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Published on September 28, 2007

Author: Abigail

Source: authorstream.com

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Effectiveness of Training of Assistive Technology for Frail Elders and Their Caregivers: Onsite and Online Education:  Effectiveness of Training of Assistive Technology for Frail Elders and Their Caregivers: Onsite and Online Education Presented at ASA-NCOA Joint Conference at Philadelphia on March 10-12, 2005 Machiko R. Tomita Ph.D. Kimberly Sewall, OTR/L Bin-Min Tsai, MS, OT Aging and Technology Depart. of Rehabilitation Science Universtiy at Buffalo, State Universtiy of New York Acknowledgement:  Acknowledgement The Community Health Foundation of Western and Central New York for funding this project Area Agency on Aging in 8 Counties in Western New York Dr. Michael Noe, Dept. of Rehabilitation Science, University at Buffalo The Assistive Technology (AT) Act of 2004:  The Assistive Technology (AT) Act of 2004 Supporting state efforts to improve the provision of AT to individuals with disabilities through comprehensive statewide programs of technology-related assistance for individuals with disabilities of all ages. Providing states with financial assistance that supports programs designed to maximize the ability of individuals with disparities and their family members and others to obtain AT devices and services. Process of Knowledge Diffusion:  Process of Knowledge Diffusion Frail elders own an average of 14 devices and use 11 devices. As frail elders’ cognition declines, informal caregivers use of devices increases. Most devices were obtained from or by recommendation of healthcare professionals when they are discharged from skilled nursing facilities Healthcare professionals do not have time to update newly marketed AT. Workshops on AT for healthcare professionals are needed. Onsite and Online AT Workshop:  Onsite and Online AT Workshop Some states offer conferences that include AT workshops but health professionals who can attend these conferences are limited. Online workshops have been rarely offered. We conducted both onsite and online workshops offering 7 CEUs. Purpose of the Study:  Purpose of the Study To find the effectiveness of onsite and online workshops in comparison to a control group. Attitudes toward AT, general and specific knowledge of AT, role caregivers, and Teaching Methods for AT Literature Review:  Literature Review Elders who use AT: Increase their active participation and overall independence with their ADLs (Mann, Hurren, Tomita, & Charvat,1995, Taylor & Hoenig, 2004), Decrease their level of residual disability (Taylor & Hoenig, 2004; Verbrugge, Rennert, & Madans,1997; Agree, 1999), Decrease the days they remain in bed (Taylor & Hoenig, 2004), Decrease their need for caregiver assistance (Hoenig, Taylor, & Sloan, 2003, Taylor & Hoenig, 2004), Delay their decline in functional health status (Mann, Ottenbacher, Fraas, Tomita and Granger; 1999), Reduce their health-care costs (Mann, Ottenbacher, Fraas, Tomita and Granger; 1999) Literature Review:  Literature Review Caregivers who attend educational interventions on AT: Illustrate fewer negative attitudes toward AT (Kane,1999), Illustrate higher satisfaction rates (Nochajaski, Tomita, & Mann, 1996), Increase the frequency of their AT use (Nochajaski, Tomita, & Mann, 1996), Use more ATs (Nochajaski, Tomita, & Mann, 1996). Research Questions:  Research Questions Part I: Effectiveness of onsite AT workshop Comparisons of onsite workshop attendants and the control group. Part II: Effectiveness of online AT workshop Comparisons of online and onsite workshop attendants. Research Questions Part 1:  Research Questions Part 1 Do scores of onsite AT workshop attendants increase from the pretest to the posttest on 1) Favorable attitudes toward AT, 2) General knowledge of AT, roles of caregivers, and effective teaching methods, and 3) Knowledge of specific AT ? Pretest Onsite workshop Posttest Research Questions Part 1:  Research Questions Part 1 2. Are the scores of AT workshop attendants higher than that of the control group on the post test in 1) General knowledge of AT, roles of caregivers, and effective teaching methods, 2) Knowledge of specific AT, and 3) Favorable attitudes towards AT Posttest Attendants O V Control Group O Method: Research Design:  Method: Research Design Quasi Experimental Study Pretest Posttest Controlled Design Pretest Posttest Onsite O X O (7 hour Interval) Control O O ( 1 month Interval) Online O X O ( 3 hour to 6 days- Interval ) Method: Sample:  Method: Sample Convenient sampling method was used. Onsite workshops were advertised in newsletters and flyers through the Area Agency on Aging in the 8 counties of Western New York. People who registered became the treatment group and people who knew that they could not attend the workshop became the control group. For the online workshop, we recruited interested people from HMOs, County Senior Services, and Nursing and Rehab Science courses at the University at Buffalo. Method: Questionnaire:  Method: Questionnaire Demographic Information 3 overall AT questions (knowledge of AT, value of AT in caring people, effectiveness of AT in reducing caregiver burden) 9 general AT/role of caregiver/teaching method questions 10 new AT questions (7 existing AT & 3 non existing AT) Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 1 ________________________________________________________________ Onsite Control Online Sex (n= 89) (n=96) (n=42) ________________________________________________________________ F 77 79 37 (86.5%) (82.3%) (88.1%) M 29 12 17 (13.5%) (17.7%) (11.9%) _______________________________________________________________________ χ2 = 1.03 (p=.598) Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 2 _____________________________________________________________________ Onsite Control Online Age (n = 89) (n = 96) (n=42) _____________________________________________________________________ 18-34 yrs. 20 (22.5%) 49 (51.0%) 25 (59.5%) 35-54 yrs. 50 (56.2%) 43 (44.8%) 15 (35.7%) 55 + yrs 19 (21.3%) 4 (4.2%) 2 (4.8%) _____________________________________________________________________ χ2 = 30.178 ( p < .001) Bold figures indicate the cells contributing statistical significance Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 3 _______________________________________________________________________ Onsite Control Online Profession (n= 89) (n=96) (n=42) _______________________________________________________________________ Nurse 24 (27.0%) 58 (60.4%) 8 (19.0%) Case manager 25 (28.1%) 7 (7.3%) 1 (2.4%) Therapists 19 (21.3%) 23 (24.0%) 27 (64.3%) Aides 7 (7.9%) 1 (1.0%) 2 (4.8%) Other 14 (15.7%) 7 (7.3%) 4 (9.5%) _______________________________________________________________________ χ2 = 65.092 ( p < .001) Bold figures indicate the cells contributing statistical significance Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 4 ________________________________________________________________________ Onsite Control Online Education (n = 89) (n = 96) (n=42) ______________________________________________________________________ High School Degree 6 (6.7%) 0 2 (4.8%) Associates Degree 21(23.6%) 13 (13.5%) 2 (4.8%) Bachelor’s Degree 43(48.3%) 69 (71.9%) 22 (52.4%) Master’s Degree 16 (18.0%) 13 (13.5%) 16 (38.1%) Doctorate Degree 0 1 (1.0%) 0 Other 3 (3.4%) 0 0 ________________________________________________________________________ χ2 = 33.008 ( p< .001) Bold figures indicate the cells contributing statistical significance Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 5 _________________________________________________________________________________________________ Workplace Onsite Control Online (n = 89) (n = 96) (n=42) _________________________________________________________________________________________________ Home healthcare agency 27 (30.3%) 4 (4.2%) 6 (14.3%) Nursing Home 10 (11.2%) 4 (4.2%) 4 (9.5%) Hospital 7 (7.9%) 51(53.15) 7 (16.7%) School 3 (3.4%) 7 (7.3%) 5 (11.9%) Private Practice 3 (3.4%) 7 (7.3%) 1 (2.4%) Unemployed 6 (6.7%) 8 (8.3%) 0 Government 31(34.8%) 15 (15.6%) 2 (2.8%) Other 2 (2.25) 0 17 (40.5%) ____________________ ________________________________________________________________ χ2 = 145.314 ( p< .001) Sample Characteristics (N = 227):  Sample Characteristics (N = 227) Table 6 How long have you been working in your profession? ___________________________________________________________________________________ Onsite Control Online (n = 89) (n = 96) (n=42) __________________________________________________________ Years 14.0 11.3 10.8 (11.4) (10.0) (10.6) ____________________________________________________________________________________ F = 1.902 (p = .152) Part 1: Onsite Workshop 8 Counties in Western New York:  Part 1: Onsite Workshop 8 Counties in Western New York Device Display at Onsite Workshop:  Device Display at Onsite Workshop Results 1: Can you please rate yourself on your own knowledge of AT?:  Results 1: Can you please rate yourself on your own knowledge of AT? a paired t = 9.260 (p < .001) Significant increase b paired t = 1.471 (p = .144) Remained same c ANCOVA controlling for the pretest F= 87.583 (p<.001) Onsite is significantly higher Results 2: How valuable do you believe the use of AT is in the role of caregiving? :  Results 2: How valuable do you believe the use of AT is in the role of caregiving? a paired t = 3.967 (p < .001) Significant increase b paired t = 2.322 (p = .022) Remained same c ANCOVA controlling for the pretest F = 21.274 (p < .001) Onsite is significantly higher Results 3: Do you believe the use of AT can decrease caregiver burden?:  Results 3: Do you believe the use of AT can decrease caregiver burden? a Paired t = 3.810 (p < .001) Significant increase b Paired t = .173 (p = .863) Remained same c ANCOVA controlling for the pretest F = 39.696 (p < .001) Onsite is significantly higher Sample Questions for General Knowledge of AT, Role of Caregivers, and Teaching Methods:  Sample Questions for General Knowledge of AT, Role of Caregivers, and Teaching Methods What is an assistive device? What is the role of a caregiver? What are some barriers to AT use or reasons for non-use? What is the most effective teaching method of assistive device use for elderly people? Results 4: Total Scores for General Knowledge/ Role of Caregivers, and Teaching Methods:  Results 4: Total Scores for General Knowledge/ Role of Caregivers, and Teaching Methods Onsite Paired t-test <.001 Onsite Paired t-test<.05 Control Paired t-test > .05 Control Paired t-test > .05 ANCOVA F< .001 ANCOVA F > .05 Sample Questions for Specific AT:  Sample Questions for Specific AT AT A turntable-style pivot disk which aids in standing transfers with people who have trunk and hip mobility problems. (physical) A Global Positioning System (GPS) watch which provides a person with directions to his/her home within a 10 miles radius. (Cognitive) Heat sensitive bath appliqués which prevent burns. (Sensory) Results 5: Total scores for Knowledge of Specific AT:  Results 5: Total scores for Knowledge of Specific AT Physical Sensory Cognitive Change score Independent t <.001 Results 6: Do you believe the AT would be useful?:  Results 6: Do you believe the AT would be useful? Change score Independent t <. 01 Part II. Online Workshop:  Part II. Online Workshop Online Workshop:  Online Workshop Pretest Seven modules Overview Devices to address physical impairments Devices to address Meal Preparation/Eating/Medication Sensory: Vision and Taste/Smell Sensory: Hearing and Touch/Dexterity Cognitive-Home Cognitive-Nursing Home Posttest Comparisons between Onsite and Online AT workshop:  Comparisons between Onsite and Online AT workshop Are the scores of Online and Onsite AT workshop attendants similar at the post test on 1) Favorable attitudes toward AT, 2) General knowledge of AT, roles of caregivers, and effective teaching methods, and 3) Knowledge of specific AT ? Posttest Onsite O ║ Online O Results 7: Can you please rate yourself on your own knowledge of AT? :  Results 7: Can you please rate yourself on your own knowledge of AT? a paired t = 1.952 (p < .05) Significant increases in Posttest b ANCOVA controlling for pretest scores F = 32.110 (p < .001) Onsite is higher Results 8: How valuable do you believe the use of AT is in the role of caregiving? :  Results 8: How valuable do you believe the use of AT is in the role of caregiving? a paired t = 1.738 (p < .05) b ANCOVA controlling for pretest scores F= 3.049 (p=.083) Onsite and Online scores are not different Results 9: Do you believe the use of AT can decrease caregiver burden?:  Results 9: Do you believe the use of AT can decrease caregiver burden? a paired t = 3.579 (p < .001) Significant increase in posttest b ANCOVA controlling for pretest scores F=.299 (p=.586) Onsite and Online scores are not different Results 10: Total Scores for General Knowledge/Role of Caregivers, and Teaching Methods:  Results 10: Total Scores for General Knowledge/Role of Caregivers, and Teaching Methods Online Paired t-test < .001 Online Paired t-test >.05 ANCOVA F<.001 ANCOVA F > .05 Results 11: Total scores for Knowledge of Specific AT:  Results 11: Total scores for Knowledge of Specific AT Physical Sensory Cognitive Online paired t-test < .001 Physical ANCOVA F < .001 Online is higher Cognitive ANCOVA F < .001 Online is higher Sensory ANCOVA F > .05 Results 12: Do you believe the AT would be useful?:  Results 12: Do you believe the AT would be useful? a Paired t = 4.231 (p < .001) Significant increase in posttest b ANCOVA controlling for pretest scores F= .567 (p=.453) Onsite and Online scores are not different Summary:  Summary Online workshop attendants were significantly younger, having a higher education (MS), and working as a therapist (mostly occupational therapists) than onsite workshop attendants. 2. Both onsite and online AT workshop attendants significantly increased favorable attitude toward AT, their knowledge of general and specific AT, role of caregivers, and teaching methods after the workshop. Summary:  Summary Onsite Workshop attendants perceived higher for being knowledgeable of AT after the workshop than online attendants and scored significantly higher for knowledge of specific AT (Physical and cognitive); however, they scored significantly lower for general AT knowledge. Attitude toward AT, knowledge of sensory devices and effective teaching methods were the same for both attendants. Discussion:  Discussion Advantage of online education is that individuals who are interested can take it at his/her own convenience and at home. Online workshop is almost as effective as onsite workshop; however, one of the reasons that people attend an onsite worship is so that they can see how AT is operated. Therefore, incorporation of a video may be important. Discussion:  Discussion AT education and home modification for persons with disability and their formal and informal caregivers is important. Effective methods such as online education by States should be encouraged and beyond this knowledge gain, benefits of the education that lead to better quality of life and cost effective ness of AT use should be documented.

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