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How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: a scoping review with narrative summary
- Authors:
- COWDELL Fiona, et al
- Journal article citation:
- Health and Social Care in the Community, 30(2), 2022, pp.776-798.
- Publisher:
- Wiley
Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. The aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. The researchers conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. This study included peer-reviewed empirical research of any design. Three authors screened papers. The review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, and the researchers have referred to the preferred reporting items for systematic reviews and meta-analyses statement. The researchers data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. This paper offers a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however the researchers have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence, this paper argues that notions of ‘best’ and ‘scores’ are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances. (Edited publisher abstract)
Development of a theory-based intervention to increase cognitively able frail elders’ engagement with advance care planning using the behaviour change wheel
- Authors:
- COMBES S, et al
- Journal article citation:
- BMC Health Services Research, 21(712), 2021, Online only
- Publisher:
- BioMed Central Ltd
Background: Advance care planning (ACP) conversations support people to think about, discuss and document their beliefs, values and preferences regarding future care. This process means that should the person loose capacity in the future, care can be provided, consistent with their personal values and beliefs. The ACP process is particularly relevant for older people living with frailty (frail elders) as they are vulnerable to sudden deterioration. However, ACP is rarely undertaken by frail elders. The aim of this study was to develop an intervention to increase multidisciplinary health and social care professionals’ (H&SCPs) engagement of cognitively able, domestic-dwelling frail elders with ACP. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel. Multiple methods were used to understand ACP barriers and enablers: a systematic integrative review, a survey (n = 73 H&SCPs), and semi-structured interviews (n = 10 frail elders, n = 8 family members). A conceptual model, developed from the integrative review, underpinned data collection for the survey and interviews. Synthesis of this data, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change for ACP to be implemented and decide content and implementation for the intervention. Results: Following the Behaviour Change Wheel system, and based on the findings of the review, survey and interviews, the prototype intervention, Conversations on Living and Dying (CLaD), was developed. The CLaD prototype consisted of one 3.5-hour educational skills session for H&SCPs supported by a toolkit. Content focussed on the relevance of ACP for frail elders, experience of ACP by frail elders, and strategies H&SCPs could adopt to encourage frail elders’ engagement with ACP. Strategies include recognising the importance of relationships and living well now, preparing frail elders for ACP conversations and starting ACP early. Participants who took part in initial prototype refinement reported that the intervention helped them think differently about ACP and encouraged them to engage with frail elders. Conclusions: The use of behavioural theory enabled the development of CLaD, an evidence-based, theory-driven, person-centred intervention to support ACP engagement with frail elders. While feasibility testing is required, initial prototype refinement demonstrated that H&SCPs found the intervention to be acceptable, engaging, and clinically valuable in their practice with frail elders and their families. (Edited publisher abstract)
The assisted living project: a process evaluation of implementation of sensor technology in community assisted living. A feasibility study
- Authors:
- HOLTHE Torhild, et al
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 15(1), 2020, pp.29-36.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Introduction: The ageing population has been described as a grand societal challenge worldwide, and access to technology is one important strategy for meeting this challenge. The Assisted Living Project has a responsible research and innovation approach and includes older adults in evaluating sensor-based functions in assisted living facilities. The purpose of involving users in research is to enhance a wider dialogue about the values, methods, and purposes of the research project. Methods: A feasibility study was carried out in order to inform the development and conduct of a pilot project with eight residents. The purposes were to evaluate the process of technology installation, the feasibility of the technology, and methods for user involvement. One resident, Hilda, gave her informed consent to take part in this feasibility study. Her sensor system consisted of two magnetic sensors, six pyroelectric infrared motion sensors, one power sensor, one push button by the entrance door, and one loudspeaker. The sensors were wirelessly connected to a controller, which registered and transmitted all data to a secure server. Results: The feasibility study suggested important modifications for the pilot project, which concerned pre-configuration of the sensors, securing efficiently, rapid installation, number of visitors during the installation, preparation necessitating a site acceptance test for the wireless network and environmental prerequisites for mounting the sensors. Furthermore, this study recommends that the signals that are transmitted from the sensors to the secure server need verification. Conclusion: A feasibility study provides an opportunity to inform develop and conduct of a main trial. The MRC framework was useful for doing a process evaluation to assess feasibility and quality of implementation, clarify causal mechanisms and identify contextual factors associated with variations in outcome. (Edited publisher abstract)
Ideal and reality; community healthcare professionals' experiences of user‐involvement in reablement
- Authors:
- JOKSTAD Kari, et al
- Journal article citation:
- Health and Social Care in the Community, 27(4), 2019, pp.907-916.
- Publisher:
- Wiley
The aim of this study was to explore healthcare professionals’ experiences of user‐involvement in reablement. The context for the study was an urban municipality in south‐eastern Norway where reablement had been implemented into home‐care services 1.5 years prior to the study. Eighteen healthcare professionals recruited from home‐care services participated in focus groups. The material was analysed using qualitative content analysis. The findings resulted in one main theme: Transforming user‐involvement from ideal to reality—a demanding process, and four sub‐themes: (a) An ideal of self‐determination and co‐operation; (b) Diverse ability to commit to what user‐involvement requires; (c) Continuous co‐creation processes; and (d) Challenged by old traditions. User‐involvement is a valued ideal that professionals strive towards when providing healthcare. Two main strategies that professionals use to enable user‐involvement were identified here: spending sufficient time and having patience with users during the initial stage of an intervention, and starting an intervention by introducing small tasks that users can master. It was also seen that if the time and arenas for interdisciplinary meetings were lacking, professionals could demonstrate traditional attitudes and practice when faced with limited user‐involvement in the intervention. There is a need for follow‐up over time at the structural, personal, and cultural levels to develop reablement as an intervention with a strong person‐centred approach. The findings of this study have relevance for practice development in several reablement settings. (Edited publisher abstract)
Ageing Well in Wales: introduction to co-producing age-friendly environments with older people in Wales
- Author:
- AGEING WELL IN WALES
- Publisher:
- Ageing Well in Wales
- Publication year:
- 2015
- Pagination:
- 7
This guide is designed as an introduction to the rationale and practice of coproducing age-friendly environments with older people. It makes the case for why it is essential to make older people equal partners at every stage of developing age-friendly environments and presents an overview of the core principles that need to be taken into account when developing such an approach. These are: older people are involved in the entire process from beginning to end; they feel safe to speak and be heard; issues relevant to older people are addressed; the decision making process is clear; the skills and experience of older people are central to the process of change; the meetings, materials and infrastructure are accessible to older people; and progress is evaluated through looking at real changes in the lives of older people and agreeing how this can be measured. (Edited publisher abstract)
Rural Wisdom evaluation: key findings: December 2021
- Author:
- NATIONAL DEVELOPMENT TEAM FOR INCLUSION
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2021
- Pagination:
- 5
- Place of publication:
- Bath
As part of the final stages of the Rural Wisdom, this briefing shares the learning from across the five years of the project to enable people living and working in other rural areas across the UK to apply and benefit from what works. Rural Wisdom is a five-year National Lottery funded project exploring the impact of community-based activities that are led by older people living in rural areas in Scotland and Wales. The aims of Rural Wisdom have evolved during the five years to reflect the changing nature of the project and the communities it was working with, but have remained focused on: reducing social isolation and loneliness; ensuring older people have a voice to lead change locally in their communities and nationally at a policy level; making sure more older people get the support they want in a way that works for them via a wider range of community-based services; influencing policy change in Scotland and Wales to ensure older people can continue to live in the rural communities they know and contribute to them. What works key messages are grouped into three areas: laying the foundations; facing forks in the road; leaving a legacy. (Edited publisher abstract)
Rural Wisdom evaluation: key findings, January 2021
- Author:
- NATIONAL DEVELOPMENT TEAM FOR INCLUSION
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2020
- Pagination:
- 10
- Place of publication:
- Bath
This document shares the key findings from the five original communities, at the end of Stage 1 of Rural Wisdom. Rural Wisdom is a five-year National Lottery funded project exploring the impact of community-based activities that are led by older people living in rural areas in Scotland and Wales. In this first stage Development Workers have been working closely with older people and the community to identify and address the key issues, achieve the project outcomes and create sustainable change. Key findings include: older people are more likely to be motivated to use their skills and experience to lead change if they feel the activity is one that is wanted by the community and they can see results for their time and effort; Development Workers are a vehicle for change – they are engaged with their community and so are aware of issues and needs and can facilitate contact with public services or organisations so older people can engage directly to influence provision; older people need links to people running all sorts of services to be able to voice their views and ideas; transport is vital for many older people to be able to get to health services and activities in their community; it is important that older people know where to get information on community activities and public services. Older people are contributing to rural communities in a variety of ways: through volunteering both formally and informally; by building connections with others in the community and participating socially; through having a voice and actively campaigning for change or improvements; by caring for other people; through imparting their knowledge and experiences to help improve services or passing on their skills and expertise to others in the community. (Edited publisher abstract)
A group-based walking study to enhance physical activity among older adults: the role of social engagement
- Authors:
- LIU Yujun, LACHMAN Margie E.
- Journal article citation:
- Research on Aging, 43(9-10), 2021, pp.368-377.
- Publisher:
- Sage
Objectives: The aim of this study was to explore social engagement and social comparisons as mechanisms to increase physical activity among older adults. Methods: Participants (N = 60, mean age = 65.7) were randomly assigned to one of two conditions. Participants in the treatment condition used the application to track their daily walking steps and interact via text messages with their group members for 4 weeks. Participants in the control group used the application only to track their own walking steps. Outcome variables included mean weekly steps, exercise self-efficacy, and social engagement. Results: The results revealed that participants in the experimental condition significantly increased their mean weekly steps and social engagement from the pretest to the posttest whereas the control group did not. These effects were maintained at the 1-month follow up. Discussion: The study expands our understanding of the motivational role of social engagement and social comparison in increasing PA among older adults. (Edited publisher abstract)
Involving institutionalized people with dementia in their care-planning meetings: Impact on their quality of life measured by a proxy method: innovative practice
- Authors:
- VILLAR Feliciano, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(5), 2019, pp.1936-1941.
- Publisher:
- Sage
The objective of the study was to assess the impact of an intervention in which people with dementia attended meetings to discuss their individual care plans on their quality of life. Fifty-two older people (M = 86.7 years, SD = 7.3) diagnosed with moderate-to-severe dementia living in four nursing homes in Spain participated in the study. The intervention was implemented with 27 residents at two of the nursing homes; the other 25 cases at the other two homes acted as controls. A proxy measure of quality of life was used. Improvements were found in quality of life as assessed by staff members, in both within and between-group comparisons, which suggests that including older people with dementia in care-planning meetings may improve their quality of life. However, further controlled studies are needed to confirm these preliminary results. (Edited publisher abstract)
Promoting supported ambulation in persons with advanced Alzheimer’s disease: a pilot study
- Authors:
- LANCIONI Giulio E., et al
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 13(1), 2018, pp.101-106.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Purpose: This study assessed the effects of an intervention programme, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer’s disease. A social validation assessment of the programme was also carried out. Method: The study included 10 participants with moderate to severe Alzheimer’s disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed. Results: The participants’ mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the programme favourably. Conclusions: A programme combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer’s disease. Implications for rehabilitation: 1) A programme based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer’s disease who are no longer able to walk independently; 2) The same programme may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participant; 3) The staff’s positive ratings of the program suggest that there may be a favourable attitude toward the acceptance and application of the programme in daily contexts. (Edited publisher abstract)