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 The Community Health Foundation of Western and Central New York The Community Health Foundation of Western and Central New York for funding this project for funding this project Area Agency on Aging in 8 Counties in Western New York Area Agency on Aging in 8 Counties in Western New York Dr. Michael Noe, Dept. of Rehabilitation Science, University at Buffalo Dr. Michael Noe, Dept. of Rehabilitation Science, University at Buffalo

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 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 Some states offer conferences that include AT workshops but health professionals who can attend these conferences are limited. Some states offer conferences that include AT workshops but health professionals who can attend these conferences are limited. Online workshops have been rarely offered. Online workshops have been rarely offered. We conducted both onsite and online workshops offering 7 CEUs. We conducted both onsite and online workshops offering 7 CEUs.

Purpose of the Study To find the effectiveness of onsite and online workshops in comparison to a control group. 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 Attitudes toward AT, general and specific knowledge of AT, role caregivers, and Teaching Methods for AT

Literature Review Elders who use AT: Elders who use AT: Increase their active participation and overall independence with their ADLs (Mann, Hurren, Tomita, & Charvat,1995, Taylor & Hoenig, 2004), 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 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 the days they remain in bed (Taylor & Hoenig, 2004), Decrease their need for caregiver assistance (Hoenig, Taylor, & Sloan, 2003, 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), 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) Reduce their health-care costs (Mann, Ottenbacher, Fraas, Tomita and Granger; 1999)

Literature Review  Caregivers who attend educational interventions on AT: educational interventions on AT:  Illustrate fewer negative attitudes toward AT (Kane,1999),  Illustrate higher satisfaction rates (N ochajaski, Tomita, & Mann, 1996),  Increase the frequency of their AT use (N ochajaski, Tomita, & Mann, 1996),  Use more ATs (N ochajaski, Tomita, & Mann, 1996).

Research Questions Part I: Effectiveness of onsite AT workshop Part I: Effectiveness of onsite AT workshop Comparisons of onsite workshop attendants and the control group. Part II: Effectiveness of online AT workshop Part II: Effectiveness of online AT workshop Comparisons of online and onsite workshop attendants.

Research Questions Part 1 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 workshopPosttest

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 Control Group O

Method: Research Design Quasi Experimental Study Quasi Experimental Study Pretest Posttest Controlled Design Pretest Posttest Controlled Design PretestPosttest OnsiteOXO (7 hour Interval) (7 hour Interval) ControlOO ( 1 month Interval) OnlineOXO ( 3 hour to 6 days- Interval )

Method: Sample Convenient sampling method was used. 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. 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. 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 Demographic Information Demographic Information 3 overall AT questions (knowledge of AT, value of AT in caring people, effectiveness of AT in reducing caregiver burden) 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 9 general AT/role of caregiver/teaching method questions 10 new AT questions (7 existing AT & 3 non existing AT) 10 new AT questions (7 existing AT & 3 non existing AT)

Sample Characteristics (N = 227) Table 1 ________________________________________________________________ OnsiteControlOnline OnsiteControlOnline Sex Sex (n= 89)(n=96)(n=42) ________________________________________________________________ F (86.5%) (82.3%)(88.1%) (86.5%) (82.3%)(88.1%) M M (13.5%) (17.7%) (11.9%) (13.5%) (17.7%) (11.9%) _______________________________________________________________________ _______________________________________________________________________ χ2 = 1.03 (p=.598) χ2 = 1.03 (p=.598)

Sample Characteristics (N = 227) Table 2 _____________________________________________________________________ OnsiteControlOnline OnsiteControlOnline Age (n = 89) (n = 96)(n=42) Age (n = 89) (n = 96)(n=42)_____________________________________________________________________ yrs. 20 (22.5%) 49 (51.0%)25 (59.5%) yrs. 50 (56.2%)43 (44.8%)15 (35.7%) 55 + yrs19 (21.3%) 4 (4.2%) 2 (4.8%) _____________________________________________________________________ χ2 = ( p <.001 ) Bold figures indicate the cells contributing statistical significance

Sample Characteristics (N = 227) Table 3 _______________________________________________________________________ OnsiteControlOnline OnsiteControlOnline Profession Profession (n= 89) (n=96)(n=42) (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 = ( p <.001 ) χ2 = ( p <.001 ) Bold figures indicate the cells contributing statistical significance Bold figures indicate the cells contributing statistical significance

Sample Characteristics (N = 227) Table 4 ________________________________________________________________________ Onsite ControlOnline Onsite ControlOnline Education (n = 89) (n = 96) (n=42) Education (n = 89) (n = 96) (n=42) ______________________________________________________________________ ______________________________________________________________________ High School Degree 6 (6.7%) 02 (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 = ( p<.001) Bold figures indicate the cells contributing statistical significance χ2 = ( p<.001) Bold figures indicate the cells contributing statistical significance

Sample Characteristics (N = 227) Table 5 _________________________________________________________________________________________________ Workplace OnsiteControl Online Workplace OnsiteControl Online (n = 89) (n = 96) (n=42) (n = 89) (n = 96) (n=42)_________________________________________________________________________________________________ Home healthcare agency 27 (30.3%) 4 (4.2%)6 (14.3%) Home healthcare agency 27 (30.3%) 4 (4.2%)6 (14.3%) Nursing Home 10 (11.2%) 4 (4.2%)4 (9.5%) Nursing Home 10 (11.2%) 4 (4.2%)4 (9.5%) Hospital 7 (7.9%)51(53.15)7 (16.7%) Hospital 7 (7.9%)51(53.15)7 (16.7%) School 3 (3.4%) 7 (7.3%)5 (11.9%) School 3 (3.4%) 7 (7.3%)5 (11.9%) Private Practice 3 (3.4%) 7 (7.3%) 1 (2.4%) Private Practice 3 (3.4%) 7 (7.3%) 1 (2.4%) Unemployed 6 (6.7%) 8 (8.3%)0 Unemployed 6 (6.7%) 8 (8.3%)0 Government 31(34.8%) 15 (15.6%)2 (2.8%) Government 31(34.8%) 15 (15.6%)2 (2.8%) Other 2 (2.25) 017 (40.5%) Other 2 (2.25) 017 (40.5%) ____________________ ________________________________________________________________ χ2 = ( p<.001) χ2 = ( p<.001)

Sample Characteristics (N = 227) Table 6 How long have you been working in your profession? ___________________________________________________________________________________ OnsiteControlOnline OnsiteControlOnline (n = 89) (n = 96)(n=42) (n = 89) (n = 96)(n=42)__________________________________________________________ Years Years (11.4) (10.0)(10.6) (11.4) (10.0)(10.6) ____________________________________________________________________________________ F = (p =.152) F = (p =.152)

Part 1: Onsite Workshop 8 Counties in Western New York

Device Display at Onsite Workshop

Results 1: Can you please rate yourself on your own knowledge of AT? a paired t = (p <.001)Significant increase b paired t = (p =.144)Remained same c ANCOVA controlling for the pretest F= (p<.001) Onsite is significantly higher

Results 2: How valuable do you believe the use of AT is in the role of caregiving? a paired t = (p <.001) Significant increase b paired t = (p =.022) Remained same c ANCOVA controlling for the pretest F = (p <.001) Onsite is significantly higher

Results 3: Do you believe the use of AT can decrease caregiver burden? a Paired t = (p <.001) Significant increase b Paired t =.173 (p =.863) Remained same c ANCOVA controlling for the pretest F = (p <.001) Onsite is significantly higher

Sample Questions for General Knowledge of AT, Role of Caregivers, and Teaching Methods What is an assistive device? What is an assistive device? What is the role of a caregiver? What is the role of a caregiver? What are some barriers to AT use or reasons for non-use? 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? 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 Onsite Paired t-test <.001Onsite Paired t-test<.05 Control Paired t-test >.05Control Paired t-test >.05 ANCOVA F.05

Sample Questions for Specific AT AT AT A turntable-style pivot disk which aids in standing transfers with people who have trunk and hip mobility problems. (physical) 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) 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) Heat sensitive bath appliqués which prevent burns. (Sensory)

Results 5: Total scores for Knowledge of Specific AT Physical Physical Sensory Sensory Cognitive Change score Independent t <.001

Results 6: Do you believe the AT would be useful? Change score Independent t <. 01

Part II. Online Workshop

Online Workshop Pretest Pretest Seven modules Seven modules Overview Overview Devices to address physical impairments Devices to address physical impairments Devices to address Meal Preparation/Eating/Medication Devices to address Meal Preparation/Eating/Medication Sensory: Vision and Taste/Smell Sensory: Vision and Taste/Smell Sensory: Hearing and Touch/Dexterity Sensory: Hearing and Touch/Dexterity Cognitive-Home Cognitive-Home Cognitive-Nursing Home Cognitive-Nursing Home Posttest Posttest

Comparisons between Onsite and Online AT workshop Are the scores of Online and Onsite AT workshop attendants similar at the post test on 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 effective teaching methods, and 3) Knowledge of specific AT ? Posttest Posttest Onsite O ║ ║ Online O Online O

Results 7: Can you please rate yourself on your own knowledge of AT? a paired t = (p <.05)Significant increases in Posttest b ANCOVA controlling for pretest scores F = (p <.001) Onsite is higher

Results 8: How valuable do you believe the use of AT is in the role of caregiving? a paired t = (p <.05) b ANCOVA controlling for pretest scores F= (p=.083) Onsite and Online scores are not different

Results 9: Do you believe the use of AT can decrease caregiver burden? a paired t = (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 Online Paired t-test.05 ANCOVA F.05

Results 11: Total scores for Knowledge of Specific AT Physical Physical Sensory 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? a Paired t = (p <.001) Significant increase in posttest b ANCOVA controlling for pretest scores F=.567 (p=.453) Onsite and Online scores are not different

Summary 1. 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 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. 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. Attitude toward AT, knowledge of sensory devices and effective teaching methods were the same for both attendants.

Discussion Advantage of online education is that individuals who are interested can take it at his/her own convenience and at home. 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. 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 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. 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.