Process evaluation of a national elderly nutrition care program in Iran: Perspectives of clients and providers

Abstract

Background The rapid growth of Iran elderly population highlights the importance of more attention to nutritional needs of this age group. Process evaluation study on the nutritional part of the national Elderly-Integrated Care Program was conducted to examine degree of exposure and satisfaction of the targets with the program components, and assess the reach, delivery, fidelity, and external contexts of the program.Methods To evaluate perspectives of clients on elderly integrated nutrition care program (EINCP) implementation process, a self-administrated questionnaire was constructed, validated, and applied to 256 individuals with the age of above 60 years attending the program at 57 health care centers of Tabriz metropolitan area of East Azerbaijan province in Iran using convenience sampling method. Another valid questionnaire was also applied to investigate viewpoint of the perceptions of 76 staffs of these health care centers as the program providers around the EINCP.Results The reach rate of the clients was reported 20.0%. Delivery of the educational components to entire program providers was accomplished (100.0%); however, the delivery of some parts of the program to the clients had some main weaknesses. The fidelity of the program tools was considered inadequate from perspectives of both clients and providers. 77.5% of the clients had exposure to the program. Clients’ satisfaction rate was varied from 4.2 to 34.7% with various available services, but 42.8% of the clients had high satisfaction with overall parts of the EINCP. The program also suffered from some external contexts such as the lack of financial support of program providers.Conclusion The format of the EINCP and strategies related to recruitment of the clients should be improved in order to minimize the barriers highlighted in this study. The providers should focus on raising the compliance of clients to receive a higher reach rate. It is suggested that program planners add periodic monitoring and evaluation of the program.