Home visiting programme for older people with health problems: process evaluation

Aim. This paper is a report of a process evaluation of the content, patient compliance and participant experiences of a home visiting programme for older people with self-reported health problems. Background. Systematic home visits by nurses to older people are a public health strategy to improve their functional abilities and prevent institutionalization. Evidence of the usefulness of these visits is conflicting, partly due to a lack of information on the intervention process in these programmes. Method. One hundred and sixty people (aged 70-84 years) participated in the programme and were visited eight times during an 18-month period (February 2003-October 2004) by experienced home nurses. The nurses recorded key elements of each visit on standard forms: topics discussed, interventions regarding health problems and risks, and compliance with these interventions. Participants' and nurses' opinions on the visits were obtained through interviews at the end of the programme. Findings. Nearly 80% of the group received the complete programme. Problems were detected in nearly all visits, mainly regarding social and psychological functioning, circulatory and musculoskeletal problems, and vision or hearing impairment. On average, ten problems and 11 interventions were recorded per participant. Nearly 40% of interventions related to referrals, 45% to advice and 17% consisted of information-giving. The compliance rate was 65% for referrals and 58% for advice. Both nurses and participants were positive about the programme. Conclusion. A health visiting programme, performed by home nurses, is feasible and appreciated by frail elders. The latter seem to be a relevant target population in view of the many and varied problems detected.