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HomeHealth Development through Publications
Frost et al. (2017): How effective are home and community-based health promotion interventions for older people with mild/pre-frailty?
To determine how effective current interventions for older adults with mild frailty living in the community are, we conducted a systematic review and meta-analysis, to summarise the current literature. We found mixed results, highlighting that no recommendatiosn for home based interventions can be made. This identified a gap in clinical practice to meet the unmet need of this popualtion. The full paper has been published here.
Gardner et al. (2017): Which intervention components contribute to intervention effects in home-based health behaviour change interventions for frail older people?
To help with the development of the HomeHealth intervention we conducted an exploratory systematic review of the literature. The aim of this was to identify which content within home-based interventions for older adults with frailty helped them to remain independent and prevent falls in the home. Some components were identified, but the underlying mechanisms were not clear. The protocol and results papers have been published.
Drennan et al. (2018): To what extent does policy in England address the needs of older, frail adults to support independence?
The final review of the development phase looked at what the current health and social care policy documents and systems recommended for health promotion in older adults with mild frailty. Despite the specific needs of this population, we found a lack of policy attention for this population of older adults with mild frailty, highlighting a missed opportunity for intervention and prevention to reduce pressures on health and social care services. Again, the full results can be found here.
Frost et al. (2017): What are the barriers and facilitators for older adults to engagement with new home-based health promotion services?
Once we had searched the literature and identified these important components, we then conducted interviews with mildly frail older adults, their carers and community health and social care professionals to identify the barriers and facilitators to engaging with home-based health promotion services. The key factors identified were transportation, knowledge of local services, social support, acceptance of limitations, and motivation. Full results can be found in this published paper.
Together these projects were used to help develop the HomeHealth intervention to help mildly frail older adults maintain their indpendence and improve their wellbeing through information, motivation, and psychological and practical support.
Walters et al. (2017): What is the feasibility and acceptability of a new home-based health promotion for older people with mild frailty (HomeHealth)?
Following the developement of the HomeHealth intervention, it was pilotted in a feasibility study, to determine the acceptability and potential effectiveness of the intervention. In this pilot study 51 participants were randomised into the control group (treatment as usual) or to receive the HomeHealth intervention. Intervention participants received 3-6 sessions with a support worker to help with goal setting, problem solving, feedback and habit formation. We found that the intervention was acceptable and significant improvement in functioning, grip strength, and psychological distress. The full report of the feasibility study can be accessed here.
Avgerinou et al. (2019): How do mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach?
Within the feasibility study, we conducted some interviews with participants who received the intervention and the staff who delivered it, to understand what people engaged well with and what could be improved. We found three themes, 1) factors affecting choice of goal, 2) factors affecting engagement with behaviour change, and 3) preceptions of goal settins and behaviour change. The results can be found here and helped to refine the intervention before rolling it out in a national clinical trial.
Frost et al. (2020): How should health promoting interventions for frail older adults be adapted to be delivered remotely during the COVID-19 pandemic?
Following the feasibility study in 2018, we were due to roll out the intervention a national clinical trial in 2020. However, the COVID-19 pandemic put the study on pause. To help us adapt to a changing world and meet the needs of older frailer adults, we conducted another review to identify how we could adapt the intervention to be delivered remotely. We found that whilst effective results can be translated to interventions being delivered remotely, it was important to ensure that those without access to digital technology were not left behind. Full results here.
Walters et al. (2020): How effective is the HomeHealth intervention on maintaining independence in older people with mild frailty? A Randomised Controlled Trial
The protocol of what we planned to do can be found here: Published study protocol.
Walters et al. (2025): Clinical and cost-effectiveness of a home-based health promotion intervention for older people with mild frailty in England: a multicentre, parallel-group, randomised controlled trial
We conducted the randomised controlled trial between 2021-2023. We found people who received the service had a 1/3 fewer unplanned hospital admissions. This saved the NHS £586 per person over the year of the study. The HomeHealth service only cost £294 per person. In our assessments we found no improvement in independence in self-care in the group that received the service. There were, however, small improvements in well-being, psychological distress and frailty score. Read the full results in the published paper.
Frost et al. (2025): A personalised health intervention to maintain independence in older people with mild frailty: a process evaluation within the HomeHealth RCT
We also conducted a full process evaluation of the trial to explore the potential mechanisms underlying the findings from the main trial. The HomeHealth service was well-received and empowered people to use other health and support services. There was high appointment attendance. However, attending sessions did not mean engaging with the service. The full results from the process evaluation have been published and can be accessed here: Process evaluation paper.
Barrado-Martín et al. (2025): Understanding how older people with mild frailty engage with behaviour change to support their independence: a qualitative study
We did a deeper analysis of the 49 interviews we conducted with people about their experience of receiving the HomeHealth intervention to explore how people with mild frailty engage with behaviour change more generally to maintain their independence. We learnt that older people with mild frailty can successfully set and work towards their own goals. The public need to know that frailty is reversible and that there are services to help them. This way they can act to reverse or delay frailty for as long as possible. Read the full results in the published paper.
Ongoing work:
We have explored the effect of the intervention for people living with multiple long-term conditions and mild cognitive impairment. We will be publishing these findings soon and the links will be added to this page.