RAM-OP: Refining the tools‚ January 2015

HelpAge International, Valid International and Brixton Health are developing an innovative method of assessing the needs of older people in emergencies, including their nutritional needs. The Rapid Assessment Method for Older People (RAM-OP) is meant to offer a simple, quick, reliable, robust and cost effective method for assessing the nutritional status and vulnerabilities of older people in humanitarian contexts.NEW_LINENEW_LINETwo field tests were carried out, each comparing RAM with the SMART method, which is the golden standard for nutritional surveys. The results show that RAM-OP is able to produce estimates of the prevalence of acute malnutrition with useful precision. Moreover, RAM-OP produces a lot of supplementary information on the status and needs of older people (diet, health, disability and impairment, income, water and sanitation, etc…), which are really useful when planning a response to a humanitarian situation. RAM-OP is also cheaper and quicker to implement than SMART, because of the smaller sample size (only 192 older people need to be interviewed to produce results with a good precision).NEW_LINENEW_LINENow that we have evidence that RAM-OP is performing well, both in rural and urban contexts, we have to work on refining the tools that we want to make available to the humanitarian community.NEW_LINENEW_LINEOur plan is to present the following instruments:NEW_LINE• A users’ manualNEW_LINE• A questionnaireNEW_LINE• A data entry file (using EpiData Entry)NEW_LINE• A data analysis file, to be used on R (free software elaborated by a team from Oxford).NEW_LINENEW_LINEAll these tools will be produced using free open-source software.NEW_LINEWe have started writing the users’ manual, but the first thing was to refine the questionnaire. When carrying out an assessment, it is quite common to want to gather too much information… The result is a long questionnaire, with questions that are not standardised (thus leading to answers lacking precision), or which are redundant, or not very relevant.NEW_LINENEW_LINEIn our case, we already had included as many standardised indicators as we could (e.g. the Kessler 6 for measuring psychological distress, or the Katz Index to measure the level of independence in activities of daily living…), but the resulting questionnaire was too long: in the latest version tested in Tanzania, it had 10 pages. This meant spending between 15 and 40 minutes with each respondent, depending on the enumerator’s skills… More fatigue from the respondents, and from the enumerators, increasing the risk of mistakes, and decreasing the quality of the data collection. This also meant spending more time on training the enumerators on how to properly administer the questionnaire. And more time on data analysis.NEW_LINENEW_LINEWhat we wanted was a more concise questionnaire, adapted to humanitarian contexts, where obtaining fast reliable assessment results is essential. We also wanted to keep the specificity of focusing on the needs of older people. It was not easy to get rid of some of the questions, and we had heated discussions, but in the end, we managed to reduce the questionnaire to 8 pages, and from around 90 questions to 66… We have kept the questions about diet diversity, the K6, the Katz Index, and also the dementia screening and the visual impairment test, but we got rid of the household size, the appetite, the role in the community, and others… which were not really useful.NEW_LINENEW_LINEWe are now working on the other tools: the data entry, and the data analysis files, while writing the users’ manual.