A group- and activity-based health promotion program for older persons with visual impairment. A summative evaluation

The general purpose of this thesis was to make a summative evaluation of the group and activity based health promotion program Discovering New Ways, to assess its impact and efficiency at client, service and society level. The health promotion program (HPP) was evaluated by a randomized controlled trial (RCT), comparing the HPP with an individual program (IP). Follow-ups took place one, four, 16 and 28 months after the intervention was completed. Three hundred and twelve persons were asked to participate in the study, 229 accepted participation. One hundred and nine were randomized to the HPP and 120 to the IP. The way in which the participants experienced learning was investigated at one and 16-months after intervention using a qualitative approach within the RCT, 101 persons participated in it. The effect on different health outcomes and costs, was investigated 28 month after intervention. A total of 131 persons participated, 62 from the HPP and 69 from the IP and. The drop-out was mainly caused by death and health problems. The cost-effectiveness study showed that the HPP was significantly more effective and from a social point of view it was also less costly. Personnel costs for the low vision clinic seemed to decrease but costs for assistive devices seemed to increase, and the clinic could organize and plan its activities more efficiently. There was also a significant difference in the development of ADL dependence; the participants in the HPP had maintained their ADL level compared to baseline while the IP participants had become more dependent. Furthermore, there was a significant difference in the development of perceived security in performing ADL; the HPP participants were more secure in 15 activities compared to the IP. Compared to baseline the HPP participants were more secure in 20 activities while the IP participants were more insecure in 12 activities. The HPP participants also reported significantly fewer health problems compared to baseline while the IP reported the same amount. The participants described their experience of learning by the HPP as giving them an awareness of the disease; they had learned by meeting others, the HPP gave them a toolbox to solve problems arising in their daily life, it gave them hope for the future and they felt confident in being able to continue to perform daily activities.In conclusion: The summative evaluation strongly indicates that the group- and activity-based program should be implemented as a first intervention choice for older persons who are in an early phase of age-related macular degeneration to support them in, maintaining their performance of ADL, to hinder a progressive dependence in ADL and to decrease self-reported health. In a first step it should be implemented at low vision clinics and next at community level, forming a chain of visual rehabilitation