Evaluating a Health Program

Alzheimer’s Intervention Evaluation
Introduction
This paper provides a basic evaluation plan for evaluating a health program for elderly patients with Alzheimer’s. The health program focuses on designing and implementing an open space concept for the patient, having a social worker regularly meet with the patient and loved one or caretakers to ensure support, having family therapy sessions available for loved ones acting as caretakers if they should want it and providing a falls prevention initiative through training in an exercise routine to strengthen the balance and agility of the elderly person—all of which are considered vital aspects to improving the health status of an elderly person with Alzheimer’s (Canning et al., 2015; Hoof, Kort, Van Warde & Blom, 2010; Rubin, 2011). The overall question an intervention evaluation asks is: Was the intervention implemented as planned? (Harris, 2010). The purpose of this paper is to provide an evaluation plan for the Health Program for Elderly Patients with Alzheimer’s.
Five Factors
The five factors that must be considered for the evaluation of the Health Program for Elderly Patients with Alzheimer’s disease are:
1. Has a falls prevention plan been initiated?
2. Has an open space room concept been implemented?
3. Has a social worker been contacted for scheduling regular visits?
4. Have family members been provided with Alzheimer’s education and access to family therapy to assist in coping with the stress of caring for a loved one with the disease?
5. Was the intended population participating as planned?
Type of Evaluation
The formative evaluation is the most appropriate type of evaluation for this health program as the evaluation is being conducted near the middle of the time allotted for the initiative to ensure that the implementation of the program has proceeded along smoothly. As Harris (2010) notes, “formative and process evaluations assess the context, the reach, the dosage, or the intensity of the initiative and the fidelity with which it is delivered. They assess the initiative at the level of resources/inputs and outputs and determine the effectiveness of the administrative functions of the program” (p. 192). The formative evaluation gives a sense of what has been done and what still needs to be done. Were the evaluation taking place at the end of the initiative, a process evaluation would be more appropriate.
Table 1. Evaluation Questions
Evaluation Questions
Formative
Outcome
Were all the components of the plan implemented?
What is the knowledge of Alzheimer’s among the participating population and what is their readiness level for dealing with Alzheimer’s?
What is the level of implementation of the Health Program (open space plan, social worker visits, family therapy, and falls prevention?
What activities have taken place to support the policy to reduce the risk of falls and confusion for the patient?
What human, financial, and material resources were provided and used?
These evaluation questions should be used to guide the formative assessment. To assist in conducting the assessment, indicators and source data have to be considered (Harris, 2010). For each formative assessment evaluation question, therefore, one must know what to look for to measure to answer the question and where that information can be found (i.e., what is the source). In the following table, the evaluation questions are provided along with the indicators and source data that should be used to answer each one.
Table 2. Indicators and Sources of Data
Evaluation Question
Indicator
Source of Data
Were all the components of the plan implemented?
· An open space concept designed to fit the patient’s home needs
· Social worker contacted and regular visits scheduled
· Family therapy offered to Alzheimer patient’s loved ones/care givers
· Information provided to loved ones/care givers regarding Alzheimer’s
· Falls prevention plan initiated w/ strength and conditioning exercises underway for the Alzheimer’s patient
· The intended population is participating as planned
· Training reports
· Record reviews
· Observation
· Site visits
· Exercise logs
What is the level of implementation of the Health Program (open space plan, social worker visits, family therapy, and falls prevention?
· Number of meetings with the social worker
· Number of sessions with the exercise and conditioning coach
· Number of family therapy sessions conducted (if applicable)
· Evidence of an open space concept implemented
· Interviews with staff and participants
· Site visits
· Record reviews
· Observation
· Session logs
What activities have taken place to support the policy to reduce the risk of falls and confusion for the patient?
· Number of strength and conditioning exercises taught
· The open space plan developed and implemented
· Social worker contacted
· Session logs
· Site visit
· Interview with participants
What human, financial, and material resources were provided and used?
· Program in place
· Personnel hired
· Space utilized
· Invoices filed
· Receipts kept
· Audit
· Session logs
· Interview with accounting staff
· Observation
· Record review
· Site visit

What is the knowledge of Alzheimer’s among the participating population and what is their readiness level for dealing with Alzheimer’s?
· Percentage increase in the knowledge of Alzheimer’s patient’s loved ones/care givers of Alzheimer’s
· Survey
· Interview with participants
To Ensure the Quality of the Evaluation
To ensure the quality of the design, a pre/post quasi-experimental design followed by a second posttest 6 months following the completion of the implementation of the intervention should be conducted (Harris, 2010). The first step in this process is to establish a baseline—this is the measure of where participants are at prior to the implementation of the intervention. In other words, family and care givers’ knowledge of Alzheimer’s is assessed. The home/living space of the patient is described. The agility, strength and conditioning of the patient is assessed. The number and frequency of falls suffered by the patient is recorded up to that point. The stress level of the family and care givers is assessed and recorded. These measures would serve as the baseline assessment. The baseline is used to show how far participants have developed following the implementation of the intervention. For instance, the baseline for knowledge will indicate a certain level. After the implementation, the goal would be to see that the knowledge level has risen from the baseline—i.e., that participants are able to tell more about Alzheimer’s, indicating that they understand the disease much better than they did before the intervention and that they are better prepared to respond to the needs of the Alzheimer’s patient.
Collecting the Data
To ensure an effective evaluation, the data has to be collected from the data sources identified in Table 2 above. As Harris (2010) notes, the data tools to use for collecting data include: a site visit report that staff file, journal entries used for recording observations and questions from participants, attendance sheets to keep track of which participants are involved, and a record review sheet to assess what steps have been taken. The evaluation should focus on maintaining participants’ interest in the implementation of the intervention to ensure that participants remain committed to the intervention. Otherwise, participant attrition will be a threat to the validity of the evaluation. Participants should also be instructed on how to keep the journal. Data collection instruments, such as surveys and interview questions have to be piloted to ensure reliability and validity. The survey instrument should include information on demographics, knowledge of Alzheimer’s, knowledge of risk factors (falls, confusion, anger, etc.), knowledge of the value of physical activity in reducing the risk of falls; attitudes about Alzheimer’s; stress levels; interaction with staff. Staff interviews should also be conducted in order to assess what level of awareness and role they played in the intervention (Harris, 2010).
Analyzing and Interpreting the Data
Once data has been collected, the evaluation must set about analyzing and interpreting the data in order to effectively understand it and act accordingly to ensure the intervention can proceed appropriately in the remaining time left. The evaluation will return both qualitative and quantitative information—i.e., data that is descriptive of the subjective experience of participants data that is empirical and can be measured statistically. Both data sets will have value and give the evaluation the triangulation needed for ensuring validity and reliability.
The data should be measured against the baseline. Both posttests are likely to yield different results. The first posttest will be taken immediately after the intervention has concluded. The second posttest takes place 6 months later, so a drop-off may be expected in terms of keeping up with conditioning exercises, therapy, social work visits, etc., especially if they are no longer perceived as necessary. The main factor to be evaluated then will be attitudes towards the disease, frequency of falls to see if they are being prevented any better than at baseline, and frequency of bouts of confusion and anger to see if the open space plan has helped to create a more accommodating environment for the patient.
Reporting the Results
The last step in the evaluation process is the reporting of the results. The results of the evaluation should be communicated to the team responsible for implementing the intervention so that they can be aware of the results and obtain the necessary feedback for improving their design. At this time, recommendations for improvements are to be given based on the interpretations of the data. Questions should also be answered from the team to ensure that feedback flows go both ways.
Conclusion
The main goal of evaluating the Health Program for Elderly Patients with Alzheimer’s disease is to assess whether the intervention was implemented as planned? The original plan, therefore, has to be developed with factors that are to be addressed, and indicators and sources of data that are to be identified so as to be able to measure the outcome of the implementation. A baseline measurement has to be taken and two posttests should be conducted, one at the conclusion of the program and one 6 months later to assess the staying power of the program. The data should be interpreted and reported to the team to facilitate the development of improvements in the program’s delivery in the future.
References
Canning, C. et al. (2015). Exercise for falls prevention in Parkinson disease: A
randomized controlled trial. Neurology, 84(3): 304-312.
Harris, M. J. (2010). Evaluating Public and Community Health Programs, John Wiley &
Sons, Incorporated ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/touromain-ebooks/detail.action?docID=484874
Hoof, J., Kort, H., Van Warde, H. & Blom, M. (2010). Environmental interventions and
the design of homes for older adults with dementia: an overview. American Journal of Alzheimers Disease and Other Dementia, 25(3): 202-232.
Rubin, A. (2011). Teaching EBP in social work: Retrospective and prospective. Journal
of Social Work, 11(1), 64-79.