Development and Formative Evaluation of the Centre for Activity and Ageing’s Home Support Exercise Program for Frail Older Adults

Abstract

The Home Support Exercise Program (HSEP) was developed to reach frail community seniors through home support workers (HSWs) rather than more costly health care professionals such as visiting nurses or physical therapists. This article describes the development and formative evaluation of the HSEP prototype, including the training of case managers and HSWs. In the HSEP’s final form, each client is instructed on 10 simple, functional, and progressive exercises and given an illustrated booklet and a short video. Ongoing encouragement is provided by specifically trained HSWs during regular visits (at least once a week). Formative evaluation of the HSEP model was used to examine and resolve implementation and delivery issues. Qualitative data were collected through focus groups or interviews with each stakeholder group—administrators/coordinators, case managers, HSWs, agency supervisors, and clients themselves. Evaluation findings were used to modify training, instructional, and support materials and the exercises.

Outcome Evaluation of the Canadian Centre for Activity and Aging’s Home Support Exercise Program for Frail Older Adults

“…Consistent with our initial findings (Tudor-Locke et al, 2000), the present study verified that we are reaching our intended target audience of frail, at-risk seniors, based on client characteristics and service use. Baseline scores on the functional-performance measures provide further evidence of the physical frailty of both groups.…”

“…Because it is conceivable that frail adults could find themselves in these situations when they go out for appointments or shopping, especially if their functional abilities and confidence improve as a result of the exercise program, we included these ABC items. Six of the ABC items (e.g., using escalators or walking on icy sidewalks) were not included because this clientele is very unlikely to do these activities, which we verified during our pilot work (Tudor-Locke et al, 2000). The same rating format, ranging from 0% (not at all confident) to 100% (completely confident) was used for both scales.…”

“…Based on pilot work (Tudor-Locke et al, 2000), it was estimated that 34 individuals would be needed in each study group to examine change over 4 months. For the comparison group, home-care-agency supervisors recruited a separate pool of 22 HSWs who had not yet received HSEP training.…”

“…The formative evaluation of the HSEP supported the feasibility of this approach (Tudor-Locke et al, 2000). The purpose of this outcome-evaluation study was to examine extent of exercise compliance and functional improvement in home-care clients receiving the HSEP over a 4-month period.…”

“…With minimal training, HSWs can introduce these exercises to their clients and provide ongoing motivation and support during regular home visits. HSWs were very enthusiastic about the HSEP and periodically reviewed or actually did the exercises with their clients (Tudor-Locke et al, 2000).…”