Evaluation of a peer educator stroke education program for the elderly

Introduction This paper reports on outcome and process evaluation of a stroke risk factor education program in a senior citizens’ center using elderly peer facilitators. The two-phase program included training sessions for Peer Facilitators (PFs), and a period of both formal and informal education in the senior center and community. Outcome evaluation assessed knowledge of stroke and stroke risk factors in the PFs and center population, and the extent to which PFs provided health information, direct assistance and emotional and moral support for positive health behaviors. Knowledge scores for PFs and experimental center members were compared with those at another center without a program, and PF activities were assessed using simple logs kept by the PFs for twelve weeks. Process evaluation provided additional information about experiences with various components of the program and qualitative information related to program effectiveness. Findings for both outcome and process evaluations indicated that the Peer Facilitator Program was successful in training elderly laypersons to carry out health education, increasing knowledge at the program center, and facilitating information and advice for stroke risk reduction. •Department of Health Education, 304 Seltzer Hall, Temple University, Philadelphia, PA 19122, Kkjod Shepherd Rehabilitation Hospital, Allen town, PA and ‘Dorothy Rider Pool Health Care Trust, Allen town, PA, USA T o whom reprint requests should be sent Stroke is the third leading cause of death in the United States (Surgeon General’s Report, 1979) and the leading cause of disability. The incidence of stroke increases with age and the long-term survival rates decrease with age (Weinfeld, 1981). Stroke prevention and treatment are becoming increasingly important as the population of elderly individuals in the United States increases. With older adults living longer, the increased incidence of chronic disease can result in great burdens of disability, dependence and high medical costs. A reduction in risk factors for stroke, along with recognition of early warning signs, has the potential to benefit the elderly by helping them to avert unnecessary disease and disability, thus improving the quality and length of life. Efforts to reach the elderly with community programs for health promotion and risk reduction are often conducted in organizations where senior citizens congregate. Senior centers are the single most numerous community service providers in the United States, and they play an important role in direct provision of health services and health education (Minkler, 1981). These settings provide good natural environments for building social networks conducive to health promotion (Goodman, 1984). The use of age peers as lay educators is a promising approach to reach more of the elderly with greater effectiveness (Hoffman, 1983). From a theoretical perspective, peer educators can both be a credible source of information, and serve as role models for health-enhancing behaviors. The strength of the peer educators lies in their ability to identify with people whom they are helping. This may include shared life experiences and similar ethnic, © IRL Press Limited, Oxford, England 121 at U niersity of T enessee ? K noville L ibaries on Jne 5, 2014 http://herrdjournals.org/ D ow nladed from K.Glanz, S.M.Marger and E.F.Meehan social, cultural, and economic backgrounds. These lay individuals can often overcome the barriers that many professionals may encountered in working with special groups. Programs to improve mental (Campbell and Chenoweth, 1981) and/or physical health (Shannon et al., 1983) using the peer educator/ counselor, or peer facilitator, approach have been implemented successfully in a number of programs for seniors. Our program was based in a senior citizens’ center, and extended out into the community via peer facilitators who were involved in other organizations. Based on a recent extensive review of health education for older persons by Rimer et al. (1985), it is clear that most programs for the elderly focus on a single health concern, e.g. hypertension, fitness, nutrition, arthritis; no programs have been reported to date which address the broad range of health and lifestyle factors related to prevention of early detection of stroke. Also, Rimer et al. (1985) have noted that most of the evaluations reported in the literature are one-group, case-study type evaluations, and thus have limited interpretability for other health educators. We were unable to locate experimental or quasi-experimental evaluations of similar programs, except for the case studies cited in the preceding paragraph. This paper reports on outcome and process evaluation of a stroke risk factor education program using elderly peer facilitators. Such an evaluation examines both whether the program’s goals were achieved, and what took place during the actual program experience with respect to participation, subjective reactions, and other events which might influence the outcomes. We believe that the quasi-experimental outcome evaluation, supplemented by qualitative data, provides comprehensive documentation of the program experience and an assessment of its effects. Program design and objectives The Peer Facilitator (PF) Program was implemented in a senior citizens’ center in a small city in southeastern Pennsylvania. Its goals were to increase seniors’ knowledge of stroke risk factors and warning signs; to establish a social support network at the center to promote healthy behaviors and to provide skills to reduce stroke risk. Prior to the intervention phase of the program, a community advisory committee was established to provide expertise on both stroke and the needs of older adults. Advisory committee members include representatives from the Lehigh County Senior Citizens Center, the Lehigh Valley Stroke Program, the Area Agency on Aging and the Allentown Housing Authority. A comprehensive packet of materials for the PFs was assembled from local and national resources. This packet included outlines for each topic to be covered, and samples of educational materials for later distribution by PFs. Guest speakers were invited for sessions on special topics, and included a physical educator, a dietitian and a pharmacist. Senior center staff made recommendations for potential PFs. The Project Coordinator met with PF candidates to explain the program and requirements. Key requirements for PFs were the ability to attend training sessions, and willingness to learn and to share new information with others. A total of 17 individuals agreed to participate in the training program and to serve as PFs upon completion of the course.