A non-randomised controlled trial of the Home Independence Program (HIP): an Australian restorative programme for older home-care clients

The Home Independence Program (HIP) is a short-term restorative programme targeted at older home-care clients, who do not have a diagnosis of dementia, when they are first referred for assistance or when they are referred for additional services because their needs have increased. This study compared the outcomes for individuals who participated in HIP with those of individuals who received 'usual' home-care services. The study was conducted in metropolitan Perth, Western Australia, between 2001 and 2003, when HIP was being trialled as a service in just one region. One hundred clients were recruited into each group and were visited at home on three occasions – service start and at 3 months and 1 year. Standardised outcome measures were used to measure functional dependency, morale, confidence in performing everyday activities without falling and functional mobility. Service outcomes were also examined at 3 months and 1 year. The HIP group showed improvements on all personal outcome measures compared with the control group. These improvements were, except for the morale scale, significantly associated with group assignment even when baseline differences between the groups were adjusted for. As regards service outcomes, the odds of the individuals who received HIP still requiring services was 0.07 (95% CI = 0.03–0.15, P  < 0.001) times those for the individuals in the control group at 3 months and 0.14 times at 12 months (95% CI = 0.07–0.29, P  < 0.001). The results of this study supported the hypothesis that older individuals referred for home care who participated in a programme to promote their independence had better individual and service outcomes than individuals who received usual home care.     

A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service

Restorative home‐care services, or re‐ablement home‐care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home‐care services had only been investigated in terms of singular outcomes such as length of home‐care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home‐care and healthcare services received over the 2‐year period following service commencement. Seven hundred and fifty older individuals referred for government‐funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home‐care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home‐care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow‐up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home‐care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2‐year follow‐up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost‐effective option than providing conventional home care.     

What constitutes ‘good care’ and ‘good carers’? The normative implications of introducing reablement in Danish home care

As populations worldwide are ageing, Western welfare states are currently implementing welfare reforms aimed at curbing the rising need for social and healthcare services for ageing populations. A central element in home‐care reforms in several welfare countries is reablement: short‐term home‐based training programmes aimed at re‐enabling older people to live in their own homes independently of care. In this paper, we explore how transitioning from compensatory care to reablement care is not merely a practical process, but also a deeply normative one. Drawing on Annemarie Mol's concept of ‘ontonorms’ we analyse the normative dynamics involved in transitioning from one form of care to another as reflected in reablement professionals' practices and discourses. The paper draws on 10 months of multisited ethnographic fieldwork carried out from April 2015 to February 2016 in a Danish municipality, including participant observations of reablement practices as well as qualitative interviews with 13 professionals working with reablement. We demonstrate that professionals generally consider reablement to represent a desirable shift in home care from ‘bad care’ practices of making people passive through compensatory care, towards ‘good care’ practices of ‘keeping people going’ despite their limitations. Moreover, we demonstrate that while therapists are valued as ‘good carers’ due to their ability to focus on development and training, nurses and in particular home helpers are devalued as ‘bad carers’ due to their ‘caring genes’ and lack of technical and theoretical skills necessary for documentation work. Finally, we discuss the implications of these normative dynamics, which may risk stigmatising compensating care practices, although this form of care to a large extent continues to coexist with reablement practices. In conclusion, we argue for a more nuanced approach to care, recognising compensatory care and reablement as complementary forms of care, each doing good under different circumstances.     

A cost study of a general practitioner hospital in the Netherlands

Objective: To perform a cost study of the first general practitioner (GP) hospital in the Netherlands.

Methods: We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hospital were compared with the expected costs of the alternative mode of care. In the GP hospital three types of bed categories were distinguished: GP beds (admission and discharge by GPs, n=131), rehabilitation beds (recovery from hospital surgery, n=62) and nursing home beds (hospital patients awaiting a vacancy in a nursing home, n=25). GPs were interviewed to indicate the best alternative form of healthcare for the GP bed patients in the absence of a GP hospital (dichotomised for this study into ‘hospital’ or ‘home care’). For the ‘rehabilitation’ and ‘nursing home’ patients the alternative care mode was admission to a hospital.

Results: The mean length of stay was 15 days for the GP beds, 31 days for the rehabilitation beds and 90 days for the nursing home beds. For the GP bed patients the costs were ?2533 per admission compared with ?3792 for hospital stay. For the group of GP bed patients for whom ‘home care’ was the best alternative, the costs were ?2494 for GP hospital days compared with ?2814, the average cost for home care of patients of 65 years and older. For rehabilitation patients the costs per patient were ?4744 compared with ?8041 in a hospital. For patients waiting for admission to a nursing home, these costs were ?13,143 and ?22,670, respectively.

Conclusion: The GP hospital might be a cost-saving alternative for elderly patients in need of intermediate medical and nursing care between hospital and home care. Further research on the cost-effectiveness of the GP hospital compared with home care and nursing home care is needed.     

Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial

Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face-to-face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health-related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well-being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI -0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P < 0.001). In conclusion, a restorative home care service may be of benefit to older people, and improves home care service efficacy.     

Living and dying: responsibility for end‐of‐life care in care homes without on‐site nursing provision ‐ a prospective study

The aim of the study was to describe the expectations and experiences of end‐of‐life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed‐method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill‐health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; ‘talking about dying’ and ‘integrating living and dying’. All participants stated that they were committed to providing end‐of‐life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end‐of‐life care, doubts from care home and primary healthcare staff about their capacity to work together when residents’ trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time.     

An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families

Introduction There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home‐based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied. Method Randomized controlled trial. Participants A total of 59 children, aged 3–5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home‐based programme consisting of 40 weekly visits. Main outcome measures Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre‐intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment. Results Fifty‐four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non‐verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families. Conclusion Improvements following the provision of a home‐based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.     

Experiences of home‐care workers with the ‘Stay Active at Home’ programme targeting reablement of community‐living older adults: An exploratory study

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may result in a need for home‐care services. Unfortunately, home‐care workers often provide support by taking over tasks, as they are used to doing things for older adults rather than with them, which undermines their possibilities to maintain their self‐care capabilities. In contrast, reablement focuses on capabilities and opportunities of older adults, rather than on disease and dependency. Consequently, older adults are stimulated to be as active as possible during daily and physical activities. The 'Stay Active at Home' programme was designed to train home‐care workers to apply reablement in practice. To explore the experiences of home‐care workers with this programme an exploratory study was conducting in the Netherlands, between April and July, 2017. In total, 20 participants were interviewed: nine nurses (including a district nurse), 10 domestic support workers and the manager of the domestic support workers. The semi‐structured interviews focused on the experienced improvements with regard to knowledge, skills, self‐efficacy and social support. Furthermore, the most and least appreciated programme components were identified. The study has shown that home‐care workers perceived the programme as useful to apply reablement. However, they also need more support with mastering particular skills and dealing with challenging situations. Future implementation of the 'Stay Active at Home' programme can potentially benefit from small adaptions. Furthermore, future research is needed to examine whether the programme leads to more (cost‐) effective home care.     

A repurposed tool: the Programme Evaluation SOAP Note

Medical Education 2010: 44 : 298–305 Context Doctors have used the subjective–objective–assessment–plan (SOAP) note format to organise data about patient problems and create plans to address each of them. We retooled this into the ‘Programme Evaluation SOAP Note’, which serves to broaden the clinician faculty member’s perspective on programme evaluation to include the curriculum and the system, as well as students. Methods The SOAP Note was chosen as the method for data recording because of its familiarity to clinician‐educators and its strengths as a representation of a clinical problem‐solving process with elements analogous to educational programme evaluation. We pilot‐tested the Programme Evaluation SOAP Note to organise faculty members' interpretations of integrated student performances during the Year 3 patient care skills objective structured clinical examination (OSCE). Results Eight community clerkship directors and lead clerkship faculty members participated as observers in the 2007 gateway examination and completed the Programme Evaluation SOAP Note. Problems with the curriculum and system far outnumbered problems identified with students. Conclusions Using the Programme Evaluation SOAP Note, clerkship leaders developed expanded lists of ‘differential diagnoses’ that could explain possible learner performance inadequacies in terms of system, curriculum and learner problems. This has informed programme improvement efforts currently underway. We plan to continue using the Programme Evaluation SOAP Note for ongoing programme improvement.     

The impact of transitional programmes on post‐transition outcomes for youth leaving out‐of‐home care: a meta‐analysis

Youth residing in out‐of‐home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta‐analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15–24 years) on post‐transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990–2014. Search terms included ‘out‐of‐home care’, ‘transition’, ‘housing’, ‘education’, ‘employment’, ‘mental health’ and ‘substance use’. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta‐analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post‐transition employment varied, while rates of post‐secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta‐analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.     

Pound for pound? Comparing the costs incurred by subjects following four commercially available weight loss programmes

Obesity is increasing in severity and prevalence representing a major public health issue within the UK. Studies suggest that, at any one time, most US and UK adults are trying to lose or maintain weight ( Offer, 2001 ). As a result the demand for weight loss schemes is high. As obesity is most prevalent amongst low income groups ( James et al., 1997 ), the financial implication of following such programmes requires investigation. This study aimed to quantify and compare the costs incurred by subjects undertaking one of four commercially available weight loss programmes. Subjects comprised of the Surrey cohort (n = 35) of a multi‐centre weight loss trial and were randomized to one of four programmes: Weight Watchers (WW), the Slim‐Fast Plan, Rosemary Conley's Diet and Fitness Plan (RC) or the Dr Atkins’ New Diet Revolution (Atkins). Participants were all aged between 21 and 60 years, had an initial body mass index in the range of 27–36 kg m^?2 and were otherwise healthy. Seven‐day estimated food diaries were completed at baseline and after 2 months of dieting and were used to calculate the weight of food consumed. The cost was subsequently based on the prices quoted on the Tesco's website. Total food and alcohol were calculated for each subject at baseline and at 2 months and total programme cost was calculated at 2 months (food costs and any additional costs as a result of programme membership fees, supplementary vitamins, etc). Food group expenditure was calculated to investigate the contribution of meat, fruit, vegetables and alcohol to total costs and change in costs. Parametric and nonparametric statistics (according to the data distribution) were used to compare change in mean costs over time (paired t‐tests, Wilcoxon signed ranks test) and by programme followed (anova ). No significant differences in baseline costs were observed between the four groups with whole sample mean food costs of £20.53 (SD 5.10). The Atkins group showed a significant increase in food expenditure at 2 months (Z = ?2.24, p = 0.03) whereas all other groups decreased their spending on food, significantly so for the RC and WW subjects (Z = ?1.96, p = 0.05; Z = ?2.67, p = 0.01). As a result, significant differences in percentage change in food expenditure were recorded across groups (χ² = 16.47, p = 0.001) with the Atkins group significantly different from both RC and WW groups. Although all programmes incurred initial ‘start‐up’ costs, only the Atkins diet had ongoing total programme costs at 2 months that were significantly greater than baseline expenditure. Increases in meat expenditure were significantly greater within the Atkins group compared with subjects following the other programmes (F = 4.01, p = 0.02). However, contrary to expectations, no significant increases in spending on fruit and vegetables were seen, with a significant decrease in expenditure on fruit observed across the whole sample and within the WW group (Z = ?2.40, p = 0.02 and Z = ?2.07, p = 0.04 respectively). This study suggests that commercial weight loss programmes, including those requiring the purchase of meal replacements, are not necessarily associated with an increase in food expenditure. However, the Atkins diet did result in an increase in food expenditure and as all the programmes are subject to potentially prohibitive ‘start‐up’ costs, such as joining fees, the issue of access for those population groups most at risk from obesity remains.     

Two-year follow-up of the 'Families for Health' programme for the treatment of childhood obesity

Background The high prevalence of obesity in children in the UK warrants continuing public health attention. ‘Families for Health’ is a family‐based group programme for the treatment of childhood obesity. Significant improvements in body mass index (BMI) z‐score (?0.21, 95% CI: ?0.35 to ?0.07, P= 0.007) and other health outcomes were seen in children at a 9‐month follow‐up. Aim To undertake a 2‐year follow‐up of families who attended ‘Families for Health’ in Coventry, to assess long‐term outcomes and costs. Methods ‘Families for Health’ is a 12‐week programme with parallel groups for parents and children, addressing parenting skills, healthy lifestyles and emotional well‐being. The intervention was delivered at a leisure centre in Coventry, England, with 27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families. A ‘before‐and‐after’ evaluation was completed with 19 (70%) children followed up at 2 years. The primary outcome was change in BMI z‐score from baseline; secondary outcomes were children's quality of life, parent–child relationships, eating/activity habits and parents' mental health. Costs to deliver the intervention and to families were recorded. Results Mean change in BMI z‐score from baseline was ?0.23 (95% CI: ?0.42 to ?0.03, P= 0.027) at the 2‐year follow‐up and eight (42%) children had a clinically significant reduction in BMI z‐score. Significant improvements were seen in children's quality of life and eating habits in the home, while there were sustained reductions in unhealthy foods and sedentary behaviour. Fruit and vegetable consumption and parent's mental health were not significantly different at 2 years. Costs of the programme were £517 per family (£402 per child), equivalent to £2543 per unit reduction in BMI z‐score. Conclusions Improvements in BMI z‐score and certain other outcomes associated with the ‘Families for Health’ programme were sustained at the 2‐year follow‐up. ‘Families for Health’ is a promising new childhood obesity intervention, and a randomized controlled trial is now indicated.     

The role of evaluation in the development of a service for children with life-limiting conditions in the community

Background Much of the care for children and young people with life‐limiting conditions is now delivered in the home and new services have developed to support families in this setting. It is essential to monitor and evaluate whether these services are meeting the needs of families. Aims To evaluate a new rural community palliative care service for children according to the perceptions of families and service providers, to make changes suggested by families and to re‐evaluate 1 year later. Method In 2005, 2 years after the onset of the service, 24 families were sent postal questionnaires, including the Measure of Process of Care (MPOC‐UK). Changes suggested by families were then implemented. In 2006, all of the families receiving care from the service (n = 27) were given the option of completing the questionnaire independently or with the support of an impartial researcher. Two families also completed qualitative interviews about their experience of the service with an impartial researcher. In both years, the service providers, (n = 12 and n = 15, respectively) were asked to complete the Measure of Process of Care for Service Providers (MPOC‐SP). The service providers were the clinicians providing direct care (paediatrician, community nurses, dietician, psychologist, occupational therapist, physiotherapist, and speech and language therapist). Results Seven (29%) of families completed the survey in 2005. Families rated ‘respectful and supportive care’ as the highest domain in the MPOC‐UK and ‘providing general information’ as the lowest. Particular emphasis was placed on improving provision of information during the following year. Fourteen (52%) families completed the survey in 2006. Scores increased across all domains in the second survey. The largest increase was ‘providing general information’. Conclusion The results from both of the MPOC tools were extremely useful in helping providers to identify aspects of the service in need of improvement and hence implement valued changes.     

General practice and specialist palliative care teams: an exploration of their working relationship from the perspective of clinical staff working in New Zealand

With the future focus on palliative and end‐of‐life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co‐ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members (n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants’ understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of ‘generalism’ and ‘specialism’ also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care.     

Weight loss, risk factor reduction and lifestyle changes in obese individuals participating in 'Your Choice': a dietitian-led weight management programme

Background: Weight loss in obese individuals can improve morbidity, mortality and lower economic costs (NICE, 2006). Current guidance recommends that lifestyle‐based interventions should be used as a first‐line approach and an adjunct to other weight loss strategies(NICE, 2006), although the evidence is limited and inconsistent (Harvey et al., 2001). ‘Your Choice’ is an ongoing weight management programme provided by the community nutrition service of South Manchester PCT, consisting of a group education day on healthy eating and physical activity, followed by 3‐monthly individual appointments for monitoring and support. The aim of this retrospective, quantitative study was to evaluate participant outcomes and satisfaction with the ‘Your Choice’ programme. Methods: This study included 123 participants that were enrolled on the programme. Health‐related outcomes, including body weight, body mass index (BMI), heart rate, blood pressure and percentage body fat, were analysed for 73 participants who attended the education day and at least one follow‐up appointment using paired t‐tests. Retrospective questionnaires were sent at the time of evaluation to all participants who had attended the education day to investigate reported lifestyle changes, self‐efficacy, and quality of life as a result of the education day, satisfaction with the programme and reasons for nonattendance. The study was approved by the University of Chester Research Ethics Committee. Results: Mean (SD) weight and BMI were 93.8 (12.7) kg and 34.9 (5.7) kg m^?2, respectively, at baseline (n = 73). Forty‐one percent participants who attended the education day had not attended a follow‐up appointment at the time of evaluation. At the time of evaluation, participation in the programme was in the range 3–18 months (median 9 months). Fourteen percent of participants lost ≥5% body weight [?8.8 (4.1) kg], 48% lost 0–4.9% [?2.3 (1.3) kg] body weight, whereas 38% gained weight [2.1 (1.7) kg]. Significant reductions in weight and BMI compared to baseline were observed for participants after two [?1.5 (4.5) kg; n = 50] and three [?1.9 (4.6) kg; n = 31] follow‐up appointments (P ≤ 0.05). Reductions in systolic blood pressure were observed at each follow up (P ≤ 0.05), but no significant changes were observed for diastolic blood pressure or heart rate. Questionnaire response rate was 51% (n = 63). Participants reported a better understanding of food groups (89%), portion sizes (92%), food labelling (78%) and healthy food choices (81%); 93% reported making positive changes to food choices and 70% reported increasing physical activity. Nighty‐five percent were satisfied with the education day overall. Reasons for nonattendance included inconvenient clinic times or locations and changing personal circumstances. Discussion: Attending ‘Your Choice’ was associated with significant reductions in weight, BMI and systolic blood pressure, although the magnitude of weight lost was below current recommendations to achieve health benefits. Participant satisfaction was rated highly, and many individuals reported making positive changes to their lifestyles as a result of the education day. The questionnaire highlighted reasons for attrition and the participants’ views of the service. Further strategies need to be identified to allow a greater number of participants to achieve and maintain weight loss in line with current recommendations. Conclusions: This study demonstrated the effectiveness of ‘Your Choice’ in terms of weight loss, lifestyle changes and participant satisfaction. Recommendations included measuring waist circumference, providing evening or weekend services and including more frequent follow up, such as support groups or drop‐in clinics. The study findings can be used to improve this programme and help develop effective weight management strategies in other UK community settings in the future. References National Institute of Health and Clinical Excellence (2006) Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: The Stationery Office. Harvey, E.L., Glenny, A.M., Kirk, S.F.L. & Summerbell, C.D. (2001) Improving health professionals’ management and the organisation of care for overweight and obese people. Cochrane Database Syst. Rev. 2 , Article No.: CD000984.     

Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand

In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse‐led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver’s strain and quality of life. This was a non‐randomised comparative study with concurrent controls, using a two‐group pre‐test and post‐test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ‐28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life.     

Patient reported outcome measures in weight management service evaluation

Background: Changes to National Health Service (NHS) commissioning (Department of Health, 2010) will increase the need for weight management services to demonstrate service effectiveness far beyond traditional variables of anthropometry and eating behaviours. Patient reported outcome measures (PROMs) can offer additional evidence of a service's effectiveness by measuring quality from the patient's perspective (The Information Centre for Health and Social Care, 2010). The aim of this study was to evaluate the use PROMS as a method of demonstrating effectiveness of a group weight management intervention. Methods: Participants who enrolled on a 10‐week group weight management intervention (n = 38) between June to December 2010 were asked to select or report three goals (excluding weight loss) that they wished to achieve within the next 3–6 months of commencing the intervention. At completion of the intervention, participants were asked to rate how they progressed on achieving these goals on a five‐point Likert item, ranging from ‘Not started’ to ‘Completed’. Results: Thirty‐seven participants (97%) documented goals, with 110 goals reported in total. Participants rated their progress of achievement against 100 goals providing a 90% completion rate. Collectively, 18 different goals were nominated, with the five most common being: clothing to fit better (15%), feeling less tired/having more energy (15%), reduced joint pain (13%), decreased cholesterol (9%) and feeling better about myself (9%). In terms of goal progression and attainment, by the conclusion of the intervention, 12% rated as ‘not started’, 21% had ‘started but not half way’, 42% were ‘halfway there’, 17% were ‘nearly completed’ and 8% rated their goal as ‘completed’. Overall, 67% of participants rated that they were between ‘half‐way there’ to ‘completed’ with their goals. Discussion: In this study, PROMs have been shown to be an effective method of demonstrating nontraditional variables of weight loss from the patient's perspective. A structured approach to gathering and analysing patient led goals, coupled with attainment scaling, has highlighted additional nonweight‐related values experienced by patients. This is demonstrated by the 67% of participants who made adjustments to their lives throughout the 10‐week programme reporting positive shifts in attainment of their personal goals. PROMs could also be considered a future tool to promote further innovations targeting user need more effectively. Conclusions: In the current NHS climate, with strong drives for the commissioning of patient centred, efficient and effective services, the use of PROMs within weight management services should be embraced. PROMs enhance the ability of services to demonstrate effectiveness to users and commissioners alike. References: Department of Health (2010) The Operating Framework for the NHS in England 2011/12. London: Department of Health. NHS Information Centre for Health and Social Care (2010) Patient Reported Outcome Measures (PROMs). http://www.ic.nhs.uk/services/patient‐reported‐outcomes‐measures‐proms (accessed 30 December 2010).