Extension professionals have a wealth of research-based information and expertise in nutrition, activities of daily living, and resource management. This knowledge is the basis for a new Extension program to train in-home caregivers. The purpose of the study described here was to evaluate the effectiveness of the Caregiver Training Program, designed and delivered by Cooperative Extension academic advisors to enhance the skills and knowledge of the in-home supportive service caregivers. Participants report positive changes in knowledge, skills, attitudes, interest, and self-confidence. Extension is uniquely qualified and positioned to provide training for caregivers to aging adults

Barrett, Gloria J

Song, Anna V

Swanson, Patti Wooten

English

Clemson University: TigerPrints

The Journal of Extension Volume 43 Number 3 Article 14 6-1-2005 Evaluation of Training Program for Caregivers to Aging Adults Gloria J. Barrett University of California Cooperative Extension, gjbtowncar@aol.com Patti Wooten Swanson University of California Cooperative Extension, pwswanson@ucdavis.edu Anna V. Song University of California, avsong@ucdavis.edu This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License. Recommended Citation Barrett, G. J., Swanson, P. W., & Song, A. V. (2005). Evaluation of Training Program for Caregivers to Aging Adults. The Journal of Extension, 43(3), Article 14. https://tigerprints.clemson.edu/joe/vol43/iss3/14 This Research in Brief is brought to you for free and open access by the Conferences at TigerPrints. It has been accepted for inclusion in The Journal of Extension by an authorized editor of TigerPrints. For more information, please contact kokeefe@clemson.edu. 	 JOEHOME JOURNAL GUIDELINES ABOUT	JOE CONTACT NATIONAL	JOB	BANKCurrent	Issues Back	IssuesJune	2005	//	Volume	43	//	Number	3	//	Research	in	Brief	//	3RIB6Evaluation	of	Training	Program	for	Caregivers	to	Aging	AdultsAbstractExtension	professionals	have	a	wealth	of	research-based	information	and	expertise	in	nutrition,activities	of	daily	living,	and	resource	management.	This	knowledge	is	the	basis	for	a	newExtension	program	to	train	in-home	caregivers.	The	purpose	of	the	study	described	here	was	toevaluate	the	effectiveness	of	the	Caregiver	Training	Program,	designed	and	delivered	byCooperative	Extension	academic	advisors	to	enhance	the	skills	and	knowledge	of	the	in-homesupportive	service	caregivers.	Participants	report	positive	changes	in	knowledge,	skills,attitudes,	interest,	and	self-confidence.	Extension	is	uniquely	qualified	and	positioned	to	providetraining	for	caregivers	to	aging	adults.	IntroductionOver	33	million	Americans	are	age	65	or	older,	and	the	number	of	seniors	in	the	U.S.	is	expected	todouble	over	the	next	30	years	(Novelli,	2004).	However,	longevity	comes	at	a	cost	(Aldwin,	2004).	Eighty	percent	of	seniors	have	at	least	one	chronic	health	condition,	and	50%	have	at	least	two.	Three	million	older	adults	say	they	cannot	perform	basic	activities	of	daily	living,	such	as	bathing,shopping,	dressing,	or	eating	(Centers	for	Disease	Control	and	Prevention,	1995).	Many	needpersonal	care	assistance	to		stay	in	their	own	homes	and	experience	the	highest	possible	quality	oflife	as	they	age.Estimates	suggest	more	than	1.5	million	adults	in	California	have	disabilities	that	require	ongoingassistance	with	day-to-day	activities	(Scharlach,	2001).	Sacramento	County	in	California	respondedto	the	need	for	in-home	caregivers	by	establishing	the	In-Home	Supportive	Services	(IHSS)	PublicAuthority.At	the	time	of	this	study,	Sacramento	County	IHSS	had	approximately	12,000	county-funded	in-home	caregivers	who	collectively	provided	1.2	million	hours	of	service	per	month.	Ofapproximately	12,000	IHSS	recipients,	52%	were	age	65	or	older,	and	10%	were	85	or	older.Approximately	85%	needed	assistance	with	personal	care.	Personal	care	refers	to	the	activities	ofdaily	living	(ADL):	eating,	bathing,	grooming,	dressing,	and	toileting	(Lynch,	2002).Gloria	J.	BarrettSacramento	County	DirectorCommunity	Development/	Public	Policy	AdvisorUniversity	of	California	Cooperative	ExtensionSacramento,	Californiagjbarrett@ucdavis.eduPatti	Wooten	SwansonNutrition,	Family	&	Consumer	Science	AdvisorUniversity	of	California	Cooperative	ExtensionSan	Diego,	Californiapwswanson@ucdavis.eduAnna	V.	SongDepartment	of	PsychologyUniversity	of	CaliforniaDavis,	Californiaavsong@ucdavis.eduIn	2002,	the	IHSS	Public	Authority	contracted	with	University	of	California	Cooperative	Extension,Sacramento	County	to	design,	deliver,	and	evaluate	a	training	program	for	the	in-home	caregivers.This	article	reports	an	evaluation	of	the	Caregiver	Training	Program,	a	new	Extension	programdesigned	and	delivered	by	Extension	academic	advisors	to	enhance	the	skills	and	knowledge	of	thein-home	caregivers.Description	of	the	Caregiver	Training	ProgramDesignThe	Cooperative	Extension	advisor	designed	a	training	program	based	on	a	needs	assessment	of1,000	in-home	caregivers	from	the	IHSS	registry	and	a	review	of	related	literature.	The	resultingCaregiver	Training	Program	included	eight	2-hour	lessons	in	three	subject-matter	areas:	healthpromotion/activities	of	daily	living	(3	lessons),	nutrition	(3	lessons),	and	resource	management	(2lessons).The	health	promotion	unit	included:Wound	care,Bowel	and	bladder	care,Diabetes,Infection	control,Dementia/memory	loss,Preventing	falls,	andSelf-neglect	(by	the	care	recipient).Nutrition	sessions	covered:The	food	guide	pyramid,Meal	planning	and	food	shopping,	andFood	safety.Resource	management	lessons	included:Finding	and	keeping	a	job	andCommunity	assets.DeliveryFifty	training	workshops	were	held	from	September	2002	through	May	2003.	Lessons	were	self-contained	and	could	be	taken	independently	of	the	others.	Training	was	optional,	and	classes	werefree.Teaching	methods	were	varied	to	maintain	interest.	Participatory	learning	strategies	includedhands-on	activities,	such	as	preparing	a	nutritional	meal,	and	interactive	activities,	such	as	smallgroup	discussion	about	changes	caregivers	could	make	in	the	kitchen	to	keep	their	client	safe.Occasionally	the	trainer	also	provided	supplemental	take-home	material,	such	as	information	fromthe	Alzheimer's	Foundation	or	a	diabetes	self-assessment.Evaluation	of	the	Caregiver	Training	ProgramA	Caregiver	Training	Evaluation	form	was	adapted	from	an	evaluation	tool	designed	by	KayRockwell	(1999)	to	assess	four	aspects	of	the	training	program:Instructional	methodsTraining	outcomesAppropriateness	of	the	training	facilitySuggestions	for	future	programmingVariablesThe	training	variables	were:1.	 Training	facilities,2.	 Presentation	objectives,3.	 Appropriateness	of	objectives,4.	 Relevance	of	content,5.	 Organization	of	content,6.	 Supportiveness	of	the	instructional	aids,	and7.	 Overall	evaluation	of	the	training.The	five	participant	outcome	variables	were:1.	 Knowledge,2.	 Skill/ability,3.	 Attitude,4.	 Interest,	and5.	 Confidence.Evaluation	InstrumentThe	evaluation	form	was	a	simple,	1-page	English-language	survey	with	14	items.	The	12	trainingand	participant	change	variables	were	measured	by	Likert-type	items,	with	"5"	as	the	highestscore.	A	closed-ended	question	(yes/no)	asked	whether	participants	would	recommend	thistraining	to	others,	and	the	last	item	asked	for	recommendations	for	future	trainings.Data	CollectionAt	the	end	of	each	training	session,	the	trainer	reminded	participants	about	the	purpose	of	atraining	objective	and	asked	them	to	review	the	specific	objectives	(on	their	class	handout)	for	theevening.	Each	participant	completed	a	Caregiver	Training	Evaluation	form	before	leaving.Data	AnalysisDescriptive	statistics	were	calculated	for	all	Likert-type	items.Regression	analysis	was	used	to	analyze	participant	change	by	the	training	variables.Multiple	regression	analysis	was	used	to	determine	which	training	variables	predicted	varioustypes	of	participant	change.FindingsA	total	of	143	caregivers	attended	one	or	more	of	50	training	classes	offered	from	September	2002through	May	2003.	Collectively,	they	completed	526	evaluation	surveys	providing	the	data	for	thisevaluation.	Training	participants	were	predominantly	female	(83%),	and	ethnically	diverse:	White(40.5%),	African	American	(22.6%),	Asian	(19.0%),	Hispanic	(17.3%),	and	American	Indian	(0.6%).Training	OutcomesParticipants	(N=	143)	reported	positive	changes	in	knowledge	(M	=	4.62,	SD	=	.72),	skill/ability	(M=	4.58,	SD	=	.76),	attitude	(M	=	4.73,	SD	=	.60),	interest	(M	=	4.71,	SD	=	.68),	and	self-confidence(M	=	4.67,	SD	=	.70)	as	a	result	of	Caregiver	Training	classes.	Over	half	of	participants	earned	aCertificate	of	Completion;	20	caregivers	received	all	three	certificates	(nutrition,	health	promotion,and	resource	management).Participant	ChangeTo	assess	overall	program	effectiveness,	mean	scores	for	self-reported	changes	in	knowledge,skill/ability,	attitude,	interest,	and	confidence	were	averaged	to	create	the	new	composite	variable,participant	change	(M	=	4.68,	SD	=	.60).	We	used	a	multiple	regression	analysis	using	participantchange	as	the	dependent	variable	and	the	seven	training	variables	as	independent	variables.	Theoverall	regression	was	significant	(F7,394	=	63.63,	p<.001).	Of	seven	independent	variables,	fourvariables	significantly	predicted	participant	change:		presentation	of	objectives	(β	=	.19,	p<.01),appropriateness	of	objectives	(β	=	.19,	p<.01),	relevance	of	content	(β	=	.19,	p<.05),	andorganization	of	content	(β	=	.16,	p<.05).	See	Table	1.Table	1.Regression	Analysis	for	Overall	Participant	Change	StandardizedCoefficientsβ tConstant	1.56Feelings	about	the	facility .00 -.012Presentation	of	objectives .19 2.74**Appropriateness	of	objectives .19 2.91**Relevance	of	content .19 2.41*Organization	of	content .16 2.12*Supportiveness	of	instructional	aids -.05 -.91Overall	evaluation	of	program .12 1.31**p<.01*p<.05Participant	Reaction	to	the	TrainingParticipants	were	satisfied	with	the	training	facilities.	They	would	recommend	the	training	to	othercaregivers	and	suggested	that	future	training	should	include	information	about	high	blood	pressureand	CPR,	and	be	offered	in	Spanish,	Russian,	and	Hmong.	Other	participants'	comments:"I	would	like	to	recommend	the	training	to	other	caregivers	because	they	will	benefit	from	it.""It	will	help	them	to	cope	with	their	problems	facing	the	job.	I	got	a	lot	out	of	this	class	andam	looking	forward	to	the	next	class!""This	was	a	very	good	class--covered	material	needed	to	help	with	clients.""I	really	enjoy	the	training	sessions.	They	have	improved	my	skill	and	thinking.""I	like	coming	to	the	class	so	I	can	learn	to	help."DiscussionTraining	EvaluationParticipants	evaluated	the	Caregiver	Training	Program	highly,	which	was	validated	by	the	fact	thatmany	attended	multiple	training	sessions	to	earn	subject-matter	certificates.	Caregivers	voluntarilyattended	training	on	their	own	time	and	did	not	receive	additional	pay	or	promotions	for	attendingtraining	or	earning	certificates.Instructional	Factors	Related	to	Training	EffectivenessThe	evaluation	indicated	four	training	variables	were	related	to	the	perceived	effectiveness	of	theCaregiver	Training	Program:Appropriate	objectivesClearly	stated	objectivesRelevant	and	timely	contentWell-organized	content.Appropriate	ObjectivesTraining	effectiveness	was	related	to	instructional	objectives	that	were	"problem-focused"	rather"information-focused"	(Levine,	2001).	Caregivers	regularly	confront	problems	related	to	physicalcare,	disease	treatment,	injury	protection,	and	patients	with	dementia.	Training	objectivesconcerned	concrete	aspects	of	preventing	and	solving	problems,	rather	than	abstract	informationabout	problems.	For	example,	in	the	session	on	"Preventing	Falls,"	one	objective	was	to	assess	thecare	recipient's	home	for	hazards	and	identify	how	to	eliminate	or	reduce	hazards	their	carerecipient	faced.Clearly-Stated	ObjectivesTraining	effectiveness	was	related	to	clearly	stated	objectives	that	were	identified	and	explained	atthe	beginning	of	each	session.	This	helps	students	understand	the	lesson	structure	and	sequence;facilitates	efficient	learning:	and	reduces	student	anxiety	because	they	understand	where	thetraining	is	going	and	what	they	will	learn	(Diamond,	1998).	This	was	important	in	the	CaregiverTraining	Program	because	many	caregivers	have	limited	educational	experience,	and	may	feeluncomfortable	in	a	classroom.Relevant	and	Timely	ContentTraining	was	effective	because	it	met	the	needs	of	caregiver	participants.	While	not	surprising,	thisis	a	reminder	that	adults	(caregivers)	seek	learning	to	meet	specific	and	current	information	needs.Adult	learners	are	"most	interested	in	information	and	ideas	that	solve	problems	they	are	currentlyfaced	with"	and	"can	be	applied	immediately"	(Levine,	2001).	In	this	case,	a	caregiver	needsassessment	guided	curriculum	development.Well-Organized	ContentClass	organization	also	influenced	training	effectiveness.	All	lessons	were	organized	in	a	linearformat,	beginning	and	ending	with	a	statement	of	objectives.	Each	session	offered	multipleopportunities	for	participants	to	share	their	insights	and	act	as	peer	"consultants."	This	approachrecognized	and	utilized	learners'	knowledge	and	experience,	an	important	adult	educationprinciple.LimitationsTraining	participants	were	self-selected,	and	outcomes	may	be	biased	toward	learners	who	arecomfortable	in	a	classroom	setting.	Conclusions	were	based	on	self-reported	data,	rather	thanobjective	outcome	measures.	Respondents	may	not	have	understood	some	terms	on	theevaluation	form.Conclusions	and	ImplicationsNow,	more	than	ever,	cooperative	extension	must	meet	community	needs	and	documentmeasurable	impact.	The	Caregiver	Training	Program	designed	and	delivered	by	SacramentoCounty	Cooperative	Extension	met	a	community	need	for	need	for	better-qualified	in-homecaregivers	to	the	elderly.	According	to	self-reported	data,	participants	felt	the	training	improvedtheir	knowledge,	skill/ability,	attitude,	interest,	and	self-confidence	as	in-home	caregivers.	This	is	incontrast	to	previously	reported	caregiver	support	and	training	programs	(Whittier,	Goon,	&	Aaker,2004).Extension	is	distinctive	in	its	emphasis	on	science-based	training	methods	and	materials.	Theeffectiveness	of	the	Caregiver	Training	Program	was	related	to	appropriate	and	clearly	statedobjectives	and	relevant,	timely,	and	well-organized	content.	While	this	may	seem	simplistic,	thefindings	correspond	to	adult	learning	principles	described	in	the	literature	and	can	provideguidance	for	other	Extension	training	programs.Extension	is	uniquely	qualified	and	positioned	to	provide	training	for	the	emerging	caregiverworkforce.	Extension	professionals	have	a	wealth	of	research-based	information	and	expertise	innutrition,	activities	of	daily	living,	and	resource	management.	Extension	also	has	the	expertise	inadult	education	and	outcome-oriented	training	that	leads	to	measurable	changes	in	knowledgeattitudes,	skills,	and	behaviors.Extension	can	also	use	its	expertise	to	assist	families	and	other	volunteer	caregivers.	We	candesign	and	deliver	training	for	family	caregivers,	drawing	on	science-based	knowledge	of	humandevelopment,	family	dynamics,	and	issues	facing	aging	families.Future	evaluation	of	the	Caregiver	Training	Program	should:Measure	the	validity	and	reliability	of	the	survey	instrument.Use	objective	measures	to	validate	self-reported	changes.Use	a	pre-test/post-test	control	group	design	or	a	pre/post	retrospective	evaluation	tool.ReferencesAdministration	of	Aging.	(2003).	A	profile	of	older	Americans.	Available	at:http://www.aoa.gov/prof/statistics/profile/2003/17.aspAldwin,	C.	&	Gilmer,	D.	(2004).	Health,	illness	and	optimal	aging.		Sage	Publication:	ThousandOaks.Centers	for	Disease	Control	and	Prevention.	(1995).	National	Center	for	Health	Statisticssupplement	on	aging	study.	Available	at:	http://www.cdc.gov/nccdphp/aag/aag_aging.htmDiamond,	R.	(1998).	Designing	&	assessing	courses	&	curricula.	Jossey-Bass	Publishers:	SanFrancisco.Levine,	J.	(2001).	The	challenges	of	helping	adults	learn:	characteristics	of	adult	learners	&implications	for	teaching	technical	information.	LearnerAssociates.netLynch,	B.	(2002).	The	first	report.	Sacramento	County	In-Home	Supportive	Services.		Unpublished.Novelli,	W.	(2004).	The	health	and	economic	effects	of	an	aging	society.	Available	at:http://www.cdc.gov/nccdphp/aag/aag_aging.htmRockwell,	K.	(1999).	Does	Extension	make	a	difference:	Measuring	program	outcomes.Unpublished,	West	Virginia	University	Jackson's	Mill	Conference	Center.Scharlach,	A.,	&	Santo,	T.	(2001).	Family	caregivers	in	California:	Needs,	interventions	and	modelprograms.	Center	for	the	Advanced	Study	of	Aging	Services,	University	of	California:	Berkeley.Whittier,	S.,	Goon,	D.,	&	Aaker,	J.	(2004).	Caregiver	support	interventions.	Available	at:http://cssr.berkeley.edu/aging/pdfs/famcare_04.pdfCopyright	©	by	Extension	Journal,	Inc.	ISSN	1077-5315.	Articles	appearing	in	the	Journal	become	the	property	of	theJournal.	 Single	 copies	 of	 articles	may	 be	 reproduced	 in	 electronic	 or	 print	 form	 for	 use	 in	 educational	 or	 trainingactivities.	Inclusion	of	articles	in	other	publications,	electronic	sources,	or	systematic	large-scale	distribution	may	bedone	only	with	prior	electronic	or	written	permission	of	the	Journal	Editorial	Office,	joe-ed@joe.org.If	you	have	difficulties	viewing	or	printing	this	page,	please	contact	JOE	Technical	Support©	Copyright	by	Extension	Journal,	Inc.	ISSN	1077-5315.	Copyright	Policy

Evaluation of Training Program for Caregivers to Aging Adults

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Evaluation of Training Program for Caregivers to Aging Adults

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