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Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By…

Presentation to Thailand’s Ministry of Public Health. Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By… Nink Pussayapibul Quality of Life Researcher Department of Sociology City University London. 13 January 2006. Presentation Outline.

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Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By…

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  1. Presentation to Thailand’s Ministry of Public Health Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By… Nink Pussayapibul Quality of Life Researcher Department of Sociology City University London 13 January 2006

  2. Presentation Outline • Introduction • Project Background • Policy Context • Project Overview • Research Aims, Research Questions and Methodology • Achievement to Date and Challenges • Preliminary Results • Quantitative Arm - Wave 1: Main Survey (Summer 2004) • Next Steps • Discussion

  3. Project Background Partnership Approach Camden Council Camden Primary Care Trust • Quality of Life Research Studentship • Advisory Panel City University

  4. 2. Quality of Life Panel 12 Older people 8 Councillors 8 Voluntary Organisations Representatives Project Background (Cont’ d) Involvement of Older Citizens Annual Report to Council Executive 1. Older People Reference Group Quality of Life Partners 770 Older people

  5. Policy Context Quality of Life Strategy for Camden’s Older Citizens • To be the vehicle to deliver on the targets set out in the Community Strategy that relate to older people, and • To progress and deliver the National Service Framework for Older People – NSF Standard 8

  6. Research Aims To evaluate the impact of the implementation of the Quality of Life Strategy on Camden’s older citizens’ perception of feeling independent, having choice and control and a sense of well-being

  7. Research Questions • How is older people’s perception of quality of life changing over time? • What impact are services having on older people’s quality of life over time? • How is the implementation of the Quality of Life Strategy affecting older people’s perception on their quality of life? How much of this is as a result of the strategy?

  8. Quantitative Arm A Panel Survey Various dimensions of social circumstances The needs satisfaction model (CASP-19) Take-up of services and satisfaction rates Comparability with other relevant data sources Qualitative Arm Gathering Stories from Older People In-depth interviews with selected members of Quality of Life Panel In-depth interviews with the selected sample; targeted to set up contrast groups based on the first wave of the quantitative survey Research Methodology

  9. Year 1 Year 2 Year 3 Oct–Dec ’03 (3m) Jan–Apr ’04 (4m) July ’04 – May ‘05 (11m) Jun – Dec ‘05 (7m) Jan – Sep ‘06 (9m) May-June ’04 (2m) Timetable Achievement-to-date • Capacity building • Initial data collection • Pre-pilot planning • Draft questionnaire design • The first main survey • Qualitative interviews • Preliminary analysis • Literature review (Cont’d) • Pilot testing • Appointment of fieldwork agency • Analysis of results from the pilot testing • Sample design • Final revision of postal questionnaire • Follow-up survey • Follow-up qualitative interviews • Final analysis • Literature review (Cont’d) • Write-up • Literature review • Questionnaire design • Pre-pilot testing • Application to Consultation Board at Camden Council • Identification of potential fieldwork agencies

  10. Achievement-to-Date Quality of Life Survey • Pre-pilot(2004) • Three focus groups – to develop questions • Two additional groups – to test the draft questionnaire • Pilot test(2004) • 100 people selected from Older People Reference Group (postal) • 70% response rate achieved • Wave 1 of main survey(Summer 2004) • 1,500 people selected from Accessible Transport database (postal) • Boost sample through the Mobile Library scheme to target housebound people • 40% response rate achieved • Preliminary report completed and used to further develop the Community Strategy • Wave 2 of main survey(Summer 2005) • 446 people who agreed to be re-contacted from the wave one (postal) • 65% response rate achieved Jan 2006

  11. Achievement-to-Date (Cont’d) Gathering Stories from Older Selected Citizens • Five in-depth interviews(May 2004) • Selected members of the Quality of Life Panel • Interviews conducted before they attended the first panel meeting • Qualitative report completed and used to further develop the Community Strategy • Follow up in-depth interviews(Nov 2005) • To gather people’s experiences as the Quality of Life panellists. • To gather their views on being active in local community. • Targeted interviews(Dec 2005) • Sixteen targeted in-depth interviews with a sub-sample of respondents from the first wave of the quantitative survey. These were targeted in order to draw out contrasts based on their use of services and quality of life scores. • The targeted interviews seek to deepen our understanding on how the services under the Quality of Life Strategy make a difference to older people’s lives. The intention is to complement the questionnaire survey and provide a more comprehensive picture of older people’s lives. Jan 2006

  12. Challenges • Secure funding to complete PhD • Limited knowledge in the field • Balance expectations/workloads between sponsor and academic demands • Research design to meet objectives while being practical • Manage project and gain support by working with various parties – eg. network, ask for flavour, subcontract etc. • Communication to various audiences – eg. policy makers, partners, older citizens and academia etc. • Time constraints within limited budget

  13. Questionnaire Structure • Your recent life event (only wave 2) • Your feelings about home and the neighbourhood • Your friends and family • Your feelings about your life • Your health • Your life in Camden • Getting out and about • Work and retirement • About yourself (only wave 1)

  14. Quality of Life Measure: CASP-19 Control Quality of Life Autonomy Self-realisation Pleasure

  15. CASP-19 (Cont’d) CONTROL • My age prevents me from doing the things I would like to • I feel that what happens to me is out of my control • I feel free to plan for the future • I feel left out of things AUTONOMY • I can do the things that I want to do • Family responsibilities prevent me from doing what I want to do • I feel that I can please myself what I can do • My health stops me from doing the things I want to do • Shortage of money stops me from doing the things that I want to do PLEASURE • I look forward to each day • I feel that my life has meaning • I enjoy the things that I do • I enjoy being in the company of others • On, balance, I look back on my life with a sense of happiness SELF- REALIZATION • I feel full of energy these days • I choose to do things that I have never done before • I feel satisfied with the way my life has turned out • I feel that life is full of opportunities • I feel that the future looks good for me

  16. Sample Census 2001 Wave 1: Preliminary FindingsSample Characteristics Average age = 72 years old

  17. Wave 1: Preliminary FindingsAge – Profile and Mean CASP 19

  18. Wave 1: Preliminary FindingsEthnicity – Profile and Mean CASP 19

  19. Wave 1: Preliminary FindingsGender – Profile and Mean CASP 19

  20. Wave 1: Preliminary FindingsSelf-assessed Health – Profile and Mean CASP 19

  21. Wave 1: Preliminary FindingsLongstanding Illness – Profile and Mean CASP 19

  22. Wave 1: Preliminary FindingsIncome Adequacy – Profile and Mean CASP 19

  23. Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile Info: 277 of out 620 people

  24. Wave 1: Preliminary FindingsService & Staff Satisfaction Level – Profile Service: 312 of out 602 people Staff: 293 of out 594 people

  25. ABOVE average ( ) quality of life scores (MeanCASP-19)* Wave 1: Preliminary FindingsService Usage Category Services Number of people who USE Housing Careline 69 x Home adaptation 53 x Warmth for All 51 x Sheltered housing service 40 x Handy Person 31 x Care and Repair 27 x Learning Library 261 Home Library/Mobile Library 55 x Free training and the use of computer service 40 A Fair COPP 31 x Exercise Specialist exercise classes for older people 44 x * Mean quality of life score = 39

  26. Number of people ABOVE average ( ) who USE quality of life scores (MeanCASP-19)* 405 93 42 10 4 76 37 32 21 14 14 8 Wave 1: Preliminary FindingsService Usage Category Services Transportation Freedom Pass Taxi-card x Dial-a-ride x PlusBus x Shop Mobility/Scooter loan Finance Welfare benefit service or pension service x Others Camden Age Concern x Resource Centres/Day centres for older people x Well&Wise x Citizens Advice Bureau Housebound Service x Good Neighbour Schemes x Outreach service x * Mean quality of life score = 39

  27. Next Steps • Present results from wave 2 fieldwork to related parties • Analyse and compare results from wave 1 and 2, and in-depth interview • Write-up

  28. References • Blane, D., R. Wiggins, et al. (2002). "Inequalities in Quality of Life in Early Old Age." ESRC Growing Older Programme Research Findings: 9. • (http://www.shef.ac.uk/uni/projects/gop/index.htm) • Camden's Promoting Independence Group (2002). Quality of Life Strategy for Camden's Older Citizens. London, London Borough of Camden: 28. • (http://www.camden.gov.uk/ccm/content/council-and-democracy/plans-and-policies/quality-of-life-strategy-for-older-citizens/quality-of-life-strategy-for-older-citizens.en) • Department of Health (2001). National Service Framework for Older People: Executive Summary. London, Department of Health: 32. • (http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4010161&chk=6GV5oj) • Hyde, M., Wiggins, R. D., Higgs, P. and Blane, D. (2003). "A Measure of Quality of Life in Early Old Age: the Theory, Development and Properties of a Needs Satisfaction Model (CASP-19)." Aging and Mental Health 7(3): 186-194.

  29. Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens Discussion For further information, please contact: Nink Pussayapibul n.pussayapibul@city.ac.uk

  30. BACK UP SLIDES

  31. Questionnaire Development • Rationales • Review of Questionnaires in the Field • Pre-pilot: Focus Group • Pilot Test

  32. Questionnaire design: Rationales • Explore various dimensions of social circumstances • Adopt the needs satisfaction model (CASP 19) • Understand take up of services and satisfaction level • Ensure comparability with other relevant data sources • Carefully include only key questions to encourage participation; Further information will be explored in the wave 2 (Summer 2005) • Start from general questions to specific questions • Consider respondent friendly format eg. font size and space etc.

  33. Questionnaire Structure – Wave 1 • Your feelings about home and the neighbourhood • Your friends and family • Your feelings about your life • Your health • Your life in Camden • Getting out and about • Work and retirement • About yourself

  34. Review Questionnaires in the Field Step 1 – Questionnaire Development Example: • Quality of Life in Early Old Age • Quality of Life through Early Old Age • English Longitudinal Study of Ageing (ELSA): Wave 1- Health and lifestyles of people aged 50 and over • British Household Panel Survey (BHPS): Wave 11 – Ageing, Health and Retirement variable component • Census 2001 • Health Survey for England (HSE) • Best Value Performance Indicator Survey (BVPI)

  35. Pre-pilot: Focus Group Step 2 – Questionnaire Development • Three groups conducted; two cold call and one in community setting - to develop questions and explore people circumstances • 1st group – Cold call 8 people • 2nd group – Cold call 5 people • 3rd group – Volunteer 6 people from the Network Group • Two additional groups from selected resource centres, plus one recall (Network Group) - to test filing in the draft questionnaire Key Findings: • Questionnaire was too long, but comprehensive • Some wordings or questions were unclear • Front page should be more attractive (eg. color photos etc.), and use exciting words (eg. avoid the word “strategy” etc.) • Some people agreed that prize draw can help increase participation for the target group

  36. Pilot Test: 100 People Step 3 – Questionnaire Development • Sampling frame • Older People Reference Group database • Criteria • Census 2001; Profile of Camden’s older citizens aged 60 and over • Age, gender, and ethnicity • Sample size • 100 people selected by purposive/quota sampling technique; over sampling non-white group • Response rate • 70% achieved Key Findings: • Some questions had no response since they are not applicable to the respondents. Therefore, suggested to add “None of these” Or “Not sure” etc. • Question related to service provision was too long and looked complicate. Some people skipped it. Therefore, suggested to reduce it to one page by selecting only the services that are directly linked to the strategy. • Some statements were not clearly linked to the corresponding tick boxes. • Some instructions were not clearly underlined. Some respondents misunderstood when reading quickly.

  37. Pilot Test: Expert Review Step 3 – Questionnaire Development (Cont’d) Key Findings: • The pilot questionnaire were also distributed to related parties to seek their expert suggestions to improve its quality • Advisory Panel • Implementation team • Selected professional researchers • Overall, it was not feasible to cut number of pages from 12 to 8 pages since too many key questions would be eliminated. • Questions that can be found in other Camden surveys were deleted eg. housing conditions etc. • Questions that are more personal should be moved towards the end. • Health related questions should be adopted from the Quality of Life in Early Old Age since they have been well tested. • Some questions were reworded to be easier to understand and avoid start the sentence with negative meaning. • Some choices were revised to be more comprehensive. • Overall format were revised to make it look more friendly and easier to catch the key points eg. section heading or instruction etc.

  38. Camden Council Camden PCT City University Project Background [Note for presentation] Partnership Approach • Quality of Life Research Studentship • PhD registration and allowance • Fieldwork • Advisory Panel • Contribute to the evaluating strategy and help shape the project’s direction • Consist of Department of Health, Audit Commission, Age Concern Camden, Better Government for Older People, University College London, Imperial College, London School of Hygiene and Tropical Medicine, and Ipsos UK. Involvement of Older Citizens • Older People Reference Group • 770 older people who have volunteered to give their opinions on issues affecting older people in Camden • Quality of Life Panel • 12 older people, 8 councillors and 8 representatives from organisations working with older people, who respond to issues raised by older people in a proactive way

  39. Sample Score range Wave 1: Preliminary FindingsMean Scores for Quality of Life Domains

  40. Wave 1: Preliminary FindingsSocial Network >> Close Relationship – Profile and Mean CASP 19

  41. Wave 1: Preliminary FindingsSocial Network >> Family and Friends – Profile and Mean CASP 19 Score Range : 0-14 Average: 10

  42. Wave 1: Preliminary FindingsSocial Network >> Frequency of Contact – Profile and Mean CASP 19 Score Range : 0-16 Average: 13

  43. Wave 1: Preliminary FindingsHome Ownership – Profile and Mean CASP 19

  44. Wave 1: Preliminary FindingsLiving Alone or Not – Profile and Mean CASP 19

  45. Wave 1: Preliminary FindingsAccess to Car – Profile and Mean CASP 19

  46. Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Like to Live in Current Neighbourhood – Profile and Mean CASP 19 Total of 676 people

  47. Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Moving Preference – Profile and Mean CASP 19 Total of 679 people

  48. Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile and Mean CASP 19 Info: 277 of out 620 people

  49. Wave 1: Preliminary FindingsService Satisfaction Level – Profile and Mean CASP 19 Service: 312 of out 602 people

  50. Wave 1: Preliminary FindingsStaff Satisfaction Level – Profile and Mean CASP 19 Staff: 293 of out 594 people

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