<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.176617.2</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Research Article</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Empowerment Model for The Elderly and Community to Improve the Welfare of the Elderly</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 2; peer review: 1 approved with reservations, 1 not approved]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Harahap</surname>
                        <given-names>Friska Indria Nora</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <uri content-type="orcid">https://orcid.org/0009-0001-5064-7078</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Kamil</surname>
                        <given-names>Mustofa</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Alvi</surname>
                        <given-names>Ria Rizkia</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Hendrawijaya</surname>
                        <given-names>Arief Tukiman</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Pradikto</surname>
                        <given-names>Bayu</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Winarti</surname>
                        <given-names>Hepy Tri</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <xref ref-type="aff" rid="a3">3</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Arnady</surname>
                        <given-names>Muhammad Adil</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Syahid</surname>
                        <given-names>Ahmad</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Rosilawati</surname>
                        <given-names>Rosilawati</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Universitas Pendidikan Indonesia, Bandung, West Java, Indonesia</aff>
                <aff id="a2">
                    <label>2</label>Universitas Jember, Jember, East Java, Indonesia</aff>
                <aff id="a3">
                    <label>3</label>Universitas Mulawarman, Samarinda, East Kalimantan, Indonesia</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:friskaharahap@upi.edu">friskaharahap@upi.edu</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>5</day>
                <month>6</month>
                <year>2026</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2026</year>
            </pub-date>
            <volume>15</volume>
            <elocation-id>153</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>13</day>
                    <month>5</month>
                    <year>2026</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2026 Harahap FIN et al.</copyright-statement>
                <copyright-year>2026</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/15-153/pdf"/>
            <abstract>
                <p>This study aims to develop and examine an empowerment model involving older people and the community to support improvements in elderly welfare. Using a mixed-methods design, the study combines quantitative assessment of welfare outcomes with qualitative exploration of empowerment processes. Quantitative data were collected from 210 elderly participants involved in community-based empowerment programs. Welfare was measured across physical, psychological, social, and economic dimensions. Data were analysed using descriptive statistics, paired-samples t-tests, and multiple regression. The results show an increase in welfare scores between pre- and post-program measurements. The mean score increased from 3.12 to 3.89 (t = 9.46, p &lt; 0.001). These findings suggest a positive association between program participation and reported welfare improvements, although causal conclusions cannot be established due to the study design. Qualitative findings provide insights into how empowerment processes may contribute to perceived improvements in well-being.</p>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>elderly empowerment; community participation; elderly welfare; community-based model; active ageing; social capital.</kwd>
            </kwd-group>
            <funding-group>
                <award-group id="fund-1" xlink:href="https://doi.org/10.13039/501100014538">
                    <funding-source>Lembaga Pengelola Dana Pendidikan</funding-source>
                </award-group>
                <funding-statement>This research was funded by BPI (Education Scholarship), PPAPT Kemdiktisaintek (Center for Higher Education Funding and Assessment), and LPDP (Indonesian Endowment Fund for Education), Ministry of Finance of the Republic of Indonesia.</funding-statement>
            </funding-group>
        </article-meta>
        <notes>
            <sec sec-type="version-changes">
                <label>Revised</label>
                <title>Amendments from Version 1</title>
                <p>This revised version includes several important improvements in response to reviewer feedback. First, the interpretation of findings has been substantially moderated to avoid causal claims, given the single-group pre&#x2013;post design without a control group. The language throughout the manuscript has been revised to reflect associative rather than causal relationships. Second, a more comprehensive discussion of study limitations has been added, including potential alternative explanations for observed changes such as regression to the mean, testing effects, and common method bias. Third, the interpretation of regression analysis has been clarified, emphasizing that the results represent cross-sectional associations rather than predictive relationships. In addition, methodological transparency has been improved by providing clearer descriptions of the research instruments and qualitative procedures. These revisions strengthen the rigor and clarity of the manuscript while maintaining its contribution as an exploratory mixed-methods study.</p>
            </sec>
        </notes>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>1. Introduction</title>
            <p>Population ageing is a global demographic trend that brings both opportunities and challenges. As life expectancy rises due to improvements in healthcare and living standards, societies are witnessing a growing proportion of elderly individuals. While this demographic transition is indicative of social progress, it also necessitates a reevaluation of existing elderly welfare programs, especially in developing contexts, where a shift from assistance to empowerment is required. Elderly welfare encompasses physical health, psychological well-being, social participation, and economic security. In China, for instance, as noted by Bao et al., the population aged 60 and older constitutes a significant 18.7% of the total population, highlighting the critical need for effective welfare strategies (
                <xref ref-type="bibr" rid="ref10">Bao et al., 2022</xref>). Various studies underscore the importance of promoting active ageing by creating environments that enable older people to engage in social, economic, and civic activities, thereby enhancing their quality of life (
                <xref ref-type="bibr" rid="ref31">Fung et al., 2023</xref>; 
                <xref ref-type="bibr" rid="ref91">Torku et al., 2021</xref>). Traditional approaches often treat older adults as passive recipients of aid, failing to foster their independence and self-efficacy (
                <xref ref-type="bibr" rid="ref28">Espinel-Jara et al., 2025</xref>; 
                <xref ref-type="bibr" rid="ref76">Rahmayani et al., 2024</xref>).</p>
            <p>In many communities, welfare programs for older people tend to be fragmented, focusing predominantly on immediate assistance rather than long-term empowerment (
                <xref ref-type="bibr" rid="ref41">Huang et al., 2025</xref>; 
                <xref ref-type="bibr" rid="ref54">L&#x00fc; &amp; Wu, 2022</xref>). This fragmentation often results from limited collaboration among families, local institutions, and social organisations, thereby diminishing the sustainability of these initiatives (
                <xref ref-type="bibr" rid="ref48">Kung et al., 2023</xref>). Therefore, there is an urgent need for holistic community-based approaches that can effectively mobilise family support and local resources while fostering elderly empowerment. Community-based empowerment offers a promising framework for enhancing elderly welfare. This model prioritises participation, social capital, and shared responsibility within the community. Empowerment initiatives, as highlighted by Wu et al., recognise elderly individuals as valuable contributors to community life, leveraging their experiences and skills to enhance social engagement (A. K. C. 
                <xref ref-type="bibr" rid="ref101">Wong et al., 2022</xref>; 
                <xref ref-type="bibr" rid="ref103">Wu et al., 2022</xref>). The active involvement of older adults in decision-making related to welfare programs not only improves their well-being but also cultivates a sense of belonging (
                <xref ref-type="bibr" rid="ref17">Cherbuin et al., 2021</xref>).</p>
            <p>Furthermore, research reveals a strong correlation between community engagement and life satisfaction among older adults. By involving them in meaningful activities such as volunteering and social participation, these models aim to bolster their independence and well-being (
                <xref ref-type="bibr" rid="ref41">Huang et al., 2025</xref>; 
                <xref ref-type="bibr" rid="ref106">Yu et al., 2021</xref>). The potential of technology, particularly Information and Communication Technology (ICT), is notably relevant, as it can facilitate social interactions and community engagement, further enhancing older adults&#x2019; quality of life (
                <xref ref-type="bibr" rid="ref42">Ivleva et al., 2024</xref>; 
                <xref ref-type="bibr" rid="ref63">Nakada et al., 2024</xref>).</p>
            <p>Intergenerational practices can strengthen social cohesion and mitigate isolation among older adults (
                <xref ref-type="bibr" rid="ref103">Wu et al., 2022</xref>; 
                <xref ref-type="bibr" rid="ref107">Zhang et al., 2025</xref>). Studies by Serrat et al. demonstrate that fostering intergenerational interactions can markedly improve the physical and emotional well-being of elderly individuals (
                <xref ref-type="bibr" rid="ref84">Serrat et al., 2021</xref>). By bridging the generational divide, communities can benefit from the wealth of knowledge and skills of older adults while simultaneously enriching younger generations&#x2019; understanding and appreciation of ageing. Social capital plays a crucial role in empowering older adults by fostering connections and strengthening community ties. A robust sense of social capital can positively influence health outcomes and enhance participation in community activities, as observed by 
                <xref ref-type="bibr" rid="ref8">Ayuningtyas et al. (2022)</xref> and 
                <xref ref-type="bibr" rid="ref77">Ram&#x00ed;rez-Arellano et al. (2021)</xref>. Communities that actively cultivate social capital may create environments conducive to ageing in place, thereby supporting elderly individuals in maintaining independence and engagement in their local contexts (
                <xref ref-type="bibr" rid="ref106">Yu et al., 2021</xref>).</p>
            <p>As the global population ages, there is a pressing need to innovate elderly welfare initiatives, shifting from passive assistance to active community-based empowerment. By embracing models that promote social participation, intergenerational relationships, and the harnessing of social capital, societies can create environments that support the independence and well-being of older adults. Future research and practice should focus on developing structured empowerment models that integrate elderly participation with community engagement, ensuring that their voices and contributions are valued in the discourse surrounding ageing.</p>
            <p>Therefore, this study aims to develop and examine an empowerment model for older people and the community to improve elderly welfare. Specifically, the study seeks to analyse the model&#x2019;s effectiveness in enhancing multiple dimensions of welfare and to identify key empowerment components that contribute to positive outcomes. The findings are expected to provide theoretical insights into empowerment-based ageing interventions and practical guidance for policymakers and practitioners in designing sustainable, community-driven elderly welfare programs.</p>
        </sec>
        <sec id="sec2">
            <title>2. Literature review</title>
            <sec id="sec3">
                <title>2.1 Concept of elderly welfare</title>
                <p>Elderly welfare is a complex, multidimensional construct encompassing aspects critical to the well-being of older adults. This notion integrates physical health, psychological well-being, social connectivity, and economic security, recognising that these dimensions interact to shape the overall quality of life (QoL) in elderly populations (
                    <xref ref-type="bibr" rid="ref14">Chatzinikolaou et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref53">Lin et al., 2020</xref>). Physical well-being refers to older adults&#x2019; functional capabilities, including mobility and access to appropriate healthcare services.</p>
                <p>Research indicates that chronic conditions and physical disabilities profoundly impact older people&#x2019;s ability to perform daily activities, ultimately influencing their overall quality of life (
                    <xref ref-type="bibr" rid="ref88">Souza et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref90">Thevathasan et al., 2025</xref>). Access to healthcare facilities and effective disease management are paramount for promoting physical well-being among older adults. Health-related quality of life (HRQoL) assessments are integral in evaluating and enhancing patients&#x2019; physical capabilities by scrutinising the impacts of diseases on their functional status and overall well-being (
                    <xref ref-type="bibr" rid="ref66">Noroozi et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref68">Owusu et al., 2025</xref>).</p>
                <p>Psychological welfare involves factors such as emotional stability, life satisfaction, and a sense of purpose. A comprehensive assessment of well-being among older adults acknowledges the significance of mental health aspects intertwined with their psychological state (
                    <xref ref-type="bibr" rid="ref78">Rohenkohl et al., 2022</xref>; 
                    <xref ref-type="bibr" rid="ref80">Safarabadi et al., 2024</xref>). According to Schaal&#x2019;s multidimensional approach, psychological well-being encompasses elements of self-acceptance, personal growth, and life meaning, which are crucial for maintaining a strong sense of identity and resilience in old age (
                    <xref ref-type="bibr" rid="ref2">Alhasan et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref97">Weiske et al., 2020</xref>). Findings show that mental health challenges, including depression and anxiety, frequently arise among older populations and must be addressed to improve their psychological welfare (
                    <xref ref-type="bibr" rid="ref49">Lazovi&#x0107; et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref67">Orr et al., 2022</xref>).</p>
                <p>Social welfare addresses the capability and opportunity for individuals to engage in meaningful social interactions and community life. Loneliness and isolation are prevalent issues that plague many elderly individuals, leading to detrimental effects on their mental and physical health (
                    <xref ref-type="bibr" rid="ref85">Shahin et al., 2022</xref>; 
                    <xref ref-type="bibr" rid="ref98">Widagdo et al., 2022</xref>). Active participation in community activities and the formation of strong interpersonal relationships are essential components of social welfare, as they significantly contribute to emotional support and a sense of belonging (
                    <xref ref-type="bibr" rid="ref37">Hammad et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref61">Mitu&#x015b; et al., 2020</xref>). The interaction between social relationships and overall well-being has been well-documented, emphasising that robust social networks are vital for sustaining emotional health (
                    <xref ref-type="bibr" rid="ref24">EKER et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref92">Tsubokawa et al., 2022</xref>).</p>
                <p>Economic welfare encompasses income stability and the ability to meet basic needs independently. Financial security is necessary for older adults to access healthcare resources, participate in social activities, and maintain a decent standard of living (
                    <xref ref-type="bibr" rid="ref51">Li et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref83">Seo et al., 2023</xref>). Research suggests that financial strain can exacerbate stress and negatively impact both psychological and physical health outcomes, reinforcing the interconnectedness of economic welfare with other dimensions of elderly well-being (
                    <xref ref-type="bibr" rid="ref3">Antunes et al., 2025</xref>; H. 
                    <xref ref-type="bibr" rid="ref94">Wang et al., 2021</xref>). Addressing economic vulnerabilities through social policies that promote financial independence and security can significantly enhance elderly welfare and their quality of life (
                    <xref ref-type="bibr" rid="ref18">Chukkali et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref99">Wilder et al., 2021</xref>).</p>
                <p>As emphasised in various studies, achieving comprehensive elderly welfare necessitates an integrated approach that harmonises healthcare interventions with social, psychological, and economic considerations (
                    <xref ref-type="bibr" rid="ref11">Bartzou et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref81">Salarfard et al., 2025</xref>). An understanding of quality of life through a multidimensional lens affords practitioners and policymakers opportunities to design effective interventions that encompass all aspects of well-being rather than relying on singular health-focused strategies (
                    <xref ref-type="bibr" rid="ref32">Giacomo et al., 2025</xref>; 
                    <xref ref-type="bibr" rid="ref35">Gudala et al., 2025</xref>). Continuous assessment and adaptation of strategies that address the diversity of elderly individuals can further enhance their quality of life (
                    <xref ref-type="bibr" rid="ref13">Chang et al., 2020</xref>; 
                    <xref ref-type="bibr" rid="ref89">Targino, 2021</xref>). Elderly welfare is a multi-faceted construct that requires a holistic approach, interweaving physical health, psychological well-being, social integration, and economic security to enhance the quality of life for older adults.</p>
            </sec>
            <sec id="sec4">
                <title>2.2 Community empowerment theory</title>
                <p>Community empowerment theory plays a crucial role in encouraging active participation and control among individuals and groups, particularly in the context of elderly welfare. This theory emphasises enabling community members to influence decisions and access resources that significantly affect their lives (
                    <xref ref-type="bibr" rid="ref73">Prasetyani et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref76">Rahmayani et al., 2024</xref>). Empowerment is a transformative process involving capacity building, social participation, and collective action that benefits ageing populations by fostering self-sufficiency and community involvement (
                    <xref ref-type="bibr" rid="ref56">Malik et al., 2020</xref>).</p>
                <p>In essence, community empowerment strengthens social capital through enhanced trust, shared norms, and collaboration among its members (
                    <xref ref-type="bibr" rid="ref29">Fafurida et al., 2024</xref>). When applied to elderly welfare, it creates an environment where older adults can engage in decision-making processes and participate actively in social activities, thereby positioning communities not just as service providers but as partners in promoting mutual support and resilience among older people, their families, and local institutions (
                    <xref ref-type="bibr" rid="ref12">Bust et al., 2022</xref>). This comprehensive approach can improve the quality of life among older adults and foster a stronger sense of belonging and satisfaction within the community (
                    <xref ref-type="bibr" rid="ref47">Kolesnyk et al., 2021</xref>). Integrating community empowerment into elderly welfare strategies can significantly enhance older adults&#x2019; agency, participation, and overall well-being, ensuring their voices are heard and valued in shaping their lives and communities.</p>
            </sec>
            <sec id="sec5">
                <title>2.3 Empowerment models for the elderly</title>
                <p>Empowerment models for older people can be categorised into family-based, community-based, and integrated approaches, each addressing different facets of elderly welfare. Family-based models prioritise caregiving and emotional support within the household context. They enhance the quality of life for elderly individuals by ensuring that their needs are met through familial ties. However, these models often place a considerable burden on family caregivers, potentially leading to caregiver burnout (
                    <xref ref-type="bibr" rid="ref39">Hidayat &amp; Elmaghfuroh, 2024</xref>). The effectiveness of family care in enhancing elder health outcomes has been documented (
                    <xref ref-type="bibr" rid="ref71">Panjaitan et al., 2024</xref>). Yet, reliance on this model may overlook the need for external support systems to alleviate the pressures families experience.</p>
                <p>Community-based models leverage local organisations, volunteers, and social groups to promote health, social engagement, and livelihood support among older people. Programs focused on physical activity, such as community yoga or exercise initiatives, have demonstrated positive effects on both physical and mental health outcomes for older adults (
                    <xref ref-type="bibr" rid="ref45">Katayama et al., 2020</xref>; 
                    <xref ref-type="bibr" rid="ref69">Pacheco et al., 2020</xref>). Furthermore, these models improve social integration by fostering connections within the community, enhancing older adults&#x2019; overall quality of life (
                    <xref ref-type="bibr" rid="ref40">Hsu et al., 2024</xref>).</p>
                <p>Integrated models combine family support with community initiatives, creating a cohesive framework that links health services, social participation, and economic activities. Research indicates that integrated models are particularly effective in promoting independence and social engagement among older people (
                    <xref ref-type="bibr" rid="ref59">Mendoza-N&#x00fa;&#x00f1;ez et al., 2022</xref>). Community programs that facilitate access to healthcare and social resources tend to yield better health outcomes than single-sector interventions alone (
                    <xref ref-type="bibr" rid="ref55">MacPherson et al., 2022</xref>). While family-based, community-based, and integrated empowerment models each offer valuable strategies for enhancing elderly welfare, empirical evidence suggests that integrated approaches provide the most comprehensive support for improving independence and quality of life among older adults. Despite the growing body of research on active ageing and community empowerment, existing studies tend to examine these domains in isolation or focus on specific program components rather than integrated frameworks. In particular, there remains a limited understanding of how empowerment processes translate into measurable improvements across multiple dimensions of elderly welfare. This study addresses this gap by proposing and empirically examining an integrated empowerment model that links participation, capacity building, social support, and economic engagement with multidimensional welfare outcomes. By situating empowerment as both a process and an outcome-oriented mechanism within community contexts, the study extends existing theoretical frameworks in community gerontology and active ageing.</p>
            </sec>
            <sec id="sec6">
                <title>2.4 Relevant previous studies</title>
                <p>Empirical studies underscore the importance of elderly empowerment programs in enhancing self-efficacy, reducing social isolation, and fostering psychosocial well-being among older adults. Research has shown that community-based elderly empowerment initiatives can increase participation in social and economic activities, which are positively correlated with better mental health and life satisfaction (
                    <xref ref-type="bibr" rid="ref75">Raharjo et al., 2024</xref>). These findings align with the premise that community involvement not only aids individual adjustment but also contributes to communal well-being.</p>
                <p>The roles of community cadres and local leadership are critical to sustaining empowerment efforts. Studies suggest that such grassroots engagement is instrumental in driving ongoing participation and support within these programs (
                    <xref ref-type="bibr" rid="ref1">Achjar et al., 2022</xref>). For example, comprehensive care initiatives that involve family and community collaboration have demonstrated significant improvements in health outcomes for older adults (
                    <xref ref-type="bibr" rid="ref7">Ayuningsasi et al., 2022</xref>). However, many existing studies examine isolated program components without establishing a structured framework that effectively connects empowerment processes with measurable welfare outcomes. This gap necessitates a more integrated approach to understanding how empowerment initiatives can comprehensively address the diverse needs of the elderly population (
                    <xref ref-type="bibr" rid="ref74">Putra et al., 2021</xref>). While existing literature highlights various aspects of elderly empowerment, the need for comprehensive frameworks that tie empowerment processes to successful welfare outcomes remains crucial for future research and practice.</p>
            </sec>
            <sec id="sec7">
                <title>2.5 Conceptual framework</title>
                <p>Based on the conceptual framework established in this study, elderly welfare is positioned as an outcome of an integrated empowerment process that engages both older people and the community. Various empowerment components play a key role, including participation, capacity building, social support, and economic engagement. Empirical evidence suggests that community involvement mediates and strengthens the relationship between these empowerment activities and welfare outcomes, leading to improvements across physical, psychological, social, and economic dimensions of elderly life (
                    <xref ref-type="bibr" rid="ref6">Attila et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref19">Dauphinais et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref102">P. Y. A. Wong et al., 2025</xref>).</p>
                <p>Community-based interventions have demonstrated that involving older adults in social and economic activities significantly enhances mental health and life satisfaction (
                    <xref ref-type="bibr" rid="ref19">Dauphinais et al., 2021</xref>; 
                    <xref ref-type="bibr" rid="ref102">P. Y. A. Wong et al., 2025</xref>). The theme of collaborative approaches emphasises the need for local engagement, with community leaders and peer support systems shown to be vital in sustaining empowerment initiatives (
                    <xref ref-type="bibr" rid="ref4">Ardhanari et al., 2021</xref>). Such local involvement allows elderly individuals to feel valued and active within their communities, which is critical for advancing their welfare and autonomy.</p>
                <p>However, the existing literature indicates that many studies have focused on isolated program components rather than a comprehensive framework linking empowerment processes to measurable welfare outcomes. This gap underscores the necessity for a systematic approach to integrating disparate empowerment activities into cohesive programs that yield significant welfare benefits for older people (
                    <xref ref-type="bibr" rid="ref26">Elsayed et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref62">Mutai et al., 2020</xref>). Therefore, this study&#x2019;s framework not only informs the development of research instruments but also guides data analysis and the interpretation of findings. The interplay of empowerment components within community contexts is essential for enhancing the welfare of elderly populations. The findings foster a deeper understanding of how integrated empowerment can effectively improve their quality of life. The conceptual diagram is shown in 
                    <xref ref-type="fig" rid="f1">
Figure 1</xref>.</p>
                <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                    <label>
Figure 1. </label>
                    <caption>
                        <title>Conceptual framework of elderly and community empowerment.</title>
                    </caption>
                    <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/201014/fabb3e33-d9d2-42eb-9950-1cf1c00aef19_figure1.gif"/>
                </fig>
                <p>
                    <xref ref-type="fig" rid="f1">
Figure 1</xref> illustrates the conceptual framework of this study, which positions elderly welfare as the outcome of an integrated empowerment process. The framework shows that empowerment components, including participation, capacity building, social support, and economic engagement, serve as the primary antecedents influencing improvements in elderly welfare across physical, psychological, social, and economic dimensions. Community involvement serves as a mediating factor, strengthening and channelling the effects of empowerment activities toward welfare outcomes. Through active engagement with families, community cadres, and local institutions, empowerment initiatives become more inclusive, sustainable, and responsive to the needs of older people. This framework underpins the development of research instruments, guides the analytical strategy, and informs the interpretation of findings in the present study.</p>
            </sec>
        </sec>
        <sec id="sec8">
            <title>3. Research methodology</title>
            <sec id="sec9">
                <title>3.1 Research design</title>
                <p>This study adopts a sequential explanatory mixed-method design to evaluate an empowerment model aimed at enhancing elderly welfare within a community context. The initial quantitative phase will gather data on the model&#x2019;s efficacy. At the same time, qualitative inquiry will follow to enrich understanding of the statistical outcomes, aligning with principles of Scientific Culture (SC) such as empirical rigour and contextual interpretation.</p>
                <p>Mixed-methods research is particularly powerful for capturing complex phenomena, as it enables a comprehensive analysis that combines the strengths of qualitative and quantitative data (
                    <xref ref-type="bibr" rid="ref38">Hicks et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref57">McCartney &amp; Fu, 2023</xref>; 
                    <xref ref-type="bibr" rid="ref86">Shaw et al., 2022</xref>). This research design has been shown to enhance methodological rigour by yielding richer, contextual insights that can elucidate and explain quantitative findings (
                    <xref ref-type="bibr" rid="ref25">Eliacin et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref65">Nanyonga et al., 2021</xref>). Previous studies suggest that a sequential explanatory approach can yield more profound insights into participants&#x2019; lived experiences, leading to better community health outcomes (
                    <xref ref-type="bibr" rid="ref15">S. Chen et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref23">Draper-Rodi et al., 2021</xref>). Employing this mixed-methods design not only allows for the assessment of changes in welfare outcomes but also provides a deeper understanding of how the empowerment process operates within community contexts.</p>
            </sec>
            <sec id="sec10">
                <title>3.2 Research setting and participants</title>
                <p>The research was conducted in selected community settings in Medan, North Sumatra, that have successfully implemented community-based elderly empowerment programs. The participants comprised diverse stakeholders, including elderly individuals aged 60 years and above who actively engaged in empowerment activities, their family members providing daily support, community cadres and local facilitators, and community stakeholders such as regional leaders and health workers. This diverse selection aligns with best practices in community-based research, facilitating a more comprehensive understanding of the impacts of empowerment (
                    <xref ref-type="bibr" rid="ref21">Djuari et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref87">Shi et al., 2024</xref>).</p>
                <p>For the quantitative phase, purposive sampling was used to select 210 elderly participants who met strict criteria for program participation. This approach is known for its efficacy in identifying relevant subjects in community-based studies, thereby enhancing the relevance of the findings (
                    <xref ref-type="bibr" rid="ref70">Pangastuti et al., 2023</xref>; 
                    <xref ref-type="bibr" rid="ref72">Park et al., 2022</xref>). The qualitative phase involved 24 informants selected through maximum variation sampling, a technique that aims to capture a wide range of perspectives, allowing for a more robust qualitative analysis of empowerment experiences (
                    <xref ref-type="bibr" rid="ref20">Demircan et al., 2023</xref>). Ethical principles were strictly observed throughout the study. Informed consent was obtained from all participants, confidentiality and anonymity were ensured, and participation was entirely voluntary. Special attention was given to the protection and dignity of elderly participants in accordance with ethical standards for social research. This mixed-methods approach enriches the findings with diverse participant insights, critical for understanding the complexities of elderly empowerment in community settings. Written informed consent was obtained from all participants prior to their involvement in the study.</p>
            </sec>
            <sec id="sec11">
                <title>3.3 Data collection techniques</title>
                <p>Quantitative data in this study were collected using a structured questionnaire administered directly to elderly participants aged 60 years and above. The questionnaire was designed to measure key constructs related to elderly welfare and empowerment in a systematic and quantifiable manner. All items were assessed using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), widely used in social science research to capture attitudes, perceptions, and levels of satisfaction (
                    <xref ref-type="bibr" rid="ref82">Samsu et al., 2021</xref>).</p>
                <p>The use of a structured questionnaire enables standardised data collection across respondents, facilitating statistical analysis and comparison of welfare outcomes before and after program implementation. The measured variables were derived from the conceptual framework and relevant literature, ensuring content validity and alignment with the study objectives, as in 
                    <xref ref-type="table" rid="T1">
Table 1</xref>. Quantitative findings were later complemented and contextualised by qualitative data obtained through interviews (
                    <xref ref-type="bibr" rid="ref96">P. Wang et al., 2023</xref>), ASs 
                    <italic toggle="yes">(FGDs)</italic> (
                    <xref ref-type="bibr" rid="ref105">Yirgu et al., 2020</xref>), observations (
                    <xref ref-type="bibr" rid="ref46">Khasanah et al., 2024</xref>), and document analysis to strengthen triangulation and interpretation of results (
                    <xref ref-type="bibr" rid="ref16">T. Chen et al., 2024</xref>).</p>
                <table-wrap id="T1" orientation="portrait" position="float">
                    <label>
Table 1. </label>
                    <caption>
                        <title>Variables and indicators of quantitative measurement.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Variable</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Dimension</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Indicators</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Scale</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="4" valign="top">Elderly welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Physical welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Functional ability, access to health services, and physical activity</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Psychological welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Life satisfaction, emotional well-being, and self-confidence
</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Social welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Social participation, peer interaction, community involvement</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Economic welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Income adequacy, productive activities, and financial independence</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="4" valign="top">Elderly empowerment</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participation</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Involvement in activities and decision-making
</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Capacity building</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Skills development, knowledge improvement</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Social support</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Family support, community support</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Self-efficacy
</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Confidence in managing daily life and challenges</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Community involvement</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Facilitation role</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Support from cadres and local institutions</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Likert 1&#x2013;5</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
            </sec>
            <sec id="sec12">
                <title>3.4 Ethical and security considerations</title>
                <p>This study adhered to ethical principles for social research involving human participants, with particular attention to the protection of older adults as a potentially vulnerable population. Ethical approval for this study was obtained from the Ethics Committee of Universitas Pendidikan Indonesia (Approval No. 176/UN40.F1/KEP/EC/2024) prior to data collection.</p>
                <p>All participants received clear information regarding the study objectives, procedures, and their rights, and provided written informed consent voluntarily before participation. Confidentiality and anonymity were strictly maintained by removing personal identifiers and using coded data for analysis and reporting. Participation involved minimal risk, as the study relied on non-invasive questionnaires and interviews conducted in an age-appropriate and respectful manner. All data were securely stored in password-protected files accessible only to the research team.</p>
            </sec>
            <sec id="sec13">
                <title>3.5 Data analysis techniques</title>
                <p>Qualitative data were analysed using a systematic thematic analysis approach. The coding process involved initial open coding, followed by axial coding to group categories into themes. To enhance credibility, coding was conducted by multiple researchers and discrepancies were discussed until consensus was reached. Member checking was also performed with selected participants to validate the findings. For the qualitative data, thematic analysis was employed, utilising coding, categorisation, and theme development to identify patterns related to both empowerment processes and welfare outcomes.</p>
            </sec>
        </sec>
        <sec id="sec14" sec-type="results">
            <title>4. Results</title>
            <sec id="sec15">
                <title>4.1 Profile of elderly and community participants</title>
                <p>Understanding the demographic and socio-economic characteristics of research participants is essential for contextualising the findings and interpreting the effectiveness of the empowerment model. Participant profiles provide insight into the living conditions, vulnerabilities, and potential resources of older adults, as well as the social environment in which empowerment initiatives are implemented. This section presents the quantitative profile of elderly respondents and the composition of qualitative informants involved in the study, as in 
                    <xref ref-type="table" rid="T2">
Table 2</xref>.</p>
                <table-wrap id="T2" orientation="portrait" position="float">
                    <label>
Table 2. </label>
                    <caption>
                        <title>Profile of elderly participants.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Characteristic</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Category</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Frequency (n)</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Percentage (%)</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="3" valign="top">Age group</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">60&#x2013;69 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">98</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">46.7</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">70&#x2013;79 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">80</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">38.1</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">&#x2265;80 years</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">32</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">15.2</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="top">Gender</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">87</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">41.4</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Female</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">123</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">58.6</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="top">Living arrangement</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Living with family</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">152</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">72.4</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Living alone/with peers</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">58</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">27.6</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="top">Education level</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Primary education or less</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">130</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">61.9</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Secondary education or higher</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">80</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">38.1</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="top">Income condition</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Limited/irregular income</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">143</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">68.1</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Regular income</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">67</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">31.9</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>
                    <xref ref-type="table" rid="T2">
Table 2</xref> shows that the majority of elderly participants were in the early elderly age group (60&#x2013;69 years), indicating a relatively active population segment suitable for empowerment-based interventions. The predominance of female participants reflects broader demographic trends of higher female life expectancy. Most respondents lived with family members, suggesting that family remains a primary support system for elderly welfare, which is a critical factor in community-based empowerment models.</p>
                <p>The relatively low educational attainment and high proportion of participants with limited or irregular income highlight the socio-economic vulnerability of the elderly population studied. These conditions underscore the relevance of empowerment programs that emphasise capacity building, social participation, and economic engagement tailored to the capabilities of older adults. In the qualitative phase, the inclusion of elderly participants, family members, and community cadres enabled triangulation of perspectives across individual, household, and community levels. This composition strengthened the analysis by capturing diverse experiences related to empowerment processes and their perceived impact on elderly welfare.</p>
            </sec>
            <sec id="sec16">
                <title>4.2 Description of the empowerment model</title>
                <p>This study implemented an integrated empowerment model designed to enhance elderly welfare through active participation and community collaboration. The model is grounded in empowerment theory and emphasises the role of older adults as active agents, supported by families and community structures. Rather than focusing on a single intervention, the model integrates multiple empowerment components to address the diverse and interconnected dimensions of elderly welfare. The implementation involved coordinated roles among elderly participants, community cadres, families, and local service institutions to ensure program effectiveness and sustainability. The components and descriptions of the Elderly Empowerment Model are shown in 
                    <xref ref-type="table" rid="T3">
Table 3</xref>.</p>
                <table-wrap id="T3" orientation="portrait" position="float">
                    <label>
Table 3. </label>
                    <caption>
                        <title>Components and description of the elderly empowerment model.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Empowerment component</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Main activities</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Key actors involved</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Expected outcomes</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Health empowerment</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Routine health checks, physical exercise sessions, and health education</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Elderly, health workers, community cadres</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Improved physical health, increased health awareness</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Social empowerment</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Group meetings, peer-support groups, and intergenerational activities</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Elderly, families, community members</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Enhanced social participation, reduced social isolation</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Economic empowerment</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Small-scale productive activities aligned with older adults&#x2019; capacities</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Elderly, community cadres, local facilitators</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Increased economic engagement, improved financial independence</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Psychosocial empowerment</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Self-efficacy training, emotional support, life-skills development</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Elderly, counsellors, community cadres</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Improved psychological well-being, stronger self-confidence
</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>
                    <xref ref-type="table" rid="T3">
Table 3</xref> illustrates that the empowerment model is structured around four interrelated components that collectively address the physical, social, economic, and psychological dimensions of elderly welfare. Health empowerment serves as a foundational element, ensuring that elderly participants maintain functional ability and health awareness necessary for active engagement. Social empowerment activities strengthen interpersonal relationships and foster a sense of belonging, both of which are critical to preventing social isolation among older adults.</p>
                <p>Economic empowerment activities are designed to be appropriate to the elderly capacities, emphasising participation and productivity rather than income maximisation. This component contributes not only to economic welfare but also to self-worth and independence. Psychosocial empowerment reinforces the model by enhancing self-efficacy and emotional resilience, enabling elderly participants to adapt more positively to ageing-related challenges. The active involvement of older adults in planning and implementation, supported by community cadres and families, reflects a participatory approach that strengthens ownership and sustainability. The integration of these components demonstrates that elderly welfare improvement is most effective when empowerment is addressed holistically through coordinated community action.</p>
            </sec>
            <sec id="sec17">
                <title>4.3 Implementation process</title>
                <p>This section describes the implementation process of the elderly empowerment model based on qualitative observations conducted throughout the program. Observational data are essential for understanding how the model operated in practice, how participants engaged with program activities, and how contextual factors influenced implementation. The implementation process was analysed thematically through systematic coding and categorisation of observation notes, allowing patterns of participation, facilitation, and contextual variation to be identified. These findings provide practical insight into the mechanisms that supported or constrained the effectiveness of the empowerment model.</p>
                <p>Observational findings indicate that empowerment activities were implemented regularly and consistently, with an average elderly attendance rate of 81% across program sessions. This high level of participation suggests strong acceptance of the program among elderly participants and indicates that the activities were perceived as relevant and manageable. Coding of observational data revealed frequent instances of active engagement, peer interaction, and routine participation, which were subsequently categorised under the broader theme of sustained participation.</p>
                <p>Community cadres emerged as a central enabling factor in the implementation process. Thematic coding highlighted their roles in participant mobilisation, activity coordination, and continuity maintenance. Categories such as facilitative leadership and organisational support demonstrate that cadres acted as key intermediaries between elderly participants, families, and local service providers. Their consistent presence contributed to program stability and reinforced older adults&#x2019; motivation to participate.</p>
                <p>Variation in implementation was also observed across community groups. Differences were most evident in the intensity of economic empowerment activities and the level of family involvement. Through thematic categorisation, communities with stronger family engagement were grouped under the theme of supportive social environment, which was associated with more consistent attendance, stronger peer support, and higher levels of collective participation among older adults. In contrast, groups with limited family involvement showed less intensive engagement, particularly in economic activities.</p>
                <p>Overall, the thematic analysis of the implementation process highlights that while program structure and facilitation are essential, family support and community dynamics are decisive in shaping the quality and consistency of empowerment implementation. These findings help explain variations in welfare outcomes and reinforce the importance of integrating family and community support within elderly empowerment initiatives.</p>
            </sec>
            <sec id="sec18">
                <title>4.4 Impact on elderly welfare</title>
                <p>This section presents the quantitative and qualitative evidence on the impact of the empowerment model on elderly welfare. Quantitative analysis was conducted to assess changes in welfare scores before and after program implementation and to identify key predictors of welfare improvement, as shown in 
                    <xref ref-type="table" rid="T4">
Table 4</xref>. Qualitative findings complement and contextualise the statistical results, providing deeper insight into how empowerment processes shape the lived experiences of elderly participants.</p>
                <table-wrap id="T4" orientation="portrait" position="float">
                    <label>
Table 4. </label>
                    <caption>
                        <title>Changes in elderly welfare scores before and after program implementation.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Welfare dimension</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Pre-program Mean (SD)</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Post-program Mean (SD)</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">t</italic>-value</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">p</italic>-value</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Physical welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.18 (0.56)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.72 (0.51)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">7.84</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">&lt;0.001</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Psychological welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.05 (0.58)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.91 (0.47)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">9.02</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">&lt;0.001</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Social welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.10 (0.55)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">4.02 (0.46)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">9.88</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">&lt;0.001</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Economic welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.14 (0.52)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.80 (0.50)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">8.41</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">&lt;0.001</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Overall welfare</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.12 (0.54)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">3.89 (0.49)</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">9.46</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">&lt;0.001</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>
                    <xref ref-type="table" rid="T4">
Table 4</xref> demonstrates a statistically significant improvement in elderly welfare following the implementation of the empowerment model. The overall mean welfare score increased markedly indicating an increase in elderly well-being following program participation suggesting that the integrated empowerment approach is associated with improvements across multiple welfare dimensions.</p>
                <p>The most significant gains were observed in social and psychological well-being, suggesting that increased participation, peer interaction, and enhanced self-efficacy played a critical role in improving elderly quality of life. These findings are further supported by the multiple regression results, which identify community participation (&#x03b2; = 0.41, 
                    <italic toggle="yes">p</italic> &lt; 0.001) and elderly self-efficacy (&#x03b2; = 0.36, 
                    <italic toggle="yes">p</italic> &lt; 0.01) were significantly associated with welfare scores jointly explaining 52% of the variance in welfare outcomes (R
                    <sup>2</sup> = 0.52). These results can be illustrated with a graph like the one in 
                    <xref ref-type="fig" rid="f2">
Figure 2</xref>.</p>
                <fig fig-type="figure" id="f2" orientation="portrait" position="float">
                    <label>
Figure 2. </label>
                    <caption>
                        <title>Comparison of elderly welfare scores before and after program implementation.</title>
                    </caption>
                    <graphic id="gr2" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/201014/fabb3e33-d9d2-42eb-9950-1cf1c00aef19_figure2.gif"/>
                </fig>
                <p>
                    <xref ref-type="fig" rid="f2">
Figure 2</xref> presents a visual comparison of the mean elderly welfare scores across five dimensions&#x2014;physical, psychological, social, economic, and overall welfare&#x2014;before and after the implementation of the empowerment program, as reported in 
                    <xref ref-type="table" rid="T4">
Table 4</xref>. The figure clearly illustrates an increase in mean scores for all dimensions following program participation.</p>
                <p>The most notable improvements are observed in social welfare and psychological welfare, indicating that empowerment activities emphasising participation, peer interaction, and self-efficacy had a substantial impact on elderly well-being. Improvements in physical and economic welfare are also evident, though slightly less pronounced, reflecting the model&#x2019;s supportive role for health-related and productive activities. Overall, the figure visually reinforces the statistical findings, demonstrating the positive and consistent effect of the integrated empowerment model on elderly welfare outcomes.</p>
            </sec>
            <sec id="sec19">
                <title>4.5 Qualitative findings</title>
                <p>To complement and deepen the quantitative results, this study employed qualitative inquiry to explore how participants and community actors experienced and perceived the empowerment processes. Qualitative findings are significant in capturing changes that are not fully reflected in numerical scores, such as shifts in self-perception, social relationships, and community attitudes. Data were analysed thematically through systematic coding, categorisation, and theme development, enabling the identification of recurring patterns related to empowerment mechanisms and welfare outcomes. The qualitative results were then integrated with quantitative findings to ensure analytical convergence and interpretive rigour, in line with Scientific Culture principles.</p>
                <p>

                    <bold>4.5.1 Theme 1: Increased Independence and Self-Reliance
</bold>
                </p>
                <p>Elderly participants consistently described greater independence in managing daily activities and making personal decisions. This theme aligns with the quantitative improvement in psychological and overall welfare scores.</p>
                <disp-quote>
                    <p>

                        <italic toggle="yes">&#x201c;Before joining the activities, I depended on my children for almost everything. Now, I can manage my daily routine and even help with small tasks at home.&#x201d;</italic> (Elderly Participant, 67 years)</p>
                    <p>

                        <italic toggle="yes">&#x201c;I feel more confident going out, attending meetings, and taking care of myself. I no longer feel like a burden.&#x201d;</italic> (Elderly Participant, 72 years)</p>
                </disp-quote>
                <p>

                    <bold>4.5.2 Theme 2: Strengthened Social Relationships and Participation</bold>
                </p>
                <p>Participants reported stronger peer relationships and a renewed sense of belonging within the community. Group activities and peer support emerged as critical mechanisms of empowerment.</p>
                <disp-quote>
                    <p>&#x201c;
                        <italic toggle="yes">Meeting friends my age every week makes me happy. We share stories, exercise together, and support each other.&#x201d;</italic> (Elderly Participant, 70 years)</p>
                    <p>

                        <italic toggle="yes">&#x201c;The elderly are more active now. They talk more, laugh more, and are eager to attend community activities.&#x201d;</italic> (Family Member)</p>
                </disp-quote>
                <p>This theme supports the quantitative finding that social welfare showed the most significant post-program improvement.</p>
                <p>

                    <bold>4.5.3 Theme 3: Enhanced Confidence and Psychological Well-Being
</bold>
                </p>
                <p>Many elderly participants expressed increased self-confidence and emotional stability, reflecting gains in self-efficacy identified in the regression analysis.</p>
                <disp-quote>
                    <p>

                        <italic toggle="yes">&#x201c;I feel useful again. Even small activities make me feel proud and confident.&#x201d;</italic> (Elderly Participant, 65 years)</p>
                    <p>

                        <italic toggle="yes">&#x201c;They are more confident expressing opinions during meetings. This is very different from before.&#x201d;</italic> (Community Cadre)</p>
                </disp-quote>
                <p>

                    <bold>4.5.4 Theme 4: Shift in Community Attitudes Toward the Elderly</bold>
                </p>
                <p>Community cadres and stakeholders highlighted a significant change in how older adults are perceived&#x2014;from passive beneficiaries to active contributors.</p>
                <disp-quote>
                    <p>

                        <italic toggle="yes">&#x201c;Now the community sees the elderly as partners. They help organise events and give advice based on their experience.&#x201d;</italic> (Community Cadre)</p>
                    <p>

                        <italic toggle="yes">&#x201c;People no longer think the elderly are only recipients of aid. They are involved and respected.&#x201d;</italic> (Local Stakeholder)</p>
                </disp-quote>
                <p>The qualitative findings provide supporting evidence for the quantitative results, particularly regarding the roles of community participation and elderly self-efficacy in relation to welfare outcomes. While statistical analysis indicates measurable changes, qualitative evidence offers insight into how participants experienced these changes. Taken together, the integrated findings suggest that empowerment processes may be associated with increased independence, social engagement, confidence, and positive community recognition&#x2014;factors that potentially contribute to improved elderly welfare.</p>
            </sec>
        </sec>
        <sec id="sec20" sec-type="discussion">
            <title>5. Discussion</title>
            <p>The proposed empowerment model is associated with improvements elderly welfare across physical, psychological, social, and economic dimensions. Research indicates that empowerment-oriented interventions significantly enhance overall welfare among older adults, suggesting that these changes extend beyond mere service provision. For instance, Hamedani et al. discuss the effectiveness of family-centred empowerment models in improving the quality of life for elderly patients with chronic conditions, emphasising the role of self-efficacy and community engagement (
                <xref ref-type="bibr" rid="ref36">Hamedani et al., 2021</xref>). This finding is reinforced by Emmawati et al., who highlight that therapeutic interventions such as life review therapy improve elderly well-being and foster a sense of purpose and community connection (
                <xref ref-type="bibr" rid="ref27">Emmawati et al., 2022</xref>).</p>
            <p>Additionally, the results of community empowerment are supported by Wong et al., who find that older adults engaged in community activities exhibit better self-care behaviours, which are positively correlated with their quality of life (
                <xref ref-type="bibr" rid="ref100">A. K. C. Wong et al., 2021</xref>). This aligns with the theory of empowerment, indicating that increased control and participation can lead to improved self-esteem and well-being among elderly individuals (
                <xref ref-type="bibr" rid="ref95">J. Wang &amp; Hoe, 2022</xref>). Programs that promote elder participation reflect their interests and capacities, leading to sustained engagement and fulfilment of welfare needs (
                <xref ref-type="bibr" rid="ref30">Fitriana, 2022</xref>).</p>
            <p>The model&#x2019;s integration of health, social, economic, and psychosocial components facilitates synergistic effects, enhancing welfare gains across these domains. This multi-faceted approach is supported by Michalski and St&#x0119;pie&#x0144;, who argue that substantial interventions are necessary to address the challenges ageing populations face in welfare systems, emphasising the importance of holistic strategies (
                <xref ref-type="bibr" rid="ref60">Michalski &amp; St&#x0119;pie&#x0144;, 2021</xref>). Furthermore, the emphasis on community participation aligns with the findings of Xiang-Jing et al., who note that improved access to community health services significantly benefits older adults, particularly those with mobility challenges (
                <xref ref-type="bibr" rid="ref104">Xiang-jing et al., 2022</xref>). Comprehensive strategies that address these needs can enhance elderly well-being more effectively than traditional models focused solely on financial support (
                <xref ref-type="bibr" rid="ref60">Michalski &amp; St&#x0119;pie&#x0144;, 2021</xref>).</p>
            <p>High attendance rates and consistent engagement in the empowerment program affirm that initiatives aligned with elderly interests foster acceptance and improve community welfare. Jung et al. emphasise the importance of considering the emotional and psychological impacts of community participation, advocating for structured activities that resonate with older adults to reduce feelings of loneliness and improve social integration (
                <xref ref-type="bibr" rid="ref44">Jung et al., 2023</xref>). This is crucial, as social isolation is linked to adverse health outcomes, indicating that fostering social connections through empowerment initiatives can lead to better health status and lower rates of depression among older adults (
                <xref ref-type="bibr" rid="ref43">Joanisse et al., 2025</xref>; 
                <xref ref-type="bibr" rid="ref50">Lee, 2021</xref>). The empowerment model successfully integrates various dimensions of welfare enhancement for older adults, showing that strong community engagement and individual self-efficacy may play an important role in improvements. The findings suggest the potential importance of adopt comprehensive, empowerment-oriented strategies in geriatric care to ensure that welfare interventions yield meaningful and lasting outcomes.</p>
            <sec id="sec21">
                <title>5.1 Comparison with previous studies</title>
                <p>The results of the study provide compelling evidence of the positive effects of community-based empowerment on elderly well-being, particularly in enhancing social participation and psychological resilience. This aligns with the findings of Mclane et al., who argue that participation in community activities fosters health and well-being across various populations, including older adults. They note positive correlations between community engagement and improved mental health outcomes (
                    <xref ref-type="bibr" rid="ref58">McLane et al., 2020</xref>). Furthermore, the relevance of community participation is echoed in research conducted by Nalla et al., which discusses the psychosocial benefits of adaptive fitness participation, reinforcing the notion that engagement in community activities enhances self-efficacy and overall quality of life (
                    <xref ref-type="bibr" rid="ref64">Nalla et al., 2021</xref>).</p>
                <p>The integration of empowerment models, as demonstrated in this study, is more effective than fragmented or sector-specific interventions. For instance, Gomes et al. elucidate the relationships among self-efficacy, physical activity, and quality of life among elderly individuals, showing that holistic approaches that incorporate multiple dimensions of empowerment lead to substantial improvements in well-being (
                    <xref ref-type="bibr" rid="ref33">Gomes et al., 2023</xref>). Such findings support the argument that integrated intervention strategies are necessary for effective elder care, facilitating improvements across multiple domains simultaneously.</p>
                <p>Moreover, this research extends existing literature by empirically demonstrating the contributions of community participation and self-efficacy to welfare outcomes through regression analysis. According to Lim et al., empowerment significantly correlates with increased community engagement; as individuals cultivate self-efficacy, they are more likely to participate actively in their communities. This pattern aligns with studies emphasising that active engagement can lead to psychological well-being and reduced feelings of loneliness among older adults (
                    <xref ref-type="bibr" rid="ref52">Lim et al., 2025</xref>). The emphasis on self-efficacy as a determinant of quality of life is corroborated by findings from Azzahra et al., who indicate that enhanced self-efficacy is associated with improved emotional and physical health outcomes (
                    <xref ref-type="bibr" rid="ref9">Azzahra et al., 2025</xref>).</p>
                <p>Furthermore, the study highlights the mechanisms through which empowerment influences elderly welfare. The findings extend the assertions of Azzahra et al. that positive self-efficacy correlates with improved quality of life, indicating that those with higher self-efficacy scores experience lower levels of depression and better overall well-being, further solidifying the impact of empowerment strategies on elsupooriderly individuals (
                    <xref ref-type="bibr" rid="ref9">Azzahra et al., 2025</xref>). Collectively, these studies suggest that community participation, reinforced by enhanced self-efficacy, forms a robust framework for improving elderly welfare. The combination of community engagement and self-efficacy is a powerful paradigm for enhancing the well-being of elderly populations. The research reinforces the need for integrated empowerment models that prioritise community participation, self-efficacy, and holistic welfare interventions to achieve meaningful outcomes in elderly care.</p>
            </sec>
            <sec id="sec22">
                <title>5.2 Implications for community development</title>
                <p>From a community development perspective, the findings underscore the significance of positioning older adults as active social agents rather than mere beneficiaries of assistance. Empowerment models that mobilise local cadres, families, and community organisations are crucial for strengthening social capital and fostering a sense of collective responsibility. According to Attila et al., developing community capacity through collaboration among members and organisations is essential for sustainable, effective community-based interventions (
                    <xref ref-type="bibr" rid="ref6">Attila et al., 2024</xref>). These collaborative approaches not only recognise the expertise within the community but also promote transparent communication and participation, creating a foundation for long-term sustainability (
                    <xref ref-type="bibr" rid="ref6">Attila et al., 2024</xref>).</p>
                <p>Community-based empowerment strategies enhance program effectiveness and embed welfare initiatives within existing community structures, ensuring their relevance and sustainability. Arizkha et al. emphasise that well-formed social networks and trust within a community facilitate participation and assistance in collective endeavours, thereby improving the quality of life and welfare of community members (
                    <xref ref-type="bibr" rid="ref5">Arizkha et al., 2023</xref>). This aligns with Mendoza-N&#x00fa;&#x00f1;ez et al., who advocate for empowerment models in community gerontology that recognise the potential of elderly individuals as valuable contributors to their communities (
                    <xref ref-type="bibr" rid="ref59">Mendoza-N&#x00fa;&#x00f1;ez et al., 2022</xref>). By promoting intergenerational solidarity and community ownership, these models support a more inclusive approach to elderly welfare.</p>
                <p>Policymakers and practitioners should thus prioritise participatory program designs and capacity-building strategies. Huang et al. stress the importance of engaging older adults in community activities, noting that such participation can lead to greater life satisfaction and social capital (
                    <xref ref-type="bibr" rid="ref41">Huang et al., 2025</xref>). This actively involves older adults in decision-making, fostering their sense of agency, which, in turn, can counter feelings of isolation and enhance their overall well-being. Additionally, community engagement has been shown to improve mental health outcomes by providing emotional support and reducing feelings of social exclusion (
                    <xref ref-type="bibr" rid="ref41">Huang et al., 2025</xref>).</p>
                <p>Furthermore, developing policies that facilitate collaborative community programs aligns with Roth et al.&#x2019;s findings on leveraging community structures to solve collective problems and enhance community well-being through shared resources and capacities (
                    <xref ref-type="bibr" rid="ref79">Roth et al., 2023</xref>). The results support the notion that investing in community-based structures and empowerment initiatives can significantly improve the sustainability of welfare programs. The evidence gathered points toward the importance of community empowerment in enhancing the well-being of elderly individuals. By fostering participatory approaches that engage local resources and promote collective responsibility, communities can create supportive environments that position older adults as pivotal contributors to societal welfare. This shift not only improves outcomes for older adults but also strengthens the community&#x2019;s social fabric.</p>
            </sec>
            <sec id="sec23">
                <title>5.3 Limitations of the study</title>
                <p>This study has several limitations that should be acknowledged, the use of a single-group pre&#x2013;post design without a control group limits the ability to draw causal inferences. The observed changes in welfare scores may be influenced by alternative explanations, including natural variation, regression to the mean, Hawthorne effects, and broader social trends.</p>
                <p>Second, all variables were measured using self-report instruments at a single point in time, which introduces the possibility of common method bias.</p>
                <p>Third, the study does not report reliability statistics (e.g., Cronbach&#x2019;s alpha), which limits the assessment of internal consistency of the measurement instruments.</p>
                <p>Finally, limited documentation of the questionnaire and qualitative coding framework may reduce the reproducibility of the study. Future research should address these limitations by employing more rigorous designs, including control groups and longitudinal approaches.</p>
            </sec>
        </sec>
        <sec id="sec24" sec-type="conclusion">
            <title>6. Conclusion</title>
            <p>This study provides evidence of positive changes in elderly welfare following participation in a community-based empowerment program. The findings highlight the potential role of community participation and self-efficacy as key factors associated with improved well-being across multiple dimensions. However, due to the limitations of the study design, these results should be interpreted as indicative rather than causal. The study contributes to the literature by offering an integrated framework that links empowerment processes with multidimensional welfare outcomes within community settings. Further research employing longitudinal and comparative designs is required to establish the effectiveness and long-term sustainability of such empowerment models, as well as to validate the relationships identified in this study across different socio-cultural contexts.</p>
        </sec>
        <sec id="sec25">
            <title>Ethical and security considerations</title>
            <p>This study adhered to ethical principles for social research involving human participants, with particular attention to the protection of older adults as a potentially vulnerable population. Ethical approval for this study was obtained from the Ethics Committee of Universitas Pendidikan Indonesia (Approval No. 176/UN40.F1/KEP/EC/2024) prior to data collection.</p>
            <p>All participants received clear information regarding the study objectives, procedures, and their rights, and provided written informed consent voluntarily before participation. Confidentiality and anonymity were strictly maintained by removing personal identifiers and using coded data for analysis and reporting. Participation involved minimal risk, as the study relied on non-invasive questionnaires and interviews conducted in an age-appropriate and respectful manner. All data were securely stored in password-protected files accessible only to the research team.</p>
        </sec>
    </body>
    <back>
        <sec id="sec26" sec-type="data-availability">
            <title>Data availability</title>
            <p>The datasets generated and analysed during the current study are not publicly available due to ethical and privacy considerations related to the protection of elderly participants, but are available from the corresponding author upon reasonable request (
                <email xlink:href="mailto:friskaharahap@upi.edu">friskaharahap@upi.edu</email>).</p>
        </sec>
        <ack>
            <title>Acknowledgment</title>
            <p>The authors would like to thank all elderly participants, community cadres, and community stakeholders for their valuable contributions to this study.</p>
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    <sub-article article-type="reviewer-report" id="report471209">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.194694.r471209</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Pr&#x00e4;g</surname>
                        <given-names>Patrick</given-names>
                    </name>
                    <xref ref-type="aff" rid="r471209a1">1</xref>
                    <role>Referee</role>
                </contrib>
                <aff id="r471209a1">
                    <label>1</label>CREST, ENSAE, Institut Polytechnique de Paris, Palaiseau, France</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>30</day>
                <month>3</month>
                <year>2026</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2026 Pr&#x00e4;g P</copyright-statement>
                <copyright-year>2026</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport471209" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.176617.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>This manuscript presents a mixed-methods evaluation of a community-based empowerment model for older adults in Medan, North Sumatra. The study has a fundamental methodological limitation that substantially undermines the causal claims made, alongside several additional concerns detailed below.</p>
            <p> </p>
            <p> The manuscript is clearly structured and the results are presented in a broadly intelligible way. The reference list is extensive and engages with relevant literature on active ageing, community empowerment, and elderly welfare across multiple dimensions. However, the literature review remains largely descriptive rather than synthetic. There is no clear articulation of how the proposed empowerment model differs from or advances existing frameworks such as community gerontology or active ageing theory. A stronger conceptual synthesis would better justify the novelty of the contribution.</p>
            <p> </p>
            <p> There is an error in section 3.1, where the following sentence appears verbatim twice in succession: "Employing this mixed-methods design will not only inform the effectiveness of the empowerment model but also inform the effectiveness of the empowerment model." This should be corrected.</p>
            <p> </p>
            <p> The abbreviation FGD is not explained.</p>
            <p> </p>
            <p> The language used throughout to describe the program's effects&#x2014;including phrases like "confirmed," "demonstrated," and "the program had a strong positive effect"&#x2014;is more confident than the study design can support, as discussed below.</p>
            <p> </p>
            <p> The study uses a single-group pre&#x2013;post design with no comparison condition. Welfare scores are measured before and after program implementation for the same 210 participants, and the observed improvement is interpreted as evidence that the empowerment model caused welfare gains. This inference is not warranted.</p>
            <p> </p>
            <p> Without a control group, there is no way to rule out a range of alternative explanations for the observed change. These include: natural recovery or seasonal variation in well-being; regression to the mean, since participants were recruited on the basis of active program involvement and may have been at a transient low point; the Hawthorne effect, whereby awareness of being studied leads to more positive self-reporting; test-retest familiarity with the questionnaire instrument; and broader secular trends in community welfare over the study period. Any or all of these could account for the pre&#x2013;post difference entirely.</p>
            <p> </p>
            <p> The paired-samples t-test is a perfectly appropriate statistical test for detecting whether scores changed, but it cannot speak to why they changed. A randomized controlled trial, a matched comparison group, or at minimum a waitlist control would be necessary before effectiveness claims could be made. Even a non-equivalent comparison community would represent a meaningful improvement over the current design.</p>
            <p> </p>
            <p> Figure 2 does not have confidence intervals or comparable measures of uncertainty.</p>
            <p> </p>
            <p> This limitation is mentioned nowhere in the manuscript except for a brief acknowledgement that the study examined "short- to medium-term outcomes," which does not capture the problem at all. Notably, the existing peer review by Noklang also does not raise this issue.</p>
            <p> </p>
            <p> The mixed-methods integration itself is well-conceived, and the sequential explanatory design is appropriate for exploring how empowerment processes operate. The qualitative component adds genuine interpretive value. The academic merit of the work is therefore not in doubt as an exploratory, descriptive study&#x2014;but the manuscript frames and positions itself as an effectiveness evaluation, which the design cannot support.</p>
            <p> </p>
            <p> Replication would not currently be possible. The questionnaire is described as measuring welfare and empowerment constructs across several dimensions, but no information is provided on how items were developed, whether the instrument was piloted, or what its psychometric properties are. Crucially, no reliability estimates (such as Cronbach's alpha) are reported for any scale, making it impossible to assess whether the observed score changes reflect genuine construct change or measurement noise.</p>
            <p> </p>
            <p> The qualitative analytic procedure is described only in general terms. There is no detail on how the coding scheme was developed, whether coding was conducted by more than one researcher, whether any form of inter-rater reliability was established, or whether member checking or other validation strategies were employed.</p>
            <p> </p>
            <p> Providing the full questionnaire, coding frameworks, and reliability statistics&#x2014;ideally as supplementary materials&#x2014;would substantially improve transparency and replicability.</p>
            <p> </p>
            <p> The use of paired-samples t-tests to assess pre&#x2013;post change is appropriate for the data structure. Effect sizes are not reported, which would help contextualize the magnitude of improvement independently of sample size.</p>
            <p> </p>
            <p> The multiple regression analysis requires more careful interpretation. Community participation and elderly self-efficacy are described as "predictors" of welfare improvement, with R&#x00b2; = 0.52. However, both predictor variables and the outcome appear to have been measured at the same time point using the same self-report instrument. This constitutes a cross-sectional association, not a predictive relationship in any meaningful temporal or causal sense. The framing implies an ordering that the data structure cannot establish, and this interpretation should be substantially moderated. The possibility of common method bias inflating these associations&#x2014;given that all variables are drawn from a single self-report questionnaire administered in the same setting&#x2014;is also not discussed.</p>
            <p> </p>
            <p> The manuscript states that datasets are available upon reasonable request from the corresponding author, citing ethical and privacy constraints. This is an acceptable position for research involving human participants. However, reproducibility would be meaningfully improved by providing anonymized datasets, the full research instruments, and qualitative coding frameworks as supplementary materials. Without these, independent verification of the findings is not possible.</p>
            <p> </p>
            <p> The conclusions are not adequately supported, primarily because of the design issues outlined above. The conclusion that the empowerment model "is efficacious in sustainably improving elderly welfare" requires evidence of a causal effect that a single-group pre&#x2013;post design cannot provide. Similarly, the claim that "community participation and elderly self-efficacy emerging as the strongest predictors of positive welfare outcomes" overstates what cross-sectional regression can establish.</p>
            <p> </p>
            <p> The qualitative findings are genuinely informative and the themes identified&#x2014;increased independence, stronger social relationships, enhanced confidence, and shifting community attitudes&#x2014;are credibly grounded in the data presented. These findings support the conclusion that participants experienced the program positively and perceived meaningful changes in their lives. This is a worthwhile contribution, but it is a different and more modest claim than the one the manuscript makes.</p>
            <p> </p>
            <p> The recommendations to policymakers, while sensible in spirit, should be tempered accordingly. Integrated, community-based empowerment programs may well be beneficial&#x2014;but this study, as designed, does not constitute the evidence base for that conclusion.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>No</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>No</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>No</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>No</p>
            <p>Reviewer Expertise:</p>
            <p>Sociology, Gerontology</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report463166">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.194694.r463166</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Noklang</surname>
                        <given-names>Sumate</given-names>
                    </name>
                    <xref ref-type="aff" rid="r463166a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-1645-1135</uri>
                </contrib>
                <aff id="r463166a1">
                    <label>1</label>Srinakharinwirot University, Bangkok, Bangkok, Thailand</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>2</day>
                <month>3</month>
                <year>2026</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2026 Noklang S</copyright-statement>
                <copyright-year>2026</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport463166" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.176617.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>
                <bold>Clarity of presentation and citation of current literature</bold>
            </p>
            <p> The manuscript is clearly structured and the presentation of results is understandable, with relevant references to ageing and empowerment literature. However, the theoretical positioning of the proposed model is not sufficiently clear. The authors do not demonstrate how the model differs from or advances existing frameworks such as community gerontology or active ageing. The literature review remains largely descriptive. Stronger conceptual synthesis and clearer articulation of the model&#x2019;s novelty would improve this aspect.</p>
            <p> </p>
            <p> 
                <bold>Appropriateness of study design and technical soundness</bold>
            </p>
            <p> The sequential explanatory mixed-methods design is appropriate for evaluating the model and understanding empowerment processes in community contexts. The integration of quantitative welfare outcomes with qualitative experiences of empowerment is methodologically coherent. The use of pre&#x2013;post comparison with predictive analysis and thematic analysis captures the complexity of the phenomenon. Overall, the research design and procedures are appropriate and technically sound.</p>
            <p> </p>
            <p> 
                <bold>Sufficiency of methodological and analytical detail for replication</bold>
            </p>
            <p> The manuscript outlines procedures and analyses at a general level, but key details needed for replication are limited. Information on measurement instruments is insufficient, including variable structure, questionnaire items, development procedures, and validity and reliability. Qualitative analysis also lacks clarity regarding coding and theme development. Providing fuller descriptions of instruments and analytic procedures would improve transparency and replicability.</p>
            <p> </p>
            <p> 
                <bold>Appropriateness of statistical analysis and interpretation</bold>
            </p>
            <p> The use of paired-sample t-tests to assess pre&#x2013;post change and multiple regression to identify predictors of welfare is appropriate. Statistical reporting and interpretation are consistent with the results and supported by qualitative evidence of increased participation and self-efficacy. The analysis and interpretation are therefore appropriate and reliable.</p>
            <p> </p>
            <p> 
                <bold>Availability of underlying data for reproducibility</bold>
            </p>
            <p> The authors state that datasets are available upon request due to ethical constraints, which is acceptable in human research. However, transparency and reproducibility would be improved by providing anonymised datasets, research instruments, or qualitative coding frameworks as supplementary materials. Such materials would enable verification and wider application of the model.</p>
            <p> </p>
            <p> 
                <bold>Adequacy of conclusions supported by results</bold>
            </p>
            <p> The conclusions are consistent with the reported significant improvements in elderly welfare and qualitative evidence of increased participation, independence, and self-efficacy. Claims remain within the scope of the data and study context without overgeneralisation. Therefore, the conclusions are adequately supported by the results.</p>
            <p> </p>
            <p> 
                <bold>Minor revision is Overall assessment</bold>
            </p>
            <p> The study provides valuable empirical evidence on community-based elderly empowerment and employs an appropriate mixed-methods research design. However, several aspects would benefit from minor clarification, particularly the articulation of the conceptual framework, the reporting of measurement validity and qualitative procedures, and the clarity of the research instruments and data used in the study.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Yes</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Partly</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Yes</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Community Psychology; Community development; Participatory Action Research (PAR); Empowerment; Social innovation; Development Education</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.</p>
        </body>
    </sub-article>
</article>
