evaluation of the london borough of camden's quality of life strategy for older citizens by…
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Presentation to Thailand’s Ministry of Public Health. Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By… Nink Pussayapibul Quality of Life Researcher Department of Sociology City University London. 13 January 2006. Presentation Outline. - PowerPoint PPT PresentationTRANSCRIPT
Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens
By…
Nink PussayapibulQuality of Life ResearcherDepartment of SociologyCity University London
13 January 2006
Presentation to Thailand’s Ministry of Public Health
2
Presentation Outline
Introduction Project Background Policy Context
Project Overview Research Aims, Research Questions and Methodology Achievement to Date and Challenges
Preliminary Results Quantitative Arm - Wave 1: Main Survey (Summer 2004) Next Steps
Discussion
3
Project Background
CamdenCouncil
CamdenPrimary
CareTrust
CityUniversity
Partnership Approach
Quality of Life Research Studentship
Advisory Panel
4
Project Background (Cont’ d)
Involvement of Older Citizens
2. Quality of Life
Panel12 Older people 8 Councillors
8 Voluntary Organisations
Representatives
1. Older People
Reference Group
770 Older people
Quality of Life Partners
Annual Report to Council Executive
5
Policy Context
Quality of Life Strategy for Camden’s Older Citizens
To be the vehicle to deliver on the targets set out in the Community Strategy that relate to older people, and
To progress and deliver the National Service Framework for Older People – NSF Standard 8
6
Research Aims
To evaluate the impact of the implementation of th
e Quality of Life Strategy on Camden’s older citize
ns’ perception of feeling independent, having choi
ce and control and a sense of well-being
7
Research Questions
1. How is older people’s perception of quality of life changing
over time?
2. What impact are services having on older people’s quality of
life over time?
3. How is the implementation of the Quality of Life Strategy
affecting older people’s perception on their quality of life?
How much of this is as a result of the strategy?
8
Research Methodology
Quantitative Arm
A Panel Survey Various dimensions of social
circumstances The needs satisfaction model
(CASP-19) Take-up of services and
satisfaction rates Comparability with other relevant
data sources
Qualitative Arm
Gathering Stories from Older People
In-depth interviews with selected members of Quality of Life Panel
In-depth interviews with the selected sample; targeted to set up contrast groups based on the first wave of the quantitative survey
9
Capacity building Initial data
collection Pre-pilot planning Draft questionnaire
design
Literature review Questionnaire design Pre-pilot testing Application to Consultation Board at
Camden Council Identification of potential fieldwork agencies
Pilot testing Appointment of fieldw
ork agency Analysis of results fro
m the pilot testing Sample design Final revision of posta
l questionnaire
The first main survey Qualitative interviews Preliminary analysis Literature review (Cont’d)
Follow-up survey Follow-up qualitative
interviews
Final analysis Literature review (Cont’d) Write-up
Year 1Oct–Dec
’03(3m)
Year 2 Year 3Jan–Apr
’04(4m)
July ’04 – May ‘05(11m)
Jun – Dec ‘05(7m)
Jan – Sep ‘06(9m)
May-June ’04
(2m)
TimetableAchievement-to-date
10
Achievement-to-DateQuality of Life Survey
Pre-pilot (2004) Three focus groups – to develop questions Two additional groups – to test the draft questionnaire
Pilot test (2004) 100 people selected from Older People Reference Group (postal) 70% response rate achieved
Wave 1 of main survey (Summer 2004) 1,500 people selected from Accessible Transport database (postal) Boost sample through the Mobile Library scheme to target housebound people 40% response rate achieved Preliminary report completed and used to further develop the Community Strategy
Wave 2 of main survey (Summer 2005) 446 people who agreed to be re-contacted from the wave one (postal) 65% response rate achieved Jan 2006
11
Achievement-to-Date (Cont’d)Gathering Stories from Older Selected Citizens
Five in-depth interviews (May 2004) Selected members of the Quality of Life Panel Interviews conducted before they attended the first panel meeting Qualitative report completed and used to further develop the Community Strategy
Follow up in-depth interviews (Nov 2005) To gather people’s experiences as the Quality of Life panellists. To gather their views on being active in local community.
Targeted interviews (Dec 2005) Sixteen targeted in-depth interviews with a sub-sample of respondents from the first
wave of the quantitative survey. These were targeted in order to draw out contrasts based on their use of services and quality of life scores.
The targeted interviews seek to deepen our understanding on how the services under the Quality of Life Strategy make a difference to older people’s lives. The intention is to complement the questionnaire survey and provide a more comprehensive picture of older people’s lives.
Jan 2006
12
Challenges Secure funding to complete PhD
Limited knowledge in the field
Balance expectations/workloads between sponsor and academic demands
Research design to meet objectives while being practical
Manage project and gain support by working with various parties – eg. network, ask for flavour, subcontract etc.
Communication to various audiences – eg. policy makers, partners, older citizens and academia etc.
Time constraints within limited budget
13
Questionnaire Structure
A. Your recent life event (only wave 2)B. Your feelings about home and the neighbourhoodC. Your friends and familyD. Your feelings about your lifeE. Your healthF. Your life in CamdenG. Getting out and aboutH. Work and retirementI. About yourself (only wave 1)
14
Quality of Life
Control
Autonomy
Self-realisation
Pleasure
Quality of Life Measure: CASP-19
15
CASP-19 (Cont’d)
CONTROL My age prevents me from doing the
things I would like to I feel that what happens to me is out
of my control I feel free to plan for the future I feel left out of things
AUTONOMY I can do the things that I want to do Family responsibilities prevent me
from doing what I want to do I feel that I can please myself what I
can do My health stops me from doing the
things I want to do Shortage of money stops me from
doing the things that I want to do
PLEASURE I look forward to each day I feel that my life has meaning I enjoy the things that I do I enjoy being in the company of others On, balance, I look back on my life
with a sense of happiness
SELF- REALIZATION I feel full of energy these days I choose to do things that I have never
done before I feel satisfied with the way my life
has turned out I feel that life is full of opportunities I feel that the future looks good for me
16
Wave 1: Preliminary FindingsSample Characteristics
Age Group
13%
26%32%29%
10%
26%
40%
24%
0%
20%
40%
60%
80%
100%
60-64 65-74 75-84 85 and over
Ethnicity
2%3%4%
90%
Chinese/Others
2%
Black/Black British
4%
Asian/Asian British
5%
White/White-mixed
89%
0%
20%
40%
60%
80%
100%
Sample
Census 2001Average age= 72 years old
17
Wave 1: Preliminary FindingsAge – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
42
3438
0
20
40
60
60-69 70-79 80 and over
Mea
n
Age Group
25% 26%
50%
0%
10%
20%
30%
40%
50%
60-69 70-79 80 and over
18
Wave 1: Preliminary FindingsEthnicity – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
Chinese/Others
36
White/Whitemixed
40
Black/BB35
Asian/AB
34
0
20
40
60
Mea
n
Ethnicity
Chinese/Others
2%
Asian/Asian British
4%
Black/BlackBritish
3%
White/White-mixed90%
0%
20%
40%
60%
80%
100%
19
Wave 1: Preliminary FindingsGender – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
40 38
0
20
40
60
Males Females
Mea
n
Gender
56%
44%
0%
20%
40%
60%
80%
100%
Males Females
20
Wave 1: Preliminary FindingsSelf-assessed Health – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
46
3037
0
20
40
60
Excellent/Good Fair Not good/Poor
Mea
n
Self-assessed Health
30% 29%42%
0%
20%
40%
60%
80%
100%
Excellent/Good Fair Not good/Poor
21
Wave 1: Preliminary FindingsLongstanding Illness – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
3644
0
20
40
60
Yes NoM
ean
Longstanding Illness
33%
67%
0%
20%
40%
60%
80%
100%
Yes No
22
Wave 1: Preliminary FindingsIncome Adequacy – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
43
3740
0
20
40
60
More thenenough
Just aboutenough
Less thanenough
Mea
n
Income Adequacy
53%
25%22%
0%
20%
40%
60%
80%
100%
More thenenough
Just aboutenough
Less thanenough
23
Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile
Information Satisfaction Level
8%
37%
10%
45%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Info:277
of out 620 people
24
Service Satisfaction Level
9%
30%
9%
52%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Wave 1: Preliminary FindingsService & Staff Satisfaction Level – Profile
Service:312
of out 602 people
Staff Satisfaction Level
10%
34%
7%
49%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Staff:293
of out 594people
25
Wave 1: Preliminary FindingsService Usage
Category Services Number of people who USE
ABOVE average ( ) quality of life
scores(Mean CASP-19)*
Housing Careline 69 xHome adaptation 53 xWarmth for All 51 xSheltered housing service 40 xHandy Person 31 xCare and Repair 27 x
Learning Library 261Home Library/Mobile Library 55 xFree training and the use of computer service 40A Fair COPP 31 x
Exercise Specialist exercise classes for older people 44 x
* Mean quality of life score = 39
26
Wave 1: Preliminary FindingsService Usage
Category Services
Transportation Freedom PassTaxi-card xDial-a-ride xPlusBus xShop Mobility/Scooter loan
Finance Welfare benefit service or pension service x
Others Camden Age Concern xResource Centres/Day centres for older people xWell&Wise xCitizens Advice Bureau Housebound Service xGood Neighbour Schemes xOutreach service
Number of people who USE
4059342104
76
37322114148 x
* Mean quality of life score = 39
ABOVE average ( ) quality of life
scores(Mean CASP-19)*
27
Next Steps
Present results from wave 2 fieldwork to related parties
Analyse and compare results from wave 1 and 2, and in-depth interview
Write-up
28
References Blane, D., R. Wiggins, et al. (2002). "Inequalities in Quality of Life in Early Old Age."
ESRC Growing Older Programme Research Findings: 9.
(http://www.shef.ac.uk/uni/projects/gop/index.htm)
Camden's Promoting Independence Group (2002). Quality of Life Strategy for Camden's Older Citizens. London, London Borough of Camden: 28.
(http://www.camden.gov.uk/ccm/content/council-and-democracy/plans-and-policies/quality-of-life-strategy-for-older-citizens/quality-of-life-strategy-for-older-citizens.en)
Department of Health (2001). National Service Framework for Older People: Executive Summary. London, Department of Health: 32.
(http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4010161&chk=6GV5oj)
Hyde, M., Wiggins, R. D., Higgs, P. and Blane, D. (2003). "A Measure of Quality of Life in Early Old Age: the Theory, Development and Properties of a Needs Satisfaction Model (CASP-19)." Aging and Mental Health 7(3): 186-194.
29
Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens
Discussion
For further information, please contact: Nink Pussayapibul
30
BACK UP SLIDES
31
Questionnaire Development
Rationales Review of Questionnaires in the Field Pre-pilot: Focus Group Pilot Test
32
Explore various dimensions of social circumstances Adopt the needs satisfaction model (CASP 19) Understand take up of services and satisfaction level Ensure comparability with other relevant data sources Carefully include only key questions to encourage parti
cipation; Further information will be explored in the wave 2 (Summer 2005)
Start from general questions to specific questions Consider respondent friendly format eg. font size and
space etc.
Questionnaire design: Rationales
33
Questionnaire Structure – Wave 1
A. Your feelings about home and the neighbourhoodB. Your friends and familyC. Your feelings about your lifeD. Your healthE. Your life in CamdenF. Getting out and aboutG. Work and retirementH. About yourself
34
Review Questionnaires in the Field
Example:
Quality of Life in Early Old Age Quality of Life through Early Old Age English Longitudinal Study of Ageing (ELSA): Wave 1-
Health and lifestyles of people aged 50 and over British Household Panel Survey (BHPS): Wave 11 –
Ageing, Health and Retirement variable component Census 2001 Health Survey for England (HSE) Best Value Performance Indicator Survey (BVPI)
Step 1 – Questionnaire Development
35
Pre-pilot: Focus Group
Three groups conducted; two cold call and one in community setting - to develop questions and explore people circumstances 1st group – Cold call 8 people
2nd group – Cold call 5 people
3rd group – Volunteer 6 people from the Network Group
Two additional groups from selected resource centres, plus one recall (Network Group) - to test filing in the draft questionnaire
Step 2 – Questionnaire Development
Questionnaire was too long, but comprehensive
Some wordings or questions were unclear
Front page should be more attractive (eg. color photos etc.), and use exciting words (eg. avoid the word “strategy” etc.)
Some people agreed that prize draw can help increase participation for the target group
Key Findings:
36
Pilot Test: 100 People Sampling frame
Older People Reference Group database
Criteria Census 2001; Profile of
Camden’s older citizens aged 60 and over
Age, gender, and ethnicity Sample size
100 people selected by purposive/quota sampling technique; over sampling non-white group
Response rate 70% achieved
Step 3 – Questionnaire Development
Some questions had no response since they are not applicable to the respondents. Therefore, suggested to add “None of these” Or “Not sure” etc.
Question related to service provision was too long and looked complicate. Some people skipped it. Therefore, suggested to reduce it to one page by selecting only the services that are directly linked to the strategy.
Some statements were not clearly linked to the corresponding tick boxes.
Some instructions were not clearly underlined. Some respondents misunderstood when reading quickly.
Key Findings:
37
Pilot Test: Expert Review Step 3 – Questionnaire Development (Cont’d)
Key Findings: The pilot questionnaire were also distributed to related parties to seek their expert suggestions to improve its quality Advisory Panel Implementation
team Selected professional
researchers
Overall, it was not feasible to cut number of pages from 12 to 8 pages since too many key questions would be eliminated.
Questions that can be found in other Camden surveys were deleted eg. housing conditions etc.
Questions that are more personal should be moved towards the end.
Health related questions should be adopted from the Quality of Life in Early Old Age since they have been well tested.
Some questions were reworded to be easier to understand and avoid start the sentence with negative meaning.
Some choices were revised to be more comprehensive.
Overall format were revised to make it look more friendly and easier to catch the key points eg. section heading or instruction etc.
38
Project Background
Partnership Approach
CamdenCouncil
CamdenPCT
CityUniversity
Quality of Life Research Studentship PhD registration and allowance Fieldwork
Advisory Panel Contribute to the evaluating strategy and help shape the
project’s direction Consist of Department of Health, Audit Commission, Age
Concern Camden, Better Government for Older People, University College London, Imperial College, London School of Hygiene and Tropical Medicine, and Ipsos UK.
Involvement of Older CitizensOlder People Reference Group 770 older people who have volunteered to give their opinions on issues affecting older people in
Camden Quality of Life Panel 12 older people, 8 councillors and 8 representatives from organisations working with older
people, who respond to issues raised by older people in a proactive way
[Note for presentation]
39
Wave 1: Preliminary FindingsMean Scores for Quality of Life Domains
Mean Scores for Quality of Life Domains
Range 0-57
Range 0-12
Range 0-15
Range 0-15
Range 0-15
39
7
10
9
13
0 10 20 30 40 50 60
CASP-19
Control
Autonomy
Self-realisation
Pleasure
Scores
Sample
Score range
40
Wave 1: Preliminary FindingsSocial Network >> Close Relationship – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
31
46
3540
0
20
40
60
Many Some One/Two None
Mea
n
Close Relationship
9%
36%31%
24%
0%
20%
40%
60%
80%
100%
Many Some One/Two None
41
Wave 1: Preliminary FindingsSocial Network >> Family and Friends – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
3742
0
20
40
60
Below/Equal average Above average
Mea
n
Family and Friends
56%44%
0%
20%
40%
60%
80%
100%
Below/Equalaverage
Above average
Score Range : 0-14Average: 10
42
Wave 1: Preliminary FindingsSocial Network >> Frequency of Contact – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
3542
0
20
40
60
Below/Equal average Above average
Mea
n
Frequency of Contact
59%
41%
0%
20%
40%
60%
80%
100%
Below/Equalaverage
Above average
Score Range : 0-16Average: 13
43
Wave 1: Preliminary FindingsHome Ownership – Profile and Mean CASP 19
Home Ownership
59%
41%
0%
20%
40%
60%
80%
100%
Owned/Sharedownership
Rented/Rent free
Mean Scores for Quality of Life(CASP-19)
4236
0
20
40
60
Owned/Sharedownership
Rented/Rent free
Mea
n
44
Wave 1: Preliminary FindingsLiving Alone or Not – Profile and Mean CASP 19
Living Alone or Not
58%
42%
0%
20%
40%
60%
80%
100%
Live as couple/withfriend/famliy
Live alone
Mean Scores for Quality of Life(CASP-19)
4138
0
20
40
60
Live as couple/withfriend/family
Live alone
Mea
n
45
Wave 1: Preliminary FindingsAccess to Car – Profile and Mean CASP 19
Access to Car
62%
38%
0%
20%
40%
60%
80%
100%
Yes No
Mean Scores for Quality of Life(CASP-19)
4237
0
20
40
60
Yes No
Mea
n
46
Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Like to Live in Current Neighbourhood – Profile and Mean CASP 19
Like to Live in Current Neighbourhood
8%(52 people)
92%(624 people)
0%
20%
40%
60%
80%
100%
Yes No
Mean Scores for Quality of Life(CASP-19)
4033
0
20
40
60
Yes NoM
ean
Total of 676 people
47
Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Moving Preference – Profile and Mean CASP 19
Moving Preference
13%(89 people)
8%(54 people)
79%(536 people)
0%
20%
40%
60%
80%
100%
Stay here Prefer tomove
Do not know
Mean Scores for Quality of Life(CASP-19)
403637
0
20
40
60
Stay here Prefer tomove
Do notknow
Mea
n
Total of 679 people
48
Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile and Mean CASP 19
Information Satisfaction Level
8%
37%
10%
45%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Mean Scores for Quality of Life(CASP-19)
3741
3539
0
20
40
60
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Mea
n
Info:277
of out 620 people
49
Service Satisfaction Level
9%
30%
9%
52%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Wave 1: Preliminary FindingsService Satisfaction Level – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
3740
3340
0
20
40
60
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Mea
n
Service:312
of out 602 people
50
Staff Satisfaction Level
10%
34%
7%
49%
0%
20%
40%
60%
80%
100%
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Wave 1: Preliminary FindingsStaff Satisfaction Level – Profile and Mean CASP 19
Mean Scores for Quality of Life(CASP-19)
373933
41
0
20
40
60
Satisfied Neithersatisfied nordissatisfied
Dissatisfied Not sure
Mea
n
Staff:293
of out 594people
51
National Service Framework for Older People (NSF-OP)
Published in March 2001
The health-driven framework sets eight new national standards of care for all older people
The standards will ensure investment is used wisely to improve quality of care and services for older people
Look to new models of care and service that emphasise prevention and rehabilitation
The Standard Eight - “To promote healthy living and an active life in later years”. It identifies that the health and well-being of older people is promoted through a co-ordinated programme of action led by the NHS with support from councils
52
National Service Framework for Older People (NSF-OP) – (Cont’d) Standard One: Rooting out age discrimination
NHS services will be provided, regardless of age, on the basis of clinical need alone. Social Care services will not use age in their eligibility criteria or policies, to restrict access to available services.
Standard Two: Person-centred careNHS and social care services treat older people as individuals and enable them to make choices about their own care. This is achieved through the single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services.
Standard Three: Intermediate careOlder people will have access to a new range of intermediate care services at home or in designated care settings to promote their independence by providing enhanced services from the NHS and councils to prevent unnecessary hospital admission and effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care.
Standard Four: General hospital careOlder people's care in hospital is delivered through appropriate specialist care and by hospital staff who have the right set of skills to meet their needs.
Standard Five: StrokeThe NHS will take action to prevent strokes, working in partnership with other agencies where appropriate.People who are thought to have had a stroke have access to diagnostic services, are treated appropriately by a specialist stroke service, and subsequently, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation.
Standard Six: FallsThe NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older people.Older people who have fallen receive effective treatment and rehabilitation and, with their carers, receive advice on prevention through a specialised falls service.
Standard Seven: Mental health in older peopleOlder people who have mental health problems have access to integrated mental health services, provided by the NHS and councils to ensure effective diagnosis, treatment and support, for them and for their carers.
Standard Eight: Promoting an active healthy life in older ageThe health and well-being of older people is promoted through a co-ordinated programme of action led by the NHS with support from councils.
53
Camden Community Strategy Published in June 2001
A multi-agency project between Camden Council, the Health Authority, the Police, Voluntary Action Camden, London Central Learning and Skills Council, and University College London (UCL)
The key areas for change that aim to improve the quality of life of Camden citizens include:
a place with stronger communities
a safer place
a healthier place
an economically successful place
an attractive and environmentally-friendly place
a place with excellent services
54
Camden Quality of Life Strategy Integrated strategies for older people aimed at promoting good health and quality of life, and to prevent or
delay frailty and disability
Demonstrate how agencies will work together and with older people to promote and provide healthy living activities, sustain people’s independence and promote positive views of ageing
Eight objectives guide the implementation of the strategy:
To promote the principles of active engagement
To make older people aware of a range of opportunities and activities that facilitate health and well-being.
To ensure older people have equal access to both statutory and non-statutory services.
To ensure older people have access to a range of services that can help to maximise their income, help them claim appropriate benefits and deal with any other advice needs they may have around financial issues.
To ensure older people feel safe and secure in their homes and in the community.
To promote a positive approach to the experience of ageing through older people working together and with others
To challenge assumptions about ageing by promoting links and activities across generations
To prepare generations for the opportunities and challenges of later year