1) offered flexibility in tailoring the 
approach to a particular health issue and a community; 
(2) has been used successfully to analyze potential 
dissemination of older adult physical activity programs 
in the US, Germany, and China;12-14 and (3) previous 

studies have reported the validity and high consistency of 
the tool.15 

The CRT provides a step-by-step protocol for 
the assessment of five dimensions of CR: (1) Community 
Knowledge of Issue, (2) Community Knowledge of 
Efforts, (3) Community Climate, (4) Leadership, and (5) 
Resources. All dimensions are scored separately using a 
nine-point anchored rating scale before an overall 
numeric value is calculated. Each score on the scale 
corresponds to one of the nine stages of CR,10 which are 
described in Table 1. 

Participant Recruitment 

The purposeful sampling was used to recruit key 
informants from a diverse range of community sectors.16 
Through online search and personal connections, we 
identified and contacted seventeen potential 
interviewees. The CRT suggests interviewing 6-12 key 
informants depending on the size of the community. In 
this study, the final sample included ten (N=10) 
individuals representing five different sectors: (1) older 
adult organizations, (2) public health agencies, (3) 
fitness/sports facilities, (4) healthcare providers, and (5) 
social service organizations. The team did not offer any 
incentives for participation. 

Interview Guide and Procedures 

The interview instrument was developed in 
accordance with the CRT and directly addressed all five 
dimensions. The final version of the guide was translated 
into the Kazakh and Russian languages and pilot-tested. 
All interviews were held in-person between June and 
December 2018 and followed a semi-structured format.17 
The team obtained a written consent from each 
informant. While interviewees were given a choice of 
three languages (Russian, Kazakh, and English), all of 
them preferred to answer the questions in Russian. Each 
interview, which lasted 45-70 minutes, was audio 
recorded with permission, and then transcribed using the 
online transcription software HappyScribe®. 



 
 
IZGUTTINOV 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.447 | http://cajgh.pitt.edu 

 
 

Stages Title Description 

1 No awareness Issue is not generally recognized by the community or leaders as a problem (or it 
may truly not be an issue). 

2 Denial/resistance At least some community members recognize that it is a concern, but there is 
little recognition that it might be occurring locally. 

3 Vague awareness Most feel that there is a local concern, but there is no immediate motivation to do 
anything about it. 

4 Preplanning There is clear recognition that something must be done, and there may even be a 
group addressing it. However, efforts are not focused or detailed. 

5 Preparation Active leaders begin planning in earnest. Community offers modest support of 
efforts. 

6 Initiation Enough information is available to justify efforts. Activities are underway. 

7 Stabilization Activities are supported by administrators or community decision makers. Staff 
are trained and experienced. 

8 
Confirmation/ 

expansion 
Efforts are in place. Community members feel comfortable using services, and 

they support expansions. Local data are regularly obtained. 

9 
Community ownership/ 

Professionalization 

Detailed and sophisticated knowledge exists about prevalence, causes, and 
consequences. Effective evaluation guides new directions. Model is applied to 

other issues. 
Table 1. Stages of community readiness

Analysis 

Although ten interviews were conducted, we 
excluded one from the analysis due to lack of analyzable 
responses and failure to provide information for scoring 
two of the CRT dimensions. Hence, a total of nine (N=9) 
interview transcripts were subject to analysis.  

We first assessed participant characteristics and 
CR scores closely following the CRT and using the 
anchored rating scales that are part of the tool.10 Two 
authors independently scored each interview before 
discussing individual assessment discrepancies and 
producing a final table with consensus scores. As 
recommended by Kostadinov et al.,18 we also calculated 
standard deviations of CR scores. 

For the purposes of qualitative data analysis, we 
developed an a-priori list of codes to conduct a deductive 
assessment based on the CRT and the interview guide. 
Then, using an inductive approach,19 we coded two 
previously translated interview transcripts in order to 

identify any emergent codes. The final codebook, 
containing 29 a-priori and four emergent codes, was used 
to code the entire dataset. Qualitative coding results were 
then discussed with the whole research team and 
eventually the themes were mapped onto one of the five 
CR dimensions. Dedoose® Version 8.1 was used for 
qualitative data analysis. 

 

Results 

Participant Characteristics 

All participants were directly involved in the 
provision of services to senior citizens or were actively 
engaged in policy issues that potentially affected older 
adult physical activity levels. Seven informants were 
female (78%) and two were male (22%). While the 
majority of interviewees were between 30 and 50 years 
old, two participants were over 60 years old. Table 2 
describes the sample characteristics. 



 
 

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Characteristic n (%) 

Gender 
   Male 
   Female 

 
2 (22) 
7 (78) 

Age category 
   30-44 years 
   45-59 years 
   >60 years 

 
5 (56) 
2 (22) 
2 (22) 

Representative from: 
   Older adult organization  
   Public health agency 
   Fitness / sports facility 
   Hospital / Healthcare provider 
   Social service organization 

 
1 (11) 
2 (22) 
3 (34) 
2 (22) 
1 (11) 

Representative job title: 
   Director / Deputy director  
   Head of the department / unit 
   Fitness instructor 
   Cardiologist 

 
2 (22) 
3 (34) 
3 (34) 
1 (11) 

Table 2. Key informant characteristics (N=9)  

Community Readiness Scores 

The overall readiness score was 3.28 
(SD=0.30), which corresponded to the vague awareness 
stage of CR. The range of individual scores for each 
dimension of each interview was between 1.0 and 5.0. 
The highest average score of 3.72 (SD=0.79) was 
observed in the Knowledge of Issue dimension, whereas 
the Knowledge of Efforts domain received the lowest 
score of 2.92 (SD=1.59).  

Table 3 represents consensus scores across each 
dimension based on all key informant interviews. The 
results suggested that four out of five dimensions were at 
vague awareness phase of CR. The only exception was 
the Knowledge of Efforts dimension, which was assessed 
to be at denial/resistance stage.  

Qualitative Assessment of Community Readiness  

Dimension 1— Community Knowledge of 
Issue: This dimension addressed the scope of community 
members’ knowledge and understanding of the issue of 
physical inactivity among senior citizens.  

There was a common general understanding that 
physical activity was important in preserving physical 
and mental wellbeing, and hence was a significant factor 
in prolonging one’s lifespan. However, when asked 
specifically about the issue of physical inactivity among 
seniors, informants (8 of 9) cited that there was lack of 
awareness. Healthy lifestyle and physical activity in 
particular were attracting the attention of younger 
generations but not among older adults.  

“They know very little about it. Now there is a tendency 
that young people are interested in healthy nutrition and 
physical activity, but they do not inform their moms and 
dads, other adults.” 

Head of Physical Therapy Unit, Hospital 2  
 

Dimension Mean ± SD (Readiness Stage) 

Community Knowledge of Issue 3.72 ± 0.79 (Vague Awareness) 

Community Knowledge of Efforts 2.92 ± 1.59 (Denial/Resistance) 

Community Climate 3.31 ± 1.22 (Vague Awareness) 

Leadership 3.11 ± 0.86 (Vague Awareness) 

Resources 3.33 ± 0.45 (Vague Awareness) 

Overall readiness 3.28 ± 0.30 (Vague Awareness) 
Table 3. Domain specific and overall community readiness scores



 
 
IZGUTTINOV 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
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According to three informants, older adults in 
the community may consider physical activity too risky 
or inappropriate for older age. 

“As they have more health concerns, they become less 
active. They believe that physical movement can damage 
their joints, allocated time for each exercise might not be 
enough, and as if from the side they will look funny doing 
those activities.”  

Deputy Director, Social Services Center 

One interviewee believed this view was shared 
by younger generations as well when they thought that 
engagement in physical activities might exacerbate their 
parents’ and grandparents’ current conditions and lead to 
complications. A number of participants (3 of 9) 
including representatives from a hospital and fitness 
facilities pointed out that physical activity was often seen 
by older adults only as a supplement to medications and 
conventional medicine. Seniors may have 
underestimated the importance of exercise, for example, 
compared to following a medication regime. Two 
informants noted that this misconception was also 
present among healthcare professionals. Main discussion 
during a patient visit was around clinical concepts of 
disease, its symptoms, and conventional treatment 
methods. A respondent went on to explain: 

“Doctors are not particularly familiar with sports either. To 
someone who has been living a sedentary life for 40 years 
they say, ‘You need to be physically active,’ and expect 
him/her to go straight into running.” 

Instructor of Nordic Walking, Independent Provider 

Dimension 2— Community Knowledge of 
Efforts: This dimension was comprised of how much 
community members knew about local efforts, if any, 
their effectiveness, and accessibility for older adults.  

Efforts from the government, private, and non-
profit sectors aimed at increasing older adult physical 
activity were fragmented and rarely present. Three out of 
nine informants could not name any physical activity 

programs offered specifically for seniors. Nordic walking 
was the only example of a structured physical activity 
program mentioned by several interviewees (5 of 9). 

“I have not seen a separate program specifically designed 
for the elderly - not from the private, nor from the public 
sector. A lot of different activities are carried out all 
around the city during summer months, but nothing is 
specific to older adults.” 

Instructor of Physical Exercise Class, Fitness Center 

Some fitness centers provided discounts for 
senior citizens to encourage the use of sports and leisure 
facilities. However, informants (3 of 9) believed that 
older adults often thought that fitness centers were for 
younger people, and it might be challenging for the 
elderly.  

Those who were involved in designing or 
delivering services or heard about physical activity 
opportunities for senior citizens were uncertain of how 
widespread those activities were and if they were popular 
among older adults. According to informants (4 of 9), 
majority of community members were unaware or had 
limited knowledge about current and future efforts. 

“We can see this by the way people call and come to us. 
They say, ‘We have elderly parents, and we do not know 
what to do with them.’ They ask for some kind of activities 
and events, but we are not aware of anything like that.” 

Director, Older Adult Organization 

Dimension 3— Community Climate: This 
dimension included the prevailing attitude of community 
members towards older age and the role of physical 
activity in older adulthood. 

Informants indicated that older adult life was 
traditionally considered as a period to be spent with 
family, grandchildren, and relatives where older adult 
physical activity was of little value to seniors themselves 
and their children. After the age of 60, people may have 
become more heavily centered on family and household 
needs. Hence, their physical activity has been limited to 



 
 

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This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

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everyday chores, such as grocery shopping and 
housekeeping.  

According to informants, older adults were 
respected in the family and community. Their rare 
participation in physical activities was usually 
welcomed, but they were not seen as active members of 
society. As cited by one key informant, TV commercials 
portrayed older people as barely moving individuals. 
Another respondent suggested to think about common 
gifts that seniors received on birthdays and other 
occasions, and explained it in the following way: 

“In our society, people very often present handkerchiefs, 
slippers, pajamas to older adults - all these gifts indicate 
that our view of the elderly is of an isolated and closed 
person. So even with our gifts we push them in the corner. 
If the community members saw them as an active part of 
society, then they would be given sports shoes, a sports 
bag, ice skating gear, active outfit.” 

Director, Older Adult Organization 

Informants acknowledged community concern 
about the issue of physical inactivity among older adults 
was limited to a group of enthusiasts and certain 
professionals, whereas the community as a whole 
expressed no concern and considered it to be an 
individual level problem. Informants (5 of 9) were 
skeptical about the problem becoming a real concern for 
city residents in near future. 

“Our society is not ready to act on it yet. Now fitness is 
experiencing some kind of a boom and maybe 
involvement of older adults will somehow be a priority in 
the future, but it is not happening now. Probably, not going 
to happen soon.” 

Instructor of Nordic Walking, Independent Provider 

Dimension 4— Leadership: This dimension 
aimed to understand the position of the appointed leaders 
and influential community members in relation the issue 
and assessed their willingness to support current as well 
as future community actions. 

Informants indicated that while the issue may 
have been a concern for the leadership, they showed no 
immediate motivation to act. Due to many other pressing 
issues needing attention and funding, older adult physical 
activity was not a priority. A respondent pointed out that 
the government’s view of senior population was limited 
to pension reforms.  

“When you ask about what is being done in relation to 
senior citizens, they [government officials] start 
explaining pension reforms. An elderly person is equal to 
pension affairs, and no one notices other aspects of older 
adult life.” 

Director, Older Adult Organization 

Dimension 5— Resources: The last dimension 
of the CRT explored the availability of local resources – 
human, money, and space – for community members to 
use in support of efforts now and in the future.  

Informants (6 of 9) cited lack of financial 
resources as one of the most common barriers for seniors 
to engage in physical activities. Free opportunities had 
been accessible on a limited or seasonal basis, whereas 
fitness center memberships were unaffordable for the 
elderly for whom pension was usually the single source 
of income. Government funding was very scarce, and 
most of older adult physical activities were self-funded 
or supported by family members. When asked about 
alternative means of funding from grants and businesses, 
key informants (7 of 9) were unable to provide examples 
and explained that very limited financial support was 
available for promotion of older adult physical activity.  

While not readily available, informants 
suggested that volunteers could be found among 
community members. To them, youth were especially 
involved in volunteering, which might help in activating 
older adults. In order to direct volunteer efforts towards 
effective promotion of physical activity among seniors, 
informants indicated that someone needed to train, 
organize, and mobilize them in a structured way.  



 
IZGUTTINOV 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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“It seems to me that the problem lies precisely in the 
absence of an organizer or a leader who will be able to take 
the ownership of the problem, advocate for a solution, and 
use his/her skills as well as networks for the benefit of 
seniors… Volunteers can be easily recruited if there is a 
leader.”  

Head of Physical Therapy Unit, Hospital 2 

In terms of expert help, there appeared to be a 
sufficient number of knowledgeable and skilled 
healthcare workers, public health practitioners, and 
fitness instructors in the community. Yet, they may not 
all be trained to work specifically with older adult 
population. Two key informants mentioned that special 
training, expertise, and desire were needed to 
successfully accomplish such work. 

Informants explained that during summer 
months, outdoor spaces could easily be used for physical 
activity sessions, but indoor spaces may not be readily 
available free of charge. Availability would also depend 
on the size of a required space. Throughout colder 
periods of the year, lack of indoor facilities in close 
proximity was thought to be a substantial barrier to 
physical activity. 

 

Discussion 

We anticipated that the local community might 
score low in its readiness to challenge the current 
situation in relation to physical inactivity among senior 
citizens. In fact, quantitative assessment suggests that CR 
in Nur-Sultan is equal to the score of 3.28 on a nine-point 
scale, which is equivalent to the stage of vague 
awareness. According to the CRT, this means that most 
people recognize the issue as a local concern, but there is 
no immediate motivation to act on it. Qualitative 
analysis, however, indicates that community awareness 
might even be more limited and only certain groups such 
as fitness instructors and gerontologists express genuine 
concern regarding the issue. Such qualitative research 
findings suggest a denial/resistance stage of CR and 

highlight the importance of conducting in-depth analysis 
of interviewee responses in addition to calculating 
readiness scores when using the CRT. This also suggests 
that a broader assessment of CR with a greater number of 
key informants is needed in the future.  

The literature points to many factors affecting 
engagement of older adults in physical activity.21,22 
While identification of barriers was not a specific goal of 
the study, through qualitative analysis we identified a 
number of obstacles that prevent seniors from leading 
active lifestyles. Physical activity is often perceived by 
community members, including the elderly, as a pursuit 
of younger people, which could be risky or inappropriate 
for older adults. There is also an emphasis on 
conventional treatment of health problems and a disease-
centric view of aging. Such beliefs, coupled with lack of 
information about the issue, appear to contribute to high 
levels of physical inactivity among seniors in Nur-Sultan.  

Another common barrier is unaffordability of 
physical activity classes in the capital city. As evidenced 
by the results of the World Values Survey,20 only around 
16% of older adults in Kazakhstan are able to save money 
and the rest “just get by” or “borrow money”. This fact 
may justify a low priority of physical activity among 
seniors. Likewise, the country and city leadership do not 
recognize the problem as a priority and have been passive 
in offering a solution. Lack of concern about the issue in 
the community and among the leadership could explain 
the scarcity of efforts. However, it is important to 
examine the current situation while taking into account 
the broader country profile. As a developing nation, 
Kazakhstan’s government seems to be focusing on 
improving and diversifying the economy, and people are 
still driven by survival values of ensuring financial and 
physical security.20 In addition, the proportion of seniors 
in the country (7.4%) is significantly lower than in 
Europe (20%) and the US (16%),23 which could be 
distancing attention from the issues of older age, 
including physical inactivity. At the same time, high 
mortality and morbidity rates from cardiovascular 



 
 

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diseases may in the near future incentivize the 
government to invest more resources in preventative 
initiatives. 

The authors of the CRT suggest directing the 
efforts at increasing awareness, empowering community 
groups, and acquiring local support in order to move the 
readiness beyond the stage of vague awareness. For that 
purpose, studies from the US and China12,14 have 
recommended disseminating information about the 
benefits of physical activity through various printed and 
electronic media. In this regard, the government of 
Kazakhstan can use its vast network of state owned or 
regulated media channels to inform the community about 
the issue and to promote greater involvement of seniors 
in physical activity.  

In the key informant interviews, Nordic walking 
was a commonly mentioned physical activity program. 
While it is not targeted at older adults, the program has 
been proven to be effective in improving heart rate, 
oxygen consumption, and quality of life.24 Promoting this 
program further may be a valid strategy to increase 
physical activity among older adults. Alternatively, 
evidence-based older adult activity programs such as 
Enhance®Fitness may be introduced in the community.25 
However, implementation in Kazakhstan would first 
require a study of feasibility and necessary adaptations. 

Given that the country’s governance structure is 
highly centralized,26 national policies are likely to be 
more effective in changing the current situation. For 
instance, inclusion of older adult physical activity 
promotion as one of the priorities in the next State 
Healthcare Development Program27 may facilitate the 
promotion of older adult physical activity and the 
adoption of evidence-based programs throughout the 
country. This in turn could aid the transition from a 
disease-centric clinical paradigm towards a more 
prevention-centric, whole-person view of health care.  

To our knowledge, this was the first effort to 
conduct a systematic evaluation of CR in Central Asia. 

Therefore, the concepts and methods of the study could 
be used by local researchers to conduct readiness 
assessments for other health and social problems in the 
communities of the region. Furthermore, in the vast 
majority of studies the CRT was used exclusively in a 
quantitative manner, whereas we went beyond that 
approach and included a qualitative assessment of key 
informant responses, which is a major strength of the 
study. Our final sample, however, included only 9 
respondents. Although we ensured inclusion of 
representatives from a diverse range of fields, the study 
would have benefited from a larger sample size and a 
greater number of participants aged over 60. In addition, 
the concept of CR is community-specific, which limits 
the generalizability of the findings.  

 

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