Feasibility and acceptability of a new home-based health promotion intervention for older people with mild frailty: Feasibility Randomised Controlled Trial
Older people with mild frailty can feel “slowed up” or fatigued, needing help with instrumental activities of daily living e.g. finances, transportation, housework, managing medication. Health promotion interventions may help maintain independence and well-being, but it is currently unclear which approaches work. We tested the feasibility/acceptability of a new home-based health promotion service for older people with mild frailty.
Design: Feasibility Randomised Controlled Trial with Process Evaluation
Study population: Older people aged 65 and over with mild frailty were recruited from four general practices across two Clinical Commissioning Groups in urban and semi-rural areas. They were individually randomised to either receive a new health promotion service ‘HomeHealth’ or treatment as usual.
‘HomeHealth’ Intervention: The service included 3-12 one-to-one sessions (at home or on the telephone) over six months with a trained support worker. The service was tailored to the participants’ needs and included behavior change techniques such as goal setting, problem solving and forming habits. Participants set their own outcome goals, broadly within the domains of mood, nutrition, social isolation and mobility/physical activity.
Measurements: Baseline and 6 month assessments included measurements of functioning, frailty phenotype, psychological wellbeing, cognition, health behaviours, quality of life, and service use. Feasibility/acceptability data included recruitment rates, retention and a mixed methods process evaluation (semi-structured interviews and postal questionnaires).
We recruited above our target of 50 people (n=51) in less time than scheduled and retention was high (n=48/51, 94%) over six months follow-up. No serious adverse events related to the intervention were observed. Findings on clinical outcomes will be presented. Results from process evaluation questionnaires (response rate 42/51, 82%, including 22/26 in the intervention arm and 20/25 control arm) show that trial and intervention procedures were acceptable to older people. The majority (19/22) of intervention participants responding were happy/very happy with the progress they made towards their goals and the majority (19/22) found the service helpful/very helpful. Positive feedback on service delivery features included timing, length/number of appointments, and home-based location. Interviews with 16/26 intervention participants and 3 service providers suggested most had had positive experiences of the service and found it highly acceptable. Valued components of the intervention included counselling and reflective listening, education, information about services, goal-setting and emotional and practical support. Ways to improve the service were identified, including extra training for support workers in handling food diary feedback and counselling skills. Service coordination was helpful to people with dementia and mild cognitive impairment, but goal-setting required carer involvement.
Overall, the new health promotion service for mildly frail older people was feasible and acceptable, with potential benefits that need to be tested in a larger-scale evaluation.