Foroumandi Elaheh, Alizadeh Mohammad, Khodayari-Zarnaq Rahim, Kheirouri Sorayya
Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
Risk Manag Healthc Policy. 2020 Aug 13;13:1135-1147. doi: 10.2147/RMHP.S261121. eCollection 2020.
As aging populations increase, many countries have begun implementation of policies to improve elder health and nutrition. This study evaluated key process components of nutrition sections of a national elderly integrated-care program in health-care centers in Iran.
With stratified three-stage random cluster sampling, a total of 256 elderly subjects (clients) and 76 staff members of health-care centers (providers) participated in the study. Quantitative and qualitative data were collected using two self-administrated questionnaires to evaluate various components of process evaluation for clients and providers. Program reach was measured by the ratio of the number in the target group who underwent the program to the number of eligible individuals. Exposure rate was measured as clients' awareness of program services. Delivery and fidelity were assessed from providers' reports for each service. Satisfaction rates were assessed for the whole program and for each service of the program. All reasons behind strengths and weaknesses in each of the process-evaluation components were examined and are reported in detail.
The clients reported low-reach (20.0%) and moderate-exposure rates of 77.5%, with a program target of 90%. Primary training sessions were delivered to the providers as intended (100%), but most planned services for clients, especially vitamin and mineral supplementation, follow-up, and physical activity sessions, were poorly implemented, as they were delivered correctly to 24.7% (n=63, vitamin and mineral supplementation), 24% (n=62, follow-up), and 40.3% (n=103, physical activity sessions) of the clients, with a set program goal of 60%. An overall low level of implementation fidelity was observed, and 39.3% (n=30) of the providers believed that most clients did not benefit from the nutritional services. Overall, less than half (42.8%, n=101) the clients were highly satisfied with the program.
The process evaluation showed insufficient reach, exposure, and fidelity of the program, as well as imprecise delivery of some services, which resulted in low levels of client satisfaction. The findings may have implications for further reinforcement of the program, and indicate the importance of continuous monitoring and evaluation of such programs.
随着老龄化人口的增加，许多国家已开始实施改善老年人健康和营养状况的政策。本研究评估了伊朗医疗保健中心一项全国老年人综合护理计划营养部分的关键流程组成部分。
采用分层三阶段随机整群抽样，共有256名老年受试者（客户）和76名医疗保健中心工作人员（提供者）参与了研究。使用两份自填式问卷收集定量和定性数据，以评估针对客户和提供者的流程评估的各个组成部分。项目覆盖范围通过接受该项目的目标群体人数与符合条件个体人数的比率来衡量。暴露率通过客户对项目服务的知晓度来衡量。从提供者对每项服务的报告中评估服务提供情况和保真度。对整个项目以及项目的每项服务评估满意度。详细检查并报告了每个流程评估组成部分优势和劣势背后的所有原因。
客户报告称覆盖范围较低（20.0%），暴露率为中等水平的77.5%，而项目目标为90%。按计划向提供者提供了初级培训课程（100%），但大多数为客户计划的服务，尤其是维生素和矿物质补充、随访以及体育活动课程，实施情况不佳，因为这些服务正确提供给客户的比例分别为24.7%（n = 63，维生素和矿物质补充）、24%（n = 62，随访）和40.3%（n = 103，体育活动课程），而设定的项目目标为60%。观察到总体实施保真度水平较低，39.3%（n = 30）的提供者认为大多数客户未从营养服务中受益。总体而言，不到一半（42.8%，n = 101）的客户对该项目高度满意。
流程评估显示该项目的覆盖范围、暴露率和保真度不足，以及一些服务的提供不准确，这导致客户满意度较低。这些发现可能对该项目的进一步强化有影响，并表明持续监测和评估此类项目的重要性。
