Pallavi Jonnalagadda , Carly Switalski Location: SHARE, India

1. Initial Steps to Protocol Implementation of the Mobility and Independent Living in Elders Study (MILES) in MedchalMandal, Andhra Pradesh, India. PallaviJonnalagadda, CarlySwitalski Location: SHARE, India Site Preceptor: Dr. K. Balasubrahmanian

2. Collaborators • “Share” is an acronym for Science Health Allied Research & Education , a service NGO and a not-for-profit organization dedicated to providing affordable healthcare infrastructure to the needy and rural population. • The study will be conducted in collaboration with the REACH program (Rural Effective Affordable Comprehensive Health Care) • REACH is a model of universal, comprehensive rural health care that provides health education, immunizations, antenatal care and primary to tertiary care for a population of 48,000 in 40 villages in the Ranga Reddy District on the northern outskirts of Hyderabad in the state of Andhra Pradesh, India. http://sharehealth.net/

3. Significance • Growth rate of 0.03% for a millennium. • Public Health initiatives - lead to high fertility and mortality differentials. • From 1901 to 1951 there was a 51.47% increase in the population. • In the latter half – from 1951 to 2001, there has been a 184.41% increase in the total population. • The Indian aged population is currently second largest in the world. • The number of the over 60 population in India will increase from 76 million in 2001 to 127 million by 2021. • Cohort to cohort increase in the size of the elderly population with fast growing visibility in ‘older old’ Ageing in India: Socio – Economic and Health Dimensions/ MoneerAlam; Ageing in India, WHO report 1999

4. The Mobility and Independent Living in Elders (MILE) Study • The Mobility and Independent Living in Elders (MILE) Study is an observational study designed to enroll 500 men and women (250 each) aged 60 years and over in selected geographic regions in the Andhra Pradesh Province of India to establish a longitudinal cohort study in India to define the prevalence, incidence and risk factors for disability and age-related disease in this population.

5. Objective • Inform and gain feedback from the elderly population (60 +) in MedchalMandal about MILES.

6. Methods – 1 An information session script was prepared containing the following: • a brief description of the project; • services provided; • questions soliciting participant opinions; • and anticipated questions regarding incentive, benefits, risks and confidentiality. • SHARE social workers, Community Health Volunteers (CHVs) and the site preceptor determined acceptability. • Translation was completed. • Two information sessions were conducted with 20 – 25 participants each in Ravalkol and Gyanapur villages. • Refreshments were provided, oral consent was sought to photograph, record and transcribe the session.

7. Methods – 2 Opinions solicited from attendees Feedback regarding MILES Do you understand why we are conducting this study? Which aspects are not clear? Do you have any concerns/ questions/ doubts with the things we are going to ask? Do you have any concerns/ questions/ doubts with the things we are going to measure? • What are the positive points about growing older? • What are the things you are most concerned about growing older? • What are some issues we haven’t included and you feel are important?

8. Results • There were 12 women and 5 men in the first session and 18 women and 6 men at the second information session. • Unanimously said there was nothing positive about growing older. • Familial neglect was main concern. • It had to be stressed that the purpose of the project was research and not primary care. • The attendees expected attentive care and provision of free medication for participating in the study. • The 50/50 health card for discounted MediCiti care was well – received. • Main health concern was joint (knee) pain. • Blood draw did not pose a problem. • Feedback was overall positive, elders were excited for personal attention from MediCiti researchers.

9. Conclusions • A clarification of research intention of the project should be provided. • Limb, joint and vision protocols should be incorporated based on the feedback.

10. Objective – 2 • Pre-test potential questionnaires.

11. Methods • An older man and woman, who attended the information session in Ravalkol village, were asked to participate in the pre-testing of the MILES questionnaire and function measurements. • Their self – reported age was 80 years each. The participants were transported to MIMS by a SHARE vehicle and accompanied throughout the visit by a SHARE staff member. • The questionnaires were administered to the participants by trained and experienced SHARE social workers. • Function measures were administered by trained interns. • A physical examination was performed by a MIMS physician and appropriate treatment was prescribed. • Breakfast and lunch were provided.

12. Results The entire visit lasted from 9:00 am to 3:00 pm including pick – up, lab testing, breakfast, administration of questionnaire, physical measurements, lunch, consultation with physician and drop – off. The following presented challenges: • The length of the visit; • Following and performing protocol prescribed instructions for spirometry; • Administering questions requiring a rating scale.

13. Conclusions • Use of show cards for questions requiring a rating scale should be explored. • Protocols for function measures like spirometry should be revised. • The length of the visit reinforced the need to have 2 or 3 visits for administration of the entire protocol.

14. My experience It was personally enriching and satisfying to work not only in my home country but also in the state that I hail from. I had the opportunity to work with an extremely dedicated and talented staff. I acquired a better understanding of the different aspects of conducting international studies.

15. Field visit by SHARE staff