3020 — Organizational, Provider, and Client Influences on Elder Participation and Outcomes in Community-Based Disability Prevention Programs

Dossa A (Center for Health Quality, Outcomes, and Economic Research, ENRM VA, Bedford, MA)

Objectives:
Health and social service requirements of disabled elders including elder veterans represent an increasing challenge for the U.S. Effective strategies to prevent elder disability include community disability prevention programs for elders with chronic disease at risk for disability. Program completion, however, remains an important barrier to their effectiveness. This study examined the association of organizational, provider, and client variables with program completion and health outcomes for a one-year evidence-based disability prevention program in 22 U.S. senior center sites. It was hypothesized that program completion and health outcomes would be positively associated with sites having more focus on relational coordination and client relationships, and with higher baseline client self-efficacy.

Methods:
This mixed methods study combined: a quantitative analysis of secondary longitudinal data of 719 elder clients; primary data on organizational and provider variables and qualitative data on provider perspectives on participation, through telephone interviews with 16 nurses, 18 social workers, and 15 site managers.

Results:
Quantitative findings showed that higher baseline self-efficacy positively influenced program completion, and functional outcomes at 12 months. Minority status negatively influenced program completion. Unexpectedly, relational coordination did not independently influence program completion or health outcomes, but its effects varied depending on client variables. Urban sites and smaller size sites positively influenced 12 month functional outcomes. Qualitative patterns showed that providers in sites with high completion rates perceived the importance of relationship building for program completion, versus low completion sites where providers perceived that client self-efficacy helped program completion. High completion sites had a higher percentage of health mentor programs (matching clients to trained elder peers) than low completion sites.

Implications:
Client self-efficacy, provider-client relationships, minority status, minority providers, and lay health mentors were associated with program completion and health outcomes.

Impacts:
Study findings have implications for the design and implementation of community-based chronic disease programs that reduce disability in elders as well as in elder veterans as follows: a need for increased practitioner awareness of client baseline self-efficacy and relationship building; a need for policy makers and community-based administrators to fund and train more minority providers; and fund more lay health mentor programs, to enhance program completion and health outcomes.