Evaluation 2010 Evaluation Quality November 10 13 2010

Evaluation 2010: Evaluation Quality November 10 -13, 2010 Participatory Evaluation A Model to Promote Well-Aging Among Persons With Intellectual and Development Disabilities Karen Widmer, M. S. Karen. Widmer@cgu. edu 707 -815 -2286 123 E. 8 th St. Claremont, CA 91711

Presentation Outline § Need for participatory evaluation in health care services § A model for participant inclusion within a case study evaluation of a center of excellence for healthy aging among adults with IDD living in group homes.

Three Standards of Quality Truth. “One must take seriously the opinions of other people…and engage them in serious discourse. ” Beauty. “Both the story and the aesthetic elements contribute to overall coherence. ” Justice. “Members of a family do not maximize their good fortune at the expense of the least-advantaged family member. ” House, E. R. (1980). Evaluating With Validity. Sage: Beverly Hills, CA.

“Padua Village” Model § Key constructs § Aging well § Future planning § Activities § Education § Healthy aging practices § Group activities § Personal health goals § Short-, medium-, and long-term outcomes § Health outcomes § Cost of service § Quality of life

Framework: Evaluation Questions § Evaluation questions § § § Understanding and feelings about “health” Wellness behaviors “Village” influences Short-term outcomes Residents’ evaluation of “Padua Village” program

Framework: Literature § Health Behavior Change theories § Stages of Change [exercise] § Theory of Planned Behavior [diet] § Material development § The Maryland Ask Me! Project § Biggest gap § Concept of health

Participatory Methods § Primary source § Resident input § Format § Semi-structured, one-on-one interview § Triangulation § § Staff interview Carer interview Medical records Environmental scan

Framework: Tools § Measurement scales § Easier to rule out than rule in § Operationalize constructs § Create the materials § Talk + Text + Pictures § Three fixed responses § Short and Long versions § Reading level § 3 rd grade => kindergarten

Resident Interview RA 4 ARE THERE MORE HEALTHY THINGS YOU WOULD LIKE TO ADD? 1 2 3 4 [Introduce Health Prompt to trigger more ideas] [Let’s talk about these pictures. These are some things people do that MIGHT be healthy, or that might NOT be healthy to do. ] [Augment w/hand motion, on one hand/other hand] Learning Going places safely 7 6 5 Seeing the doctor or nurse Activities by myself 8 [Go through prompt, or let them talk through it if they want] Are there any more HEALTHY things you would like to add [to the Stars prompt]? Are there any more NOT HEALTHY things you would like to add [to the Stars prompt]? Being with others Spiritual Activities/Volunteering 10 9 Working House Work 11 Eating Personal Care 12 Exercising/Sports Sleeping [Write on Stars Prompt in GREEN]

Resident Interview RE 5 WHAT FOODS DO YOU PICK AT A RESTAURANT? When you go to a restaurant, what foods do you pick? [Refer to Menu Prompt] Here are some foods you might pick, but you can tell me anything you want. [Write in alternative food selections as provided]

Resident Interview RC 1 DO YOU DO THESE THINGS MORE BY YOURSELF, OR WITH OTHERS? [Some people work mostly by themselves. Others like to work in groups. ] [Continue to use health prompt] Do you do these things more by yourself, or with others? By Myself With Others Some By Myself Some With Others

Resident Interview DIVIDER End of Section On-going q Restate comment q Affirm neutral contribution Thank you for giving me an answer Section q We are now at end of section q Let’s ____ (stretch, move, get a drink, shrug our shoulders) q Want to tell a joke? q Would you like to answer more questions? q Would you like to take a break? ! ! ! Applause ! ! !

Resident Interview Hurdles § Attention span § Applause *** § Motion (stretching, relocating) *** § Other (jokes, water, snacks) § Resident disposition § Bored § Resistant § Communication § Difficult to trust own questions § Difficult to understand responses § Time to process answers

What Did We Find? § Positive reception § Outcomes § § § Triangulation added confidence Trends impressive “Village” very important At what level did residents understand health concepts? A few clear positive improvement suggestions

Conclusions §Model for participatory evaluation across platforms §Social and organizational components §Other settings across wide range of cognitive/language ability §Infer associations §Healthy behavior and positive healthy aging outcomes * Program participants were also included in a larger study of diagnostic/age peers who received the community standard of care

Conclusions “The findings of our evaluation will promote social justice by maximizing the inclusion of persons with a wide range of cognitive and language abilities in evaluation of programs that support well aging and other quality of life outcomes. ” Harriet Aranow, Ph. D. Principal Investigator Padua Village Uni. Health Grant

REFERENCES Prochaska, J. , & Di. Clemente, C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276 -288. doi: 10. 1037/h 0088437. Fishbein, M. (2002). An integrative model for behavioral prediction and its application to health promotion. In R. J. Di. Clemente, R. A. Crosby, & M. C. Kegler (Eds. ), Emerging Theories in Health Promotion Practice and Research (pp. 215234). San Francisco, CA, Jossey-Bass. Bonham, G. S. , Basehart, S. , Schalock, R. L. , Marchand, C. B. , Kirchner, N. , & Rumenap, J. M. (2004). Consumer-Based Quality of Life Assessment: The Maryland Ask Me! Project. Mental Retardation, 42(5), 338 -355.