Background
Methods
Participants and setting
Volunteers as a component of health TAPESTRY
Data collection and measures
Area | Question |
---|---|
Overall Understanding of Health TAPESTRY | What do you think is the goal or purpose of the Health TAPESTRY program? |
What do you think are the essential elements or parts of Health TAPESTRY? | |
What do you think is the value or benefits of Health TAPESTRY for clients? | |
Thinking of the Health TAPESTRY intervention overall, what are the things that are working well so far with Health TAPESTRY? | |
Thinking about your experience in Health TAPESTRY so far: | |
What do you value most deeply about your role as a Health TAPESTRY volunteer? | |
Can you describe a time when you felt most fulfilled to be part of the Health TAPESTRY program? | |
When did you felt most frustrated as a volunteer in the Health TAPESTRY program? | |
How did you find the experience of working with a volunteer partner? | |
What do you think are the things that are NOT working well so far? | |
Do you think there are any drawbacks, threats or risks in using Health TAPESTRY, and if so, what are they? | |
Would you recommend others to volunteer in Health TAPESTRY? Why or why not? Who do you think would be interested to volunteer? | |
Normalization of HEALTH Tapestry in Volunteer Practice | How do you understand your role (e.g. tasks and responsibilities) in relation to the Health TAPESTRY program? |
How do you understand your role in relation to others involved in Health TAPESTRY such as the health care team and clients? | |
What, if anything, was done to make you feel that in your role as a volunteer, you were valued as an integral component of the Health TAPESTRY program? | |
Do you feel that you had opportunities to give feedback and make improvements to the Health TAPESTRY program, and if yes, how? | |
Resources | How has the Health TAPESTRY program provided you with the knowledge, skills, and resources necessary to: |
Use the technological components of the program (VLC, TAP App, kindredPHR)? | |
Navigate your clients to community resources? | |
How well do you feel you were trained and prepared to be a Health TAPESTRY volunteer? | |
Impacts and Outcomes | How successful do you think the Health TAPESTRY program is in supporting older adults to identify and reach their life and health goals (goal-setting)? |
In what ways, if any, did Health TAPESTRY impact you? | |
What opportunities came out of your participation in Health TAPESTRY that you would not otherwise have had? | |
Sustainability and Spread | From your experience of the TAPESTRY intervention so far, do you think Health TAPESTRY is sustainable (can keep going)? |
How do you see Health TAPESTRY being scaled up [spreading it wider]? | |
Closing | Do you have anything else to add? |
Data analysis
Findings
The population and sample
Participants | n (%) |
---|---|
Volunteers | 30 (31.3) |
Gender | |
Female | 20 (66.7) |
Male | 10 (33.3) |
Age (years) | |
25 or younger | 17 |
60 or older | 12 |
missing age | 1 |
Category | |
novice | 16 (53.3) |
experienced | 14 (46.7) |
Employment status | |
student | 15 (50.0) |
retired | 11 (36.7) |
working or seeking employment | 2 (6.7) |
missing employment status | 2 (6.7) |
Original Recruitment Source | |
university student centre | 8 (26.7) |
local/campus newspaper | 8 (26.7) |
word-of-mouth | 6 (20.0) |
poster/flyer | 4 (13.3) |
other | 3 (10.0) |
missing recruitment source | 1 (3.3) |
Clients | 32 (33.3) |
Age Category | |
70–79 years | 19 (59.4) |
80 years + | 13 (40.6) |
Gender | |
Female | 16 (50.0) |
Male | 16 (50.0) |
Health Care Providers and Staff | 33 (34.4) |
Type | |
Family physician/medical resident | 11 (33.3) |
Allied health (dietitian, occupational therapist, physiotherapist, pharmacist, system navigator, psychologist) | 11 (33.3) |
Nurse (nurse practitioner, registered practical nurse) | 7 (21.2) |
Administrative support | 2 (6.1) |
Health care managers | 2 (6.1) |
Volunteer Coordinator | 1 (1.0) |
Total | 96 (100) |
Volunteer & Category | Baseline Mean (SD) | Final Mean (SD) | Change in Mean | Times scale completed | Number of home visits |
---|---|---|---|---|---|
Vol-1 (E) | 100.0 (0.0) | 83.3 (11.5) | −16.7 | 11 | 56 |
Vol-3 (E) | 93.3 (11.5) | 90.0 (10.0) | −3.3 | 25 | 26 |
Vol-4 (E) | 90.0 (10.0) | 83.3 (20.8) | −6.7 | 10 | 18 |
Vol-8 (E) | 90.0 (0.0) | 83.3 (5.8) | −6.7 | 8 | 15 |
Vol-9 (E) | 93.3 (11.5) | 76.7 (15.3) | −16.6 | 24 | 72 |
Vol-10 (E) | 100.0 (0.0) | 90.0 (0.0) | −10.0 | 7 | 34 |
Vol-17 (E) | 100.0 (0.0) | 96.7 (5.8) | −3.3 | 9 | 24 |
Vol-18 (E) | 100.0 (0.0) | 100.0 (0.0) | 0.0 | 12 | 34 |
Vol-19 (E) | 96.7 (5.8) | Missing | N/A | 1 | 37 |
Vol-20 (E) | 83.3 (11.5) | 80.0 (10.0) | −3.3 | 4 | 11 |
Vol-21 (E) | 86.7 (5.8) | 63.3 (5.8) | −23.4 | 11 | 16 |
Vol-22 (E) | 90.0 (17.3) | 76.7 (25.2) | −13.3 | 15 | 49 |
E Total | 93.6 (5.8) | 83.9 (10.2) | −9.7 (7.3) | 11.4 (7.1) | 32.7 (18.5) |
Vol-5 (N) | 90.0 (0.0) | 83.3 (5.8) | −6.7 | 6 | 17 |
Vol-6 (N) | 100.0 (0.0) | 90.0 (0.0) | −10.0 | 4 | 28 |
Vol-7 (N) | 96.7 (5.8) | 80.0 (10.0) | −16.7 | 4 | 22 |
Vol-12 (N) | 100.0 (0.0) | 86.7 (5.8) | −13.3 | 4 | 19 |
Vol-13 (N) | 80.0 (0.0) | 86.7 (5.8) | 6.7 | 4 | 6 |
Vol-14 (N) | 86.7 (5.8) | 90.0 (0.0) | 3.3 | 2 | 6 |
Vol-16 (N) | 90.0 (0.0) | 80.0 (10.0) | −10.0 | 7 | 17 |
Vol-23 (N) | 66.7 (5.8) | Missing | N/A | 1 | 10 |
Vol-25 (N) | 80.0 (10.0) | Missing | N/A | 1 | 10 |
Vol-26 (N) | 76.7 (5.8) | 73.3 (5.8) | −3.4 | 4 | 11 |
Vol-27 (N) | 56.7 (30.6) | 66.7 (15.3) | 10.0 | 3 | 17 |
N Total | 84.0 (13.7) | 81.9 (7.8) | −2.1 (9.3) | 3.6 (1.9) | 14.8 (6.9) |
TOTAL | 89.0 (11.2) | 83.0 (9.0) | −6.0 (8.4) | 7.7 (6.5) | 24.1 (16.6) |
Themes
Volunteer training: “An investment in volunteers”
Volunteers also identified some training gaps such as knowledge of local community resources. Several volunteers also described the difficulty of dealing with particularly sensitive or emotional situations, not feeling they fully understood the role volunteers could or should play in these scenarios, and not feeling fully prepared to deal with unexpected situations.“I personally enjoyed doing the simulated patients and creative things like that I found to be beneficial. They left the most lasting impact and I could actually remember everything that happened in those training sessions.” (Vol-6, Novice)
Overall, they felt the training program was very robust compared to other volunteer positions.“I’ve had a few interviews where we have people break down and cry and they’re grieving over a lost loved one, and it’s really hard, you know. I mean I’m not a social worker. I don’t pretend to be, and I don’t have the skills but what can you do, right.” (Vol-10, Experienced)
However, the initial long gap of time between training and seeing clients was a challenge.“It’s like an investment in the volunteers…” (Vol-12, Novice)
“I feel bad because I feel like I’m the best trained volunteer in the history of the world, but now I have forgotten it all — well not really forgotten, but there was a long time frame.” (Vol-8, Novice)
Intergenerational volunteer pairing: “The best of both worlds”
Volunteers often described the intergenerational volunteer pairing as one of the strongest points of the program. It exposed volunteers to people in age groups other than their own. Older volunteers were generally identified as relating better to clients and having more depth of experience.“…Sometimes we are going into complete stranger’s homes right. We don’t know who these people are, so just having a partner there with you is very comforting." (Vol-16, Novice)
Younger volunteers were understood as having more technology knowledge and motivation to learn and experience.“I think they often are able to relate better to the clients. I’ve had experiences where my partner has said something like, ‘Oh, I have like a daughter who’s going through a similar situation or, yeah, I get those aches and pains too’; Just kind of providing that empathy and forming that relationship better than I could do as a student.” (Vol-6, Novice)
However, many volunteers commented that they tended to default to certain roles – younger volunteers entering information into the tablet, older volunteers taking the lead on facilitating conversation. Some novice volunteers expressed frustration over this.“A number of the partners I have been with don’t really know how to use an iPad or aren’t really … tech-savvy or comfortable with it. So in that way you get the best of both worlds.” (Vol-5, Novice)
Pairing volunteers also came with some unexpected generational challenges, such as communication between the two groups.“It makes sense I think because our generation is more tech-savvy and it’s easier for us to immediately know how to navigate an iPad. But at the same time, it’s slightly frustrating because I wanted the opportunity to actually practice communication skills and speaking with a client.” (Vol-13, Novice)
“…Sometimes it gets a bit difficult because sometimes some of them prefer phone calls and not emailing or texting which is faster for students, if you’re on the go, you’re like, can’t we text them?” (Vol-16, Novice)
Understanding the volunteer role and its scope: “Lay people involved in care”
Volunteers understood their responsibilities to include keeping within boundaries, working confidentially, and basing interactions on client comfort.“… Just because it has to do with health doesn’t necessarily mean that it has to be health care professionals. If you can think of innovative ways for lay people to be involved in the care, as a community, to make people’s lives better and to have a share in community, I think that’s just really one of the highlights of [Health] TAPESTRY.” (Vol-1, Experienced)
Yet at times they struggled to understand their role, particularly the scope of volunteer practice and amount of advice they could give.“There’s a responsibility of confidentiality obviously and presenting yourself in a professional manner and making them feel comfortable.” (Vol-4, Experienced)
The main activities that volunteers saw as part of their role were: collecting information for the primary care team, listening to clients, helping clients think critically, and facilitating goal setting.“…Sometimes I’m just really wanting to say something that I know would be helpful and I know I’m not sort of supposed to interact that way. Sometimes I’m just not exactly sure how much input we can give personally.” (Vol-1, Experienced)
Providers felt some functions were particularly suited to volunteers, such as transmitting information and some system navigation, while other issues had to be managed by the clinical team.“We’re not there to assist them in providing any sort of advice, but rather just to give them the ability to think about things critically in a way that they might have not thought about before, in that they can solve their own problems by thinking about what they need to address. . . and see what resources are available to them. And then we are almost like a mirror or something.” (Vol-14, Novice)
However, multiple volunteers described feeling they had limited knowledge or ability to navigate clients to community resources, though some reported being able to provide at least some information.“I see no reason why they couldn’t do some of the system navigation stuff at a first pass if there is an obvious need and an obvious resource and if they had training and information about local connections and resources, I think that would be very helpful. I think anything that would require any treatment has to come to the clinic, obviously.” (PC-1)
“Different volunteers know different things; like I personally am not from [City], so I can’t tell someone, ‘Oh did you know there’s a gym just down the road.’” (Vol-6, Novice)
Volunteers as extensions of primary care teams: “Be[ing] the eyes where they live”
Volunteers recognized that they were not bound by the time constraints of clinical health care, enabling them to collect rich information during the approximately 1-h home visits. On average, volunteers visited each client 3–4 times, including a scheduled 3-month follow-up visit.“I think that one of the values to them is that we get to be the eyes in where they live and see things that the health care team may not ever see. And obviously we are asking questions too that the health care team doesn’t always have time to explore in the normal course of their work with that patient.” (Vol-9, Experienced)
Providers valued this benefit of volunteers, and for the most part saw volunteer home visits as extensions of the work they do.“Some clients would say that, I really appreciate the fact that someone actually came into my home and listened to what I had to say, without interrupting, without any time constraint; like you know, the doctor can only stay with me for 10 minutes or 15 minutes.” (Vol-15, Novice)
“The role that they are doing currently of going into the home and spending relaxed time with the person and covering all these assessment areas, I think itself is enormous.” (PC-4)
The disconnect between volunteers and the clinical team: “Is something being done?”
Providers also experienced a disconnection between themselves and volunteers. They largely described having no direct connections to volunteers at all.“I’m submitting all this information, now where is it? It just feels like it’s just – where is it going? That was like the biggest question that I had. Who’s seeing this? Is something actually being done with this?” (Vol-12, Novice)
This lack of connection made it difficult for providers to understand what was happening on home visits and how they could use volunteers to the fullest extent.“Direct exposure, none. So all of my understanding has been second-hand reports and anecdotes and stories and...” (PC-5)
To further add to the provider-volunteer disconnect, at times providers were uncertain how to interpret report, questioning if they could trust the information.“We haven’t heard from the volunteers, so we really don’t know how all the interaction is happening with the patient… We’re not really getting a lot, and we probably haven’t thought outside the box a lot of how to use these volunteers in the loop around care. And we don’t know them, so it’s very hard to ask a stranger.” (Hud-8)
Volunteers did feel very connected to the volunteer coordinator though, finding her to be strong in communication, scheduling, and showing volunteers are valued.“It’s not a specialist’s report or an investigation or something else that’s coming into our lab but it’s a volunteer…I don’t know much of what they have been trained with and how they are performing these kinds of assessments… So I think the aspect of a volunteer who I don’t know what training they’ve had for this assessment, plays a role into my thought process.” (Hud-9)
They also described support from the overall program team, particularly appreciating the opportunities to give and receive feedback, and the flexibility of the program to follow-up.“Even during the first Lunch & Learn, [Volunteer Coordinator] greeted me by name without even hesitating. I was amazed by that. I think that’s really, really important in terms of making sure volunteers feel valued and just making sure they are motivated to continue doing a good job.” (Vol-13, Novice)
However, volunteers described some logistics issues, including communication between volunteers, negotiating availability between volunteers with differing schedules, and transportation to client homes.“I like how there was lots of opportunity for feedback in terms of always asking the volunteers what was working, because we’re their front line in delivering those questionnaires. I know that people had concerns about the goals questionnaire and it was nice to see that the research team was being receptive of that feedback.” (Vol-14, Novice)
“If [volunteer coordinator] asks two people if they are available on a day and time and one replies all and one doesn’t, the other one doesn’t know, okay, was she up for it, is it on, is it confirmed? And then you sit back and wait and you put a question mark.” (Vol-8, Experienced)
“Learning… all the time”: impacts on volunteers
Volunteers also felt that gaining exposure to older adults was a program benefit. Many described changing their views of older adults and awareness of the issues facing this population, including isolation, falls, and the spectrum of health presentations.“…If I’m not actively answering the questions I am able to absorb what they are saying and understand what they are saying. And that for me has been a really important learning skill because you’re talking about improving communication as well, but it’s just about as much as listening as it is about talking.” (Vol-12, Novice)
Volunteers felt that volunteering with Health TAPESTRY was purposeful, of value, and contributed to research and society, helping them feel pride in their contribution. Volunteers also felt excited to be part of something new in healthcare.“It helped me understand what 70-year-olds are all about because, you know, it sounds dumb but I have only ever known two 70-plus-year-olds; my grandma and my papa. And so it’s helpful to know more older adults and realize that they’re people like you and they have their own goals and just breaking pre-conceived notions about them.” (Vol-14, Novice)
Volunteers were able to apply things they had learned previously, and the experience built value or added motivation to volunteers’ existing work, volunteering, and schooling.“Being able to have the privilege to have the time to help them has had a very positive impact on me. I have done all types of different volunteer work, but when it’s one-on-one personal, it just kind of makes you feel proud; and it makes me feel proud of the community that offers it.” (Vol-18, Experienced)
The understanding of healthy aging stemming from TAP-App questionnaires (on topics such as nutrition, physical activity, and mobility) was transferable to volunteers and their families, particularly with older volunteers.“I’m going into medicine next year and it kind of made me realize that there’s so many opportunities within medicine to develop new ideas and new ways of providing care.” (Vol-14, Novice)
“I too am looking to this particular age group and am not far removed from that; I too have all along, every time I ask the questions I reflect back on my own experience too, and I think like where do I fit in this and what can I learn. And, so I find that I am learning as well all the time, which I love.” (Vol-3, Experienced)
Clients’ acceptance of volunteers
Only a few clients identified concerns, which were primarily about the skill and confidence of some volunteers.“I sort of felt, I don’t know if it’s privileged, but wow, I’m getting these people coming here to sit with me and visit with me. And so I just felt it was a different experience.” (C-03)
“I always felt that I was training them rather than that they were sort of training me, if that’s the right way of putting it.” (C-48)