Adaptation and evaluation of early intervention for older people in Iranian. (EASY-Care program in Iran) Dr Reza Fadayevatan, MD, MPH, PhD Head of Ageing Department, The University of Social welfare and Rehabilitation Sciences
Outlines- I Current status of older people population in Iran and Tehran Iran Ministry of Health Program for older people Elderly health service package
Outlines- II EASY-Care in Iran Undertaken programs On-going projects Up-coming programs
Current Status of older people population in Iran (latest census) Total number of population: 70,495,782 Number of older people population: 5,121,043 Percentage of older people: 7.26% Number of people aged 100+ in Tehran province:1891
Population of Older people in Tehran Tehran province: Total number of population : 13,422,366 Number of older people: 973,183
Tehran Different age groups living alone in Age groups 60-64 65-69 70-74 75 + Total The number of older people 14561 18217 22043 34685 89506
Ageing index The ratio of the population of people over 60 years of age to under 15 1986 1996 2006 Ageing Index 6.68% 10.93% 20.68%
Iran Ministry of Health Program for Older People Start date: 2005 Setting: 30 cities in Iran Domains of the package: Cardiovascular disease Diabetes Mental disorders Incontinence Falls Nutritional disease Hearing and seeing Osteoporosis Dementia Acute lung tuberculosis Immunization
Questionnaires of Iran Ministry of Health Program for older people Questionnaire at first admission Periodic care forms Referral forms Follow up forms
EASY-Care, Mission throughpeopleolderoflifetheimproveto better assessment and response to their health andcareneeds.
EASY-Care Standard: Domains Biography & Reason for Assessment Seeing, Hearing & Communicating Looking After Yourself Mobility Safety Accommodation & Finance Staying Healthy Mental Health and Well-Being Other Information
EASY-Care International Research Network Europe Belgium Czech Republic England Finland France Germany Greece Italy Latvia Lithuania Netherlands Poland Portugal Russia Scotland Sweden Switzerland Turkey
EASY-Care International Research Network Australia Brazil Canada Colombia Hong Kong Iran Malaysia Taiwan USA The University of Sheffield
EASY-Care, Undertaken programs in Iran 2008 Signing the contract with The University of Sheffield to start the work
2009 Preparatory work; Setting, budget, team members, professions empowerment etc. To set up a research team To attend EASY-Care symposium, IAGG, Paris To attend training course at The University of Sheffield, University of Warwick and Turkey
2010 Providing project budget Allocating the office for EASY-Care project at Tehran University of Medical Sciences (TUMS) To carry out review of literature Some courses in methodology of validation studies 1 PhD student on Easy Care (Warwick)
2011 Developing a care-plan for approaching at-risk people Digitalization EASY-Care Care plan CGA Developing a protocol for translation and cross-cultural adaptation using three protocols including: IQOLA (International Quality of Life Assessment) IPAQ (International Physical Activity Questionnaire) WHO recommendations
EASY-Care Ongoing projects (2011-present) 1. Psychometric properties of Farsi version of the EASY-Care instrument 2. Comparison of risk of falls and risk of breaking down in care between Iranian and Portuguese older people 3. Psychometric properties of the EASY-Care standard instrument as a global instrument.
Psychometric properties of Farsi version of the EASY-Care instrument (1 st ongoing project) Translation Forward Translation Review and assessment Backward Translation Pilot Study Main Study
Translation-I Forward translation A) Translation selection conducted using following criteria: 1. Health professional, familiar with terminology of Gerontology 2. Target language, mother tongue speaker 3. Knowledgeable of the English language culture, preferably graduated in an English-speaking country
Translation-II B) Translation Instruction was given to translator: 1. Translator should emphasize on the conceptual equivalence 2. Translator should consider the definition of the original term 3. Translation should be simple, clear and concise 4. Some words may not have equivalent or need to be changed to match with a similar concept in the target population 5. Translator should avoid the use of any jargons such as technical terms and idioms.
Review and assessment-i The original questionnaire and the preliminary forwardtranslation reviewed by two health care professionals and one professional translator both in qualitative and quantitative methods.
Review and assessment-ii Qualitative assessment 1. Comparing and adapting structures, writing style and conceptual equivalence 2. Identifying unclear expressions and suggesting alternatives
Review and assessment-iii Quantitative assessment The three experts rated the quality of translation in a Thurston scaling exercise from 0 (not all perfect) to 10 (perfect)
Back translation-i Backward translation A) Translation selection conducted using following criteria 1. Health professional, familiar with terminology of Gerontology 2. Target language, mother tongue speaker 3. Knowledgeable of the English speaking culture preferably graduated in an English-speaking country
Back translation-ii Back translation Instruction based on Brislin method (2000) was given to translator: 1. Translator should emphasize on the conceptual equivalence and cultural equivalence rather than linguistic equivalence. 2. Discrepancies should be discussed with the EASY-care network members in Iran
Pilot Study Aims: 1. To assess acceptability of the EASY-Care instrument from perspective of older people 2. To assess acceptability of the EASY-Care instrument from perspective of specialists
To assess acceptability of the EASY-Care instrument from perspective of older people Sample size: 50 older people were involved. 25 females and 25 males. All of them were over 60. After achieving informed signed consent, EASY-Care instrument and the questionnaire developed to assess the acceptability of EASY-care were completed. Data analysis: The data was analyzed using SPSS version 16.
Method: A questionnaire was developed for assessing the acceptability of the instrument asking questions about: the length and clarity of the instrument needs identification recommending the instrument for use with other older people.
Findings: 1. EASY-Care was highly accepted by older people in Iran and their suggestions included. 2. More research is needed to investigate acceptability of the EASY-Care in other cultures to generate a global version of the EASY-Care.
To assess acceptability of the EASY-Care instrument from perspective of specialists Methods Sample size : Data collection continued until the topic was saturated (15 specialists recruited). Method: A questionnaire was developed for assessing acceptability of the instrument asking three questions about: 1. needs identification 2. addressing the needs 3. preventing loss of health, independence and well-being in older people
Data analysis Data was analyzed using SPSS version 16. Findings Although all 3 scales mean scores showed the acceptability of the EASY-Care, the lowest mean scores were found for needs identification (M=1.33, SD=0.46).
Main Study (ongoing project) Aims Investigating of validity and reliability, item and test parameters of Persian version of the EASY-Care standard instrument. Target Population 500 male and female aged 60 and over
Inclusion Criteria: aged 60 and above; having consent to participate in the study. Exclusion criteria : having significant cognitive impairment (Abbreviated Mental Test (AMT) <7) and having a diagnosis of psychotic disorders.
Instruments Socio-demographic and health characteristics questionnaire Abbreviated Mental Test (AMT) EASY-Care standard instrument SF-36
Data collection The researcher read the questionnaires to the participants if they were unable to read. However, importantly, the researcher does not interpret the questionnaires or fill out the forms for the participants.
Data Analysis Data analysis will be done based on Classic Test Theory (CTT) and Item-Response Theory (IRT).
Validation process based on CTT Assessing reliability Test-retest conducted as reproducibility measure after a two week interval. Internal consistency was measured with Cronbach s alpha. Inter-rater reliability was estimated based on the correlation of scores between two raters who rate the EASY-Care.
Investigating validity Content validity assessed in an expert panel Construct-related validity Confirmatory Factor Analysis Exploratory Factor Analysis Concurrent validity will be assessed using correlation with SF-36 and AMT.
Ethical Considerations The study was approved by Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences on 20/05/2010 and all participants gave a written consent form and an information sheet inviting them to take part in the study which included coverage of the aim of the study. Participation in this study is voluntary.
Comparison of independency between Iranian and Portuguese older people: A cross-cultural study (2 nd ongoing project)
Aims: Psychometric properties of independency score of EASY-care Comparison of classic Test Theory (CTT) and Item Response Theory (IRT) Cultural differences in Iran and portugal
Methods-I Type of study: Exploratory study Setting: community dwelling older people and residential (male and female) living in Tehran (Iran) and Aveiro (Portugal)
Methods-II Sampling: The participants recruited through a random sampling, non probability, sample of convenience, only consented participants Sample size: 799 (319 Iranian and 460 Portuguese older people)
Methods-III Method A sample of 319 Iranian and 460 Portuguese older people were measured using the 18-items independence scale of the EASY-Care. The data were analyzed using Rasch rating Scale Model (RSM) by WINSTEPS 3.49 (Linacre, 2004) software program.
Methods- VI Data analysis Step 1: Based on Classic Test Theory (CTT) using LERTAP (5) Step 2: Based on the Rasch Scale Model (RSM) of Item Response Theory (IRT) using Linacre (3.49)
Outcome: Developing a global instrument through: 1. Analyzing the UK version of the EASY-Care using CTT 2. Analyzing data from all countries using IRT
Psychometric properties of the EASY-Care standard instrument as a global instrument.(3 rd ongoing project) Aim: Developing a global assessment instrument for older people using IRT Data collection is currently being carried out worldwide.
Upcoming programs Clinical outcome evaluation Cost effectiveness Forming the National Advisory Board Presenting the whole work in the 20 th IAGG conference, Seoul 2013 Comparison of risk of falls and risk of breaking down in care between Iranian and Portuguese older people
Thank you for listening 54