scholarly journals PHYSICAL ACTIVITY PREFERENCES OF OLDER ADULT MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER CLIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S500-S500
Author(s):  
Victoria S Davila ◽  
Lauren Pietzak ◽  
Danielle Rossi ◽  
Karen Phipps ◽  
Margaret Danilovich
Keyword(s):  
Physical Activity ◽  
Older Adult ◽  
Health Belief ◽  
Care Program ◽  
Structured Interview ◽  
Structured Interviews ◽  
Community Based ◽  
Individual Level ◽  
Personalized Approach ◽  
Community Based Services

Abstract Despite the known effectiveness, physical activity (PA) is not currently offered to older adult clients receiving Medicaid Home and Community Based Services (HCBS). To optimize PA implementation within Medicaid HCBS, understanding client preferences for PA programming is needed. Thus, the objective of this exploratory qualitative study was to identify the PA preferences of HCBS clients including mode, duration, implementation strategy, and frequency, as well as barriers and motivators to PA. We recruited participants from the Illinois’ Department on Aging Community Care Program. We conducted semi-structured interviews in participants’ homes which were audio recorded, transcribed, and analyzed using Dedoose (version 7.0.23). We derived semi-structured interview questions from the Health Belief, Social Cognitive, and Health Action Process Approach framework. We used a structured coding approach using conventional content analysis to derive codes from the text, then applied these codes to each interview and examined the frequency to determine themes. The most frequently referenced theme was barriers to PA, primarily co-morbidities. The primary motivator was social support by a peer or instructor. The preferred PA program components were walking 2-3 days per week with duration varying from 20 minutes to 2 hours. Clients also preferred individualized PA instruction versus a passive strategy such as pamphlets or videotapes. Our findings show that individual-level factors most significantly influence PA participation and should be addressed among Medicaid HCBS clients. We recommend Medicaid HCBS consider a personalized approach of PA implementation with their clients.

Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy

2007 ◽  
Vol 191 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Giovanni De Girolamo ◽  
Angelo Barbato ◽  
Renata Bracco ◽  
Andrea Gaddini ◽  
Rossella Miglio ◽  
...  
Keyword(s):  
Patient Care ◽  
Full Range ◽  
Great Variability ◽  
Structured Interviews ◽  
Community Based ◽  
Public And Private ◽  
Psychiatric Admissions ◽  
Italian Regions ◽  
Hospital Days ◽  
Community Based Services

BackgroundLegislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care.AimsTo survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders.MethodStructured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily.ResultsOverall, Italy (except Sicily) has atotal of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10 000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10 000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10 000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for atotal of 114 570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities.ConclusionsThe overall number of acute beds per 10 000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.

scholarly journals Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina

2019 ◽  
Vol 16 (2) ◽  
pp. 213 ◽  
Author(s):  
Maria Belizan ◽  
R. Chaparro ◽  
Marilina Santero ◽  
Natalia Elorriaga ◽  
Nadja Kartschmit ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Local Community ◽  
Project Evaluation ◽  
Political Support ◽  
Healthy Diet ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Community Based Interventions ◽  
Community Based

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups

2016 ◽  
Vol 40 (3) ◽  
pp. 294-331 ◽  
Author(s):  
Marion Herens ◽  
Annemarie Wagemakers ◽  
Lenneke Vaandrager ◽  
Johan van Ophem ◽  
Maria Koelen
Keyword(s):  
Physical Activity ◽  
Local Governance ◽  
Community Outreach ◽  
Vulnerable Groups ◽  
Outreach Program ◽  
Intersectoral Collaboration ◽  
Structured Interviews ◽  
Community Based ◽  
Physical Activity Programs ◽  
Socially Vulnerable Groups

This article presents a practitioner-based approach to identify key combinations of contextual factors (C) and mechanisms (M) that trigger outcomes (O) in Dutch community-based health-enhancing physical activity (CBHEPA) programs targeting socially vulnerable groups. Data were collected in six programs using semi-structured interviews and focus groups using a timeline technique. Sessions were recorded, anonymized, and transcribed. A realist synthesis protocol was used for data-driven and thematic analysis of CMO configurations. CMO configurations related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants’ active lifestyles. We have refined the CBHEPA program theory by showing that actors’ passion for, and past experiences with, physical activity programs trigger outcomes, alongside their commitment to socially vulnerable target groups. Project discontinuity, limited access to resources, and a trainer’s stand-alone position were negative configurations. The authors conclude that local governance structures appear often to lack adaptive capacity to accommodate multilevel processes to sustain programs.

scholarly journals Considerations for Individual-Level Versus Whole-School Physical Activity Interventions: Stakeholder Perspectives

2021 ◽  
Vol 18 (14) ◽  
pp. 7628
Author(s):  
Byron Tibbitts ◽  
Kathryn Willis ◽  
Tom Reid ◽  
Simon J. Sebire ◽  
Rona Campbell ◽  
...  
Keyword(s):  
Physical Activity ◽  
School Environment ◽  
Evidence Base ◽  
Activity Levels ◽  
Structured Interviews ◽  
Individual Level ◽  
Whole School ◽  
School Based ◽  
School Based Interventions ◽  
Whole School Approach

Strategies to address declining physical activity levels among children and adolescents have focused on ‘individual-level’ approaches which often fail to demonstrate impact. Recent attention has been on an alternative ‘whole-school’ approach to increasing physical activity that involves promoting physical activity throughout all aspects of the school environment. There is, however, a lack of evidence on how whole-school physical activity approaches could be implemented in the UK. This qualitative study explored perspectives of key stakeholders on potential reasons for the lack of impact of individual-level school-based interventions on children’s physical activity, and key considerations for adopting a whole-school approach. Nineteen semi-structured interviews were conducted with a range of stakeholders involved in the implementation of physical activity programmes in UK schools. Data were analysed using an inductive approach. Respondents suggested that individual-level school-based interventions to increase physical activity often failed to consult end users in the design and were typically implemented in environments unsupportive of long-term change. They subsequently outlined specific barriers and key facilitators for the adoption and implementation of whole-school approaches in UK settings and recommended a shift in research foci towards building an evidence base around educational outcomes and whole-school implementation insights.

scholarly journals Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

2020 ◽  
pp. 073346482092451
Author(s):  
Esther M. Friedman ◽  
Regina A. Shih ◽  
Sangeeta C. Ahluwalia ◽  
Virginia I. Kotzias ◽  
Jessica L. Phillips ◽  
...  
Keyword(s):  
Long Term Care ◽  
Aging In Place ◽  
Care Program ◽  
Community Based ◽  
Term Care ◽  
Incentive Program ◽  
Policy Goals ◽  
Services And Supports ◽  
Community Based Services

Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to “rebalance” Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.

scholarly journals  Physical activity in the classroom: Using RE-AIM to evaluate a national school reform – a mixed methods study

2021 ◽  
Author(s):  
Sofie Koch ◽  
Charlotte Skau Pawlowski ◽  
Thomas Skovgaard ◽  
Natascha Holbæk Pedersen ◽  
Jens Troelsen
Keyword(s):  
Physical Activity ◽  
Public Schools ◽  
Mixed Methods ◽  
School Reform ◽  
Implementation Process ◽  
Structured Interview ◽  
School Management ◽  
Evaluation Tool ◽  
Structured Interviews ◽  
Competencies Development

Abstract Background In 2014, the Danish Government introduced a wide-ranging school reform that applied to all public schools in Denmark. A distinctive feature of the reform was that it became mandatory to implement an average of 45 minutes of daily physical activity within the curriculum. Using the RE-AIM framework as an evaluation tool, the objective of the current study was to evaluate the reach, effectiveness, adoption, implementation, and maintenance of mandatory physical activity within curriculum at ten Danish schools. Methods A complementary mixed methods approach using accelerometers, questionnaires, and semi-structured interviews was conducted. A total of 11 representative school were invited to participate, including 993 students, 131 teachers, and 11 school managers. Students were invited to wear an accelerometer for seven consecutive days. Teachers were invited to participate in a questionnaire and school managers were encouraged to take part in a semi-structured interview. Results A total of 10 schools were included in the analysis, including 846 students, 76 teachers, and 10 school managers. Results showed that, on average, 45.2% of the students were active at least 45 minutes daily within curriculum. Teacher and school management interest in physical activity, competencies development, and shared decision-making were identified as central factors for adoption of the requirement. Scheduling physical activity within timetables and collaborations with external parties were found to influence the implementation dimension. Finally, internal coordination, motivated school staff, and school management priority were identified as centrals factors for maintenance. Conclusions This study provides an evaluation on a national physical activity requirement in Danish public schools. When introcuding a wide-ranging national requirement on physical activity within curriculum, school managers need to prioritize and support the implementation process. Teachers need to be involved in the decision processes, in order to ensure motivation and local ownership. The study also highlight the benefits of an internal coordinator as well as development of a shared strategy among schools, municipalities, and other stakeholders in order to succeed with the implementation.

scholarly journals Development of a Functional and Psychosocial Evaluation Toolkit Using Mixed Methodology in a Community-Based Physical Activity Program for Childhood Cancer Survivors

2021 ◽  
Author(s):  
Jena Shank ◽  
Carolina Chamorro-Viña ◽  
Gregory Guilcher ◽  
Fiona Schulte ◽  
S. Nicole Culos-Reed
Keyword(s):  
Physical Activity ◽  
Knowledge Translation ◽  
Childhood Cancer ◽  
Program Effectiveness ◽  
Energy Levels ◽  
Childhood Cancer Survivors ◽  
Activity Levels ◽  
Structured Interviews ◽  
Community Based ◽  
Pediatric Cancer Patients

Abstract Purpose The evidence demonstrating the benefits of exercise and PA in patients and survivors of childhood cancer has been translated into a handful of community-based programs, such as the Pediatric cancer patients and survivors Engaging in Exercise for Recovery Program (PEER). In order to support the translation of research to practice, the next step in knowledge translation is to evaluate program effectiveness. An evaluation must consider the goals of the PEER program, feedback from key stakeholders and logistics of this program. Thus, the purpose of this study was to develop an evaluation toolkit with an algorithm for implementation for the PEER program. Methods Semi-structured interviews were conducted with three different groups (stakeholders in pediatric oncology, PEER parents and PEER participants). The interviews were transcribed and coded by two independent reviewers. Results Key themes extracted from the interviews were split into physical and psychosocial themes. The most commonly reported psychosocial themes were QOL, fatigue/energy levels, fun and confidence levels; and physical themes included motor skills, physical literacy and physical activity levels. Tools were compiled into the evaluation based on key themes identified as well as logistics of PEER. An algorithm was developed to tailor the evaluation to participants based on age, cognitive ability and mobility. Conclusion To date, this is the first evaluation toolkit and algorithm developed for a specific community-based PA program, the PEER program. The next step in knowledge-translation will be to implement the evaluation to assess feasibility, and share the evaluation for adoption within other developing programs.

scholarly journals Residence in HUD Housing Associated With Greater Benefit From HCBS Services for Medicaid Enrollees in Pennsylvania

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 477-478
Author(s):  
Damian Da Costa ◽  
Howard Degenholtz
Keyword(s):  
Nursing Home ◽  
Multinomial Logistic Regression ◽  
Nursing Home Admission ◽  
Community Based ◽  
Term Care ◽  
Individual Level ◽  
Risk Of Death ◽  
Care Services ◽  
Community Residence ◽  
Community Based Services

Abstract State Medicaid programs seek to shift the delivery of long-term care services away from institutional settings and toward community-based settings by expanding access to home-and-community-based services (HCBS). HCBS are hypothesized to prevent or delay the need for protracted nursing home stays. This study explores the question of which types of community residence maximize this protective effect of HCBS. We used a probabilistic matching technique to identify whether waiver-eligible Medicaid enrollees were likely to reside in project-based HUD housing in 2013. We applied multinomial logistic regression to observe the risk of long-stay nursing home admission (>100 days) relative to persistent community residence in the subsequent four years. Our model controlled for age, race, gender, urban status, and receipt of home-and-community based services. Our predictor of interest was the interaction between receipt of home and community based services (HCBS) and residence in HUD housing. The eligible baseline population included 152,632 community-residing Pennsylvania Medicaid enrollees in 2013. The analytic sample excluded individuals who died during 2013 or who were no longer waiver-eligible after 2013. Residence in HUD project-based housing while receiving HCBS is independently associated with a 27% percent reduction in risk of long-stay nursing home admission (p = .01) when controlling for individual-level demographics. No significant association was observed between the predictor of interest and risk of death during the follow-up period, suggesting that this finding is not likely confounded by individual health status. Further research should test whether this association is causal and specify possible mechanisms.

scholarly journals Formative Evaluation of Open Goals: A UK Community-Based Multi-Sport Family Programme

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 119
Author(s):  
Leanne Burton ◽  
Kathryn Curran ◽  
Lawrence Foweather
Keyword(s):  
Physical Activity ◽  
Formative Evaluation ◽  
Target Area ◽  
Activity Levels ◽  
Structured Interviews ◽  
Community Based ◽  
Social Barriers ◽  
North West ◽  
Physical Activity Levels ◽  
Regular Family

Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of ‘Open Goals’ (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club’s charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May–July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children’s behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.

scholarly journals Patterns of home- and community‐based services in older adults with dementia: an analysis of the long‐term care system in Taiwan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen-Fu Wang ◽  
Yung-Yu Su ◽  
Kai-Ming Jhang ◽  
Chun-Min Chen
Keyword(s):  
Service Use ◽  
Long Term Care ◽  
Community Support ◽  
Structured Interview ◽  
Service Utilisation ◽  
Community Based ◽  
Term Care ◽  
Factors Influencing ◽  
Community Based Services

Abstract Background Understanding the specific characteristics of the patients with dementia is essential in developing services required to meet their needs. The purpose of this study was to investigate the patterns of use of home- and community-based services (HCBS) by patients with dementia and the factors influencing the utilisation of these services. Methods We analysed a dataset of patients with dementia receiving long-term care at a medical centre. All participating patients were required to complete a structured interview form every 6 months to assess their need for service utilisation. Between 2015 and 2018, a total of 822 patients fulfilled the criteria for dementia, and 737 people had assessment records, of whom 244 had used social services. Robust Poisson regression analyses were performed to estimate HCBS usage and the factors influencing service utilisation. Results The overall service utilisation rate was 33 %. Most patients used only one service, and assistive devices were used as the main service. Regarding the factors influencing service use, dementia concomitant with dependency increased the use of HCBS. These results suggest that patients with mild dependency might prefer to use community support services, whereas those with moderate to severe dependency being more likely to utilise in-home care services. Conclusions This study provides empirical evidence regarding the use of long-term care resources by patients with dementia in the community. Providing customised HCBS, rather than a non-specialised service assumed to be suitable for every patient, is essential for ensuring good patient care. In addition, attention needs to be paid to patients with care needs who do not use HCBS.

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