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Effects, costs and feasibility of the 'Stay Active at Home' Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial.

ABSTRACT: BACKGROUND:According to the principles of Reablement, home care services are meant to be goal-oriented, holistic and person-centred taking into account the capabilities and opportunities of older adults. However, home care services traditionally focus on doing things for older adults rather than with them. To implement Reablement in practice, the 'Stay Active at Home' programme was developed. It is assumed that the programme leads to a reduction in sedentary behaviour in older adults and consequently more cost-effective outcomes in terms of their health and wellbeing. However, this has yet to be proven. METHODS/ DESIGN:A two-group cluster randomised controlled trial with 12 months follow-up will be conducted. Ten nursing teams will be selected, pre-stratified on working area and randomised into an intervention group ('Stay Active at Home') or control group (no training). All nurses of the participating teams are eligible to participate in the study. Older adults and, if applicable, their domestic support workers (DSWs) will be allocated to the intervention or control group as well, based on the allocation of the nursing team. Older adults are eligible to participate, if they: 1) receive homecare services by the selected teams; and 2) are 65 years or older. Older adults will be excluded if they: 1) are terminally ill or bedbound; 2) have serious cognitive or psychological problems; or 3) are unable to communicate in Dutch. DSWs are eligible to participate if they provide services to clients who fulfil the eligibility criteria for older adults. The study consists of an effect evaluation (primary outcome: sedentary behaviour in older adults), an economic evaluation and a process evaluation. Data for the effect and economic evaluation will be collected at baseline and 6 and/or 12 months after baseline using performance-based and self-reported measures. In addition, data from client records will be extracted. A mixed-methods design will be applied for the process evaluation, collecting data of older adults and professionals throughout the study period. DISCUSSION:This study will result in evidence about the effectiveness, cost-effectiveness and feasibility of the 'Stay Active at Home' programme. TRIAL REGISTRATION:ClinicalTrials.gov: NCT03293303 , registered on 20 September 2017.

SUBMITTER: Metzelthin SF

PROVIDER: S-EPMC6234661 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Effects, costs and feasibility of the 'Stay Active at Home' Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial.

Metzelthin Silke F SF Rooijackers Teuni H TH Zijlstra Gertrud A R GAR van Rossum Erik E Veenstra Marja Y MY Koster Annemarie A Evers Silvia M A A SMAA van Breukelen Gerard J P GJP Kempen Gertrudis I J M GIJM

BMC geriatrics 20181113 1

<h4>Background</h4>According to the principles of Reablement, home care services are meant to be goal-oriented, holistic and person-centred taking into account the capabilities and opportunities of older adults. However, home care services traditionally focus on doing things for older adults rather than with them. To implement Reablement in practice, the 'Stay Active at Home' programme was developed. It is assumed that the programme leads to a reduction in sedentary behaviour in older adults and ...[more]

PMID: 30424738

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Project description:BACKGROUND:To evaluate whether a training programme is a feasible approach to facilitate occupational health professionals' (OHPs) use of knowledge and skills provided by a guideline. METHODS:Feasibility was evaluated by researching three aspects: 'acceptability', 'implementation' and 'limited efficacy'. Statements on acceptability and implementation were rated by OHPs on 10-point visual analogue scales after following the training programme (T2). Answers were analysed using descriptive statistics. Barriers to and facilitators of implementation were explored through open-ended questions at T2, which were qualitatively analysed. Limited efficacy was evaluated by measuring the level of knowledge and skills at baseline (T0), after reading the guideline (T1) and directly after completing the training programme (T2). Increase in knowledge and skills was analysed using a non-paramatric Friedman test and post-hoc Wilcoxon signed rank tests (two-tailed). RESULTS:The 38 OHPs found the training programme acceptable, judging that it was relevant (M: 8, SD: 1), increased their capability (M: 7, SD: 1), adhered to their daily practice (M: 8, SD: 1) and enhanced their guidance and assessment of people with a chronic disease (M: 8, SD: 1). OHPs found that it was feasible to implement the programme on a larger scale (M: 7, SD: 1) but foresaw barriers such as 'time', 'money' and organizational constraints. The reported facilitators were primarily related to the added value of the knowledge and skills to the OHPs' guidance and assessment, and that the programme taught them to apply the evidence in practice. Regarding limited efficacy, a significant increase was seen in OHPs' knowledge and skills over time (X2 (2)?=?53.656, p <?0.001), with the median score improving from 6.3 (T0), 8.3 (T1) and 12.3 (T2). Post-hoc tests indicated a significant improvement between T0 and T1 (p?<?0.001) and between T1 and T2 (p?<?0.001). CONCLUSIONS:The training programme was found to be a feasible approach to facilitate OHPs' use of knowledge and skills provided by the guideline, from the perspective of OHPs generally (acceptability and implementation) and with respect to their increase in knowledge and skills in particular (limited efficacy).

Project description:BackgroundAs suggested by the World Health Organization, breastfeeding peer support is being introduced worldwide to support women's breastfeeding needs. Evidence has shown that when such support is offered to women, the duration and exclusivity of breastfeeding is increased. We developed an innovative home-based intervention to sustain exclusive breastfeeding in Hong Kong. However, potential barriers must be addressed before a full randomised controlled trial (RCT) is conducted. The aim of this study was to determine the feasibility of a breastfeeding support programme with home-based visits from peer supporters over a six month period among postpartum Chinese women in Hong Kong.MethodsWe conducted a feasibility and pilot randomised controlled trial. Twenty primiparous women intending to breastfeed their healthy term singleton infant were recruited from a hospital in Kowloon, Hong Kong between February and March 2019. Participants were randomly allocated to the intervention or control group. Participants in the intervention group received five home-based visits with a peer supporter over a six month period, as well as standard care, whereas participants in the control group received standard care only. We assessed feasibility, compliance, and acceptability of the breastfeeding peer support programme. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity.ResultsIt was feasible to recruit and train existing peer supporters, and peer supporters were able to deliver the intervention, which was acceptable to women, but rates of stopping the intervention and loss to follow-up were high. There was higher retention seen within the first month. Women interviewed at the end of the study reported that the intervention was positive. The cessation risk of any, and exclusive breastfeeding were not statistically different between the intervention and control groups.ConclusionsThis study provided valuable information on feasibility of the trial design and intervention. Modifications to the intervention, such as targeting women with lower breastfeeding self-efficacy, or combining home visits with technology and telephone follow-up may be more appropriate in a larger trial. Implementing the programme early during the antenatal phase and tailoring peer support to most appropriately sustain exclusive breastfeeding and other feeding modes should be incorporated in a future home-based peer support arm.Trial registrationNCT03705494 on 15 Oct 2018.

Project description:BackgroundCommunity-based programmes for children with excess weight are widely available, but few have been developed to meet the needs of culturally diverse populations. We adapted an existing children's weight management programme, focusing on Pakistani and Bangladeshi communities. We report the evaluation of this programme to assess feasibility of programme delivery, acceptability of the programme to participants from diverse communities, and feasibility of methods to inform a future trial.MethodsA cluster-randomised feasibility trial was undertaken in a large UK city. Children's weight management programmes (n?=?24) were randomised to be delivered as the adapted or the standard programme (2:1 ratio). Routine data on participant attendance (n?=?243) at the sessions were used to estimate the proportion of families completing the adapted and standard programmes (to indicate programme acceptability). Families planning to attend the programmes were recruited to participate in the feasibility study (n?=?92). Outcome data were collected from children and parents at baseline, end of programme, and 6 months post-programme. A subsample (n?=?24) of those attending the adapted programme participated in interviews to gain their views of the content and delivery and assess programme acceptability. Feasibility of programme delivery was assessed through observation and consultation with facilitators, and data on costs were collected.ResultsThe proportion of Pakistani and Bangladeshi families and families of all ethnicities completing the adapted programme was similar: 78.8% (95% CI 64.8-88.2%) and 76.3% (95% CI 67.0-83.6%) respectively. OR for completion of adapted vs. standard programme was 2.40 (95% CI 1.32-4.34, p?=?0.004). The programme was feasible to deliver with some refinements, and participant interview data showed that the programme was well received. Study participant recruitment was successful, but attrition was high (35% at 6 months). Data collection was mostly feasible, but participant burden was high. Data collection on cost of programme delivery was feasible, but costs to families were more challenging to capture.ConclusionsThis culturally adapted programme was feasible to deliver and highly acceptable to participants, with increased completion rates compared with the standard programme. Consideration should be given to a future trial to evaluate its clinical and cost-effectiveness.Trial registrationISRCTN81798055, registered: 13/05/2014.

Project description:BACKGROUND: While evaluation is, in theory, a component of training programmes in health planning, training needs in this area remain significant. Improving health systems necessarily calls for having more professionals who are skilled in evaluation. Thus, the Université de Ouagadougou (Burkina Faso) and the Université de Montréal (Canada) have partnered to establish, in Burkina Faso, a master's-degree programme in population and health with a course in programme evaluation. This article describes the four-week (150-hour) course taken by two cohorts (2005-2006/2006-2007) of health professionals from 11 francophone African countries. We discuss how the course came to be, its content, its teaching processes and the master's programme results for students. METHODS: The conceptual framework was adapted from Kirkpatrick's (1996) four-level evaluation model: reaction, learning, behaviour, results. Reaction was evaluated based on a standardized questionnaire for all the master's courses and lessons. Learning and behaviour competences were assessed by means of a questionnaire (pretest/post-test, one year after) adapted from the work of Stevahn L, King JA, Ghere G, Minnema J: Establishing Essential Competencies for Program Evaluators. Am J Eval 2005, 26(1):43-59. Master's programme effects were tested by comparing the difference in mean scores between times (before, after, one year after) using pretest/post-test designs. Paired sample tests were used to compare mean scores. RESULTS: The teaching is skills-based, interactive and participative. Students of the first cohort gave the evaluation course the highest score (4.4/5) for overall satisfaction among the 16 courses (3.4-4.4) in the master's programme. What they most appreciated was that the forms of evaluation were well adapted to the content and format of the learning activities. By the end of the master's programme, both cohorts of students considered that they had greatly improved their mastery of the 60 competences (p<0.001). This level was maintained one year after completing the master's degree, except for reflective practice (p<0.05). Those who had carried out an evaluation in the intervening 12 months reported a negative gap between their declared mastery and their actual application. However, this is only statistically significant for reflective practice (p < 0.05). CONCLUSION: This study shows the importance of integrating summative evaluation into the learning process. Skills-based teaching is much appreciated and well-adapted. Creating a master's programme in population and health in Africa and providing training in evaluation to high-level health professionals from many countries augurs well for scaling up the practice of evaluation in African health systems.

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Effects, costs and feasibility of the 'Stay Active at Home' Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial.

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Effects, costs and feasibility of the 'Stay Active at Home' Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial.

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