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Background: The global population of older adults is increasing, and complex, multidimensional health challenges become more prevalent with age. This challenges the sustainability of healthcare services and highlights the need for health-promoting approaches that support older adults’ functioning and ability to live at home. Early identification of health needs is central to such efforts.
Health needs assessment provides a systematic approach to identifying health, functional, and care-related needs and may support timely advice and measures in municipal home care services. However, assessment practices vary, important health domains may remain under-assessed, and healthcare professionals may lack sufficient competence to apply holistic and interprofessional assessment tools in practice. Although simulation training may strengthen assessment skills, clinical reasoning, and collaboration, knowledge remains limited about how such training is applied and transferred to everyday practice in municipal home care.
Overall aim and research questions: The overall aim of this thesis was to explore how training can prepare healthcare professionals to assess the health needs of older adults living at home across physical, cognitive, mental, sensory, behavioral, and social domains, and to examine healthcare professionals’ experiences of conducting interprofessional health needs assessments in municipal home care services. The thesis also aimed to explore how such assessments may support the identification of appropriate health-promoting advice and measures.
Three empirical studies, presented as Papers I–III, addressed the following research questions: (1) What pedagogical approaches are used when training healthcare professionals to assess the health needs of older adults living at home, what content and foci are included in such training, and what outcomes are reported by healthcare professionals and older adults? (2) How do healthcare professionals reflect on and experience interprofessional simulation training involving systematic assessment of
an older adult’s holistic health needs and consideration of appropriate measures based on the assessment? and (3) How do healthcare professionals experience and reflect on conducting health needs assessments of older adults living at home?
Methods: This thesis employed an explorative research design comprising one scoping review and two qualitative empirical studies. Paper I was a scoping review of 23 peer-reviewed studies on pedagogical approaches used to train healthcare professionals in assessing physical, mental, and social health needs among older adults living at home. Data were analyzed using semantic, inductive reflexive thematic analysis. Paper II was a qualitative study of interprofessional simulation training with structured debriefing, involving 11 healthcare professionals from a municipal health and welfare office. Five audio-recorded and transcribed debriefing sessions were analyzed using semantic, inductive reflexive thematic analysis. Paper III was a qualitative study based on triadic interviews with nine healthcare professionals who had participated in the simulation training and subsequently conducted health needs assessments in the homes of 40 older adults. Six audio-recorded and transcribed interviews were analyzed using longitudinal, inductive-deductive reflexive thematic analysis.
Results: The findings indicate that assessment tools were feasible to use and supported more holistic and consistent assessment of older adults’ health needs in municipal home care. The tools helped healthcare professionals identify needs that might otherwise have remained unnoticed and provided an overview of older adults’ health, functioning, resources, and activities of daily living. Assessment scores supported dialogue with older adults, health-promoting advice, measures, and enabled monitoring changes over time. However, the value of the tools depended on healthcare professionals’ competence, communication skills, and ability to adapt assessments to older adults’ individual situations. Some areas, including hearing, vision, alcohol use, and mental health, were experienced as more difficult to translate into advice and follow-up.
Interprofessional collaboration strengthened the assessment process by supporting shared responsibility, documentation, integration of professional perspectives, confidence, and prioritization of measures. Training with blended learning approach was perceived as important for developing assessment competence. Interprofessional simulation training in home-like laboratory settings provided a safe and authentic arena for practicing tool use, communication, collaboration, and consideration of appropriate measures before conducting assessments in municipal home care. Continued use in practice appeared to strengthen healthcare professionals’ familiarity with, confidence in, and perceived usefulness of the tools over time.
Conclusion: This thesis contributes new knowledge about training for and conduct of health needs assessment in municipal home care services. The findings suggest that systematic assessment may support timely, individualized, and health-promoting measures for older adults living at home by making health needs, resources, and everyday circumstances more visible. However, this requires more than assessment tools alone. Their value depends on professional judgement, communication skills, interprofessional collaboration, and competence to translate findings into relevant advice and measures. Healthcare professionals may be prepared for health needs assessment through blended teaching approaches, interprofessional simulation training, and continued use in practice. Overall, health needs assessment in municipal home care should be understood as a relational, collaborative, and competence-dependent practice.
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