{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:01:47Z","timestamp":1792000907231,"version":"4.4.0"},"reference-count":260,"publisher":"National Institute for Health and Care Research","issue":"73","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["12\/192\/10"],"award-info":[{"award-number":["12\/192\/10"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"Background<\/jats:title>Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health\/social care costs. However, we know little about effective approaches to preventing frailty progression.<\/jats:p><\/jats:sec>Objectives<\/jats:title>(1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT).<\/jats:p><\/jats:sec>Design<\/jats:title>Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation.<\/jats:p><\/jats:sec>Intervention development<\/jats:title>Two systematic reviews (including systematic searches of 14 databases and registries, 1990\u20132016 and 1980\u20132014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65\u201394 years) (n<\/jats:italic>\u2009=\u200944), carers (n<\/jats:italic>\u2009=\u200912) and health\/social care professionals (n<\/jats:italic>\u2009=\u200927). These data, and our evidence reviews, fed into development of the \u2018HomeHealth\u2019 intervention in collaboration with older people and multidisciplinary stakeholders. \u2018HomeHealth\u2019 comprised 3\u20136 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation.<\/jats:p><\/jats:sec>Feasibility RCT<\/jats:title>Single-blind RCT, individually randomised to \u2018HomeHealth\u2019 or treatment as usual (TAU).<\/jats:p><\/jats:sec>Setting<\/jats:title>Community settings in London and Hertfordshire, UK.<\/jats:p><\/jats:sec>Participants<\/jats:title>A total of 51 community-dwelling adults aged \u2265\u200965 years with mild frailty.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Feasibility \u2013 recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation\/costs.<\/jats:p><\/jats:sec>Results<\/jats:title>We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (\u00a3307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68;p<\/jats:italic>\u2009=\u20090.004), better grip strength (+6.48\u2009kg;p<\/jats:italic>\u2009=\u20090.02), reduced psychological distress (12-item General Health Questionnaire \u20133.92;p<\/jats:italic>\u2009=\u20090.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder\/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible.<\/jats:p><\/jats:sec>Future work<\/jats:title>A large, definitive RCT of the HomeHealth service is warranted.<\/jats:p><\/jats:sec>Study registration<\/jats:title>This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672.<\/jats:p><\/jats:sec>Funding<\/jats:title>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment<\/jats:italic>; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta21730","type":"journal-article","created":{"date-parts":[[2017,12,7]],"date-time":"2017-12-07T10:44:52Z","timestamp":1512643492000},"page":"1-128","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT"],"prefix":"10.3310","volume":"21","clinical-trial-number":[{"clinical-trial-number":"isrctn11986672","registry":"10.18810\/isrctn","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-2430","authenticated-orcid":true,"given":"Kate","family":"Walters","sequence":"first","affiliation":[{"name":"Department of Primary Care and Population Health, University College London, London, 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