Survey methods and response rates among rural community dwelling older adults

Complicated Pleural Infection is Associated With Prolonged Recovery and Reduced Functional Ability

BACKGROUND

Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients' recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery.

METHODS

We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire.

RESULTS

Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781).

CONCLUSION

Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.

Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial

Background

Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS).

Methods

We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm).

Findings

Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18).

Interpretation

The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally.

Funding

US National Institute on Drug Abuse.

Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study

BACKGROUND

Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS.

METHODS

From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity.

RESULTS

On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity.

CONCLUSION

Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.

Methods to increase response to postal and electronic questionnaires

BACKGROUND

Self-administered questionnaires are widely used to collect data in epidemiological research, but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research.

OBJECTIVES

To identify effective strategies to increase response to postal and electronic questionnaires.

SEARCH METHODS

We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented.

SELECTION CRITERIA

Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre-defined criteria.

DATA COLLECTION AND ANALYSIS

We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi2 test and quantified the degree of inconsistency between trial results using the I2 statistic.

MAIN RESULTS

Postal We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I2 = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24). The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I2 = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I2 = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow-up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non-monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I2 = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non-monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I2 = 57%); using a single-sided rather than a double-sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I2 = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first-class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54). The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00). Electronic We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I2 = 19%). The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I2 = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non-monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e-questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I2 = 94%); and using a more interesting e-questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I2 = 41%). The odds of response also increased with: personalised e-questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I2 = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64). The odds of response were reduced when: "Survey" was mentioned in the e-mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e-questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01). The odds of response using a postal questionnaire were over twice those using an e-questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I2 = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I2 = 97%); and when administering the e-questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94).

AUTHORS' CONCLUSIONS

Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.

Patient Perspectives on Artificial Intelligence in Healthcare Decision Making: A Multi-Center Comparative Study

Objective

Investigate the patient opinion on the use of Artificial Intelligence (AI) in Orthopaedics.

Methods

397 orthopaedic patients from a large urban academic center and a rural health system completed a 37-component survey querying patient demographics and perspectives on clinical scenarios involving AI. An average comfort score was calculated from thirteen Likert-scale questions (1, not comfortable; 10, very comfortable). Secondary outcomes requested a binary opinion on whether it is acceptable for patient healthcare data to be used to create AI (yes/no) and the impact of AI on: orthopaedic care (positive/negative); healthcare cost (increase/decrease); and their decision to refuse healthcare if cost increased (yes/no). Bivariate and multivariable analyses were employed to identify characteristics that impacted patient perspectives.

Results

The average comfort score across the population was 6.4, with significant bivariate differences between age (p = 0.0086), gender (p = 0.0001), education (p = 0.0029), experience with AI/ML (p < 0.0001), survey format (p < 0.0001), and four binary outcomes (p < 0.05). When controlling for age and education, multivariable regression identified significant relationships between comfort score and experience with AI/ML (p = 0.0018) and each of the four binary outcomes (p < 0.05). In the final multivariable model gender, survey format, perceived impact of AI on orthopaedic care, and the decision to refuse care if it were to increase cost remained significantly associated with the average AI comfort score (p < 0.05). Additionally, patients were not comfortable undergoing surgery entirely by a robot with distant physician supervision compared to close supervision.

Conclusion

The orthopaedic patient appears comfortable with AI joining the care team.

Perceptions of Caring Recruitment Among Older Adults: African Americans and Non-Latinx Whites

BACKGROUND

African Americans (AAs) are underrepresented in health-related research studies. Few studies have investigated how behaviors of study recruiters affect recruitment of older AAs versus non-Latinx Whites (NLWs).

OBJECTIVES

The aim of this study was to explore whether caring behaviors influence AA and NLW older adults' decision to participate in hypothetical, high-commitment, health-related research studies and differences in participants' enrollment decisions by race.

METHODS

Using a descriptive, cross-sectional study design, guided by Kristen Swanson's middle-range theory of caring, a research-savvy sample of 60 AA and 60 NLW adults (age > 65 years) were randomly assigned one of two written vignettes. The concept of caring behaviors was manipulated and illustrated in a hypothetical recruitment scenario. A participant feedback survey was used to assess (a) participants' perceptions of caring and uncaring behaviors exhibited by the fictitious research recruiter, (b) differences in their willingness to participate based on vignette type, and (c) participants' judgment of the research recruiter as being caring or uncaring. A chi-square test assessed the association among categorical variables (caring behavior and participants' race).

RESULTS

Participants who received the vignette with the high caring recruiter were more than twice as likely to agree to participate in the study than those who received the vignette with the low caring recruiter. AA and NLW participants did not differ in their likelihood to agree to participate. Participants who received the caring vignette and judged the recruiter as caring were 5 times as likely to agree to participate in the high-commitment study than those who received the uncaring vignette ( p < .001). Associations did not vary by race.

DISCUSSION

This experimental study of equally recruited older adults from an existing longitudinal study revealed that caring behaviors in recruitment strategies are associated with an increased likelihood of participation in high-commitment research with older adults. The research-savvy AA participants were just as likely to participate in the hypothetical high-commitment research as their NLW peers when the fictional research recruiter was perceived as having caring behaviors. When targeting specific populations, it is essential to employ nuanced recruitment approaches where the study recruiters are attuned to caring behaviors.

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

BACKGROUND

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.

METHODS

This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.

RESULTS

We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.

CONCLUSIONS

Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.

Empty Houses, Loose Dogs, and Engaged Citizens: Lessons Learned From Community Participatory Data Collection in Rural Areas

Rural surveys tend to oversample easy to reach populations, which can misrepresent community health needs. To achieve baseline data reflective of the communities served by the high obesity program (HOP), an innovative evaluation plan was created to prioritize equity and reflect the whole community. Principles of Community-Based Participatory Research (CBPR) were used to guide instrument development, research protocols, and data collection. A random sample of addresses created with United States Postal Service records provided a representative list of addresses in three HOP counties in Louisiana. Local data collectors were recruited to go door to door at the selected addresses to collect in-person surveys (N = 682; response rate of 84%). Over a quarter of participants reported using the charitable food system and walking for transportation at least weekly. Collecting door to door data in rural communities presents unique challenges, including abandoned properties, inaccurate address records, loose dogs, and at times, racial tensions and houses far removed from public roads. Lessons learned include the importance of local knowledge, adapting protocols to fit local conditions, and community awareness of the survey. Health practitioners need confidence when they are making data-based decisions about interventions, and one way to provide this confidence is to collect data from a true cross-section of the community. With a plan and in partnership with community members, a probability sample is feasible to collect in rural communities.

A comparison of survey incentive methods to recruit rural cancer survivors into cancer care delivery research studies

Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X2 (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.

Influence of cantonal health policy frameworks & activities on the influenza vaccination rate in patients with non-communicable diseases in Switzerland

BACKGROUND AND OBJECTIVE

Seasonal influenza may cause serious illness, especially in high-risk populations such as older adults and individuals suffering from non-communicable diseases (NCD) and may be prevented by a vaccination. However, an assessment of the impact of the Swiss legal frameworks and number of health activities on influenza vaccination coverage of the population at the cantonal level is lacking.

METHODS

Two participating healthcare insurers sent out 25,000 semi-structured questionnaires to their subscribers aged 60-85 in five Swiss cantons selected according to the number of health activities and legal framework regarding influenza vaccination and linguistic region. Influenza vaccination coverage of the participants was evaluated and stratified by disease status, age, canton, and linguistic region. Results were compared by cantonal activities, legal framework, and linguistic region.

RESULTS

7,617 valid questionnaires were evaluated from the cantons Aargau, Jura, St. Gallen, Schwyz, and Vaud. 47.9 % stated to have an NCD, with the most frequent being muscle/ skeletal disease (36.7%). Before 2018, 48.6% were vaccinated against influenza, and 35.9% in 2019, with the highest in canton Vaud. In all cantons and in both survey periods, NCD patients and those aged 73-85 had a higher vaccination coverage than participants without NCD, and aged 60-72. There was no difference in the odds of getting an influenza shot based on legal framework. Although a comparison of the number of activities between the German-speaking cantons did not reveal any significant differences, the odds of the participants living in a French-speaking canton getting an influenza vaccination was more likely than those living in a German-speaking canton.

CONCLUSION

There was no association between the investigated cantonal frameworks and number of health activities and influenza vaccination coverage in NCD patients in the selected cantons. However, age, disease status and linguistic region appear to have an influence on vaccination uptake.

Cumulative effect of loneliness and social isolation on health outcomes among older adults

OBJECTIVES

Loneliness and social isolation are described similarly yet are distinct constructs. Numerous studies have examined each construct separately; however, less effort has been dedicated to exploring the impacts in combination. This study sought to describe the cumulative effects on late-life health outcomes.

METHOD

Survey data collected in 2018-2019 of a randomly sampled population of US older adults, age 65+, were utilized (N = 6,994). Survey measures included loneliness and social isolation using the UCLA-3 Loneliness Scale and Social Network Index. Participants were grouped into four categories based on overlap. Groups were lonely only, socially isolated only, both lonely and socially isolated, or neither. Bivariate and adjusted associations were examined.

RESULTS

Among participants (mean age = 76.5 years), 9.8% (n = 684) were considered lonely only, 20.6% (n = 1,439) socially isolated only, 9.1% (n = 639) both lonely and socially isolated, and 60.5% (n = 4,232) neither. Those considered both lonely and socially isolated were more likely to be older, female, less healthy, depressed, with lower quality of life and greater medical costs in bivariate analyses. In adjusted results, participants who were both lonely and socially isolated had significantly higher rates of ER visits and marginally higher medical costs.

CONCLUSION

Results demonstrate cumulative effects of these constructs among older adults. Findings not only fill a gap in research exploring the impacts of loneliness and social isolation later in life, but also confirm the need for approaches targeting older adults who are both lonely and socially isolated. As the COVID-19 pandemic continues, this priority will continue to be urgent for older adults.

Loneliness, Social Isolation, and All-Cause Mortality in a Large Sample of Older Adults

Objectives

Using data from a large random sample of U.S. older adults (N = 7982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and combined effects.

Methods

The UCLA-3 Loneliness Scale and the Social Network Index (SNI) were used to define loneliness and social isolation. Cox proportional hazards regression models were performed.

Results

Among study participants, there were 548 deaths. In separate, adjusted models, loneliness (severe and moderate) and social isolation (limited and moderate social network) were both associated with all-cause mortality. When modeled together, social isolation (limited and moderate social network) along with severe loneliness remained significantly associated with mortality.

Discussion

Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality within our population of older adults. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.

Tailoring research recruitment strategies to survey harder-to-reach populations: A discussion paper

AIMS

A discussion of the challenges of recruiting participants from harder-to-reach populations for quantitative survey studies and potential avenues for tailored strategies to address these challenges.

DESIGN

Discussion paper.

DATA SOURCES

The search was conducted on August 2, 2021, in the CINAHL and PubMed databases, and in Google scholar. The initial search identified 5880 articles, and the final analysis included 44 articles that met the inclusion criteria. Articles were retained if they addressed methodological challenges or strategies for recruitment and concerned research with harder-to-reach populations.

IMPLICATIONS FOR NURSING

This article draws on the literature regarding the challenges of recruiting research participants from harder-to-reach populations and known strategies for overcoming them. These strategies include, for example, establishing a trusting relationship between the researcher and the participant community and gaining in-depth knowledge of the target population. These challenges and strategies for recruiting participants from these populations are discussed specifically in the context of quantitative survey research.

CONCLUSION

Nurse researchers conducting quantitative survey studies with participants from harder-to-reach populations must tailor their recruitment strategies to the target population and, most importantly, be flexible and creative in their recruitment methods.

IMPACT

The article discusses the challenges of recruiting participants from harder-to-reach populations and strategies to overcome them in quantitative survey studies. Successful recruitment requires researchers to develop a thorough understanding of the harder-to-reach population, develop partnerships to locate and access potential participants, build trust with the community, tailor their language, minimize participation risk and resource constraints, recognize the cognitive and physical demands required, and be flexible and creative in developing recruitment strategies. This knowledge can enable the inclusion of more people from harder-to-reach populations in survey studies and provide evidence that can inform research and practice to provide healthcare tailored to their needs and ultimately help improve their health and well-being.

Does advance contact with research participants increase response to questionnaires: an updated systematic review and meta-analysis

Background

Questionnaires remain one of the most common forms of data collection in epidemiology, psychology and other human-sciences. However, results can be badly affected by non-response. One way to potentially reduce non-response is by sending potential study participants advance communication. The last systematic review to examine the effect of questionnaire pre-notification on response is 10 years old, and lacked a risk of bias assessment.

Objectives

Update the section of the Cochrane systematic review, Edwards et al. (2009), on pre-notification to include 1) recently published studies, 2) an assessment of risk of bias, 3) Explore if heterogeneity is reduced by: delay between pre-contact and questionnaire delivery, the method of pre-contact, if pre-contact and questionnaire delivery differ, if the pre-contact includes a foot-in-the-door manipulation, and study’s the risk of bias.

Methods

Inclusion criteria: population: any population, intervention: comparison of some type of pre-notification, comparison group: no pre-notification, outcome: response rates. Study design: randomised controlled trails. Exclusion criteria: NA. Data sources: Studies which cited or were included in Edwards et al. (2009); We additionally searched: CINAHL, Web of Science, PsycInfo, MEDLINE, EconLit, EMBASE, Cochrane Central, Cochrane CMR, ERIC, and Sociological Abstracts. The searches were implemented in June 2018 and May 2021. Study screening: a single reviewer screened studies, with a random 10% sample independently screened to ascertain accuracy. Data extraction: data was extracted by a single reviewer twice, with a week between each extraction. Risk of Bias: within studies bias was assessed using the Cochrane Risk of Bias tool (ROB1) by a single unblinded reviewer, across studies bias was assessed using funnel plots. Synthesis Method: study results were meta-analysed with a random effects model using the final response rate as the outcome. Evaluation of Uncertainty: Uncertainty was evaluated using the GRADE approach.

Results

One hundred seven trials were included with 211,802 participants. Over-all pre-notification increased response, OR = 1.33 (95% CI: 1.20–1.47). However, there was a large amount of heterogeneity (I² = 97.1%), which was not explained by the subgroup analyses. In addition, when studies at high or unclear risk of bias were excluded the effect was to reduced OR = 1.09 (95% CI: 0.99–1.20). Because of the large amount of heterogeneity, even after restricting to low risk of bias studies, there is still moderate uncertainty in these results.

Conclusions

Using the GRADE evaluation, this review finds moderate evidence that pre-notification may not have an effect on response rates.

Funding

Economic and Social Research Council.

Preregistration

None.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01435-2.

The INSPIRE Population Survey: development, dissemination and respondent characteristics

BACKGROUND

Most older adults prefer to continue living at home despite increasing care needs and demand for services. To aid in maintaining independence, integrated care models for community-dwelling older people are promoted as the most cost-effective approach. The implementation of such care models is challenging and often the end-users are not involved or their needs are not considered. We conducted a population survey in order to understand the needs and preferences of home-dwelling older adults living in Canton Basel-Landschaft, Switzerland. The aims of this paper are to chronicle the development of the INSPIRE Population Survey, outline its variables and measurements, describe the marketing strategy utilized for survey dissemination and report on the response rate and respondent characteristics.

METHODS

The INSPIRE Population Survey, conducted between March and August 2019, is a cross-sectional survey of older adults aged 75 and older living at home in Canton Basel-Landschaft. The questionnaire was developed by expert input and stakeholder involvement. Its readability and acceptability were pilot-tested with older people. To ensure the likelihood of a high and representative response rate, a meticulous step-by-step marketing strategy was developed prior to the dissemination of the questionnaire.

RESULTS

The overall response rate was 30.7% (n = 8,846), with variations between 20.6 and 34.5% across the different care regions in the canton. A generally higher response rate was found in the care regions with a higher density and which bordered the urban city of Basel. We received support from local stakeholders, policy makers and media through using a broad combination of marketing channels and targeting our community partners who have a strong relationship with our target audience.

CONCLUSIONS

Although recruiting older adults in research is challenging, our study shows that a high response rate can be achieved by developing the survey through expert input and by involving all important stakeholders, including older adults, throughout the entire process.

Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study

BACKGROUND

The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters.

AIMS

To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices.

METHOD

Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ± 8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices.

RESULTS

66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (β = 0.359, p = 0.004) as the strongest determinant, followed by attitude (β = 0.195, p = 0.093), and perceived behavioral control (PBC) (β = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (β = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (β = 0.636, p < 0.001) on future PPP implementations.

DISCUSSION

This study demonstrates utility of the TPB in predicting implementation of PPPs.

CONCLUSIONS

Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.

Self-reported oral health problems and the ability to organize dental care of community-dwelling elderly aged ≥75 years

Background

It is unclear how many community-dwelling elderly (≥75 years) experience oral health problems (e.g. pain, dry mouth, chewing problems) and how they manage their dental care needs. This study aimed to assess self-reported oral health problems in elderly who are frail or have complex care needs, and their ability to organize dental care when reporting oral pain.

Methods

Three thousand five hundred thirty-three community-dwelling elderly participating in the “Embrace” project were asked to complete questionnaires regarding oral status and oral health problems. Frailty was assessed with the Groningen Frailty Indicator (GFI). Intermed for Elderly Self-Assessment (IM-E-SA) was used to determine complexity of care needs. Next, elderly who reported oral pain were interviewed about their oral pain complaints, their need for dental care, and their ability to organize and receive dental care. For statistical analyses Chi²-tests and the one-way ANOVA were used.

Results

One thousand six hundred twenty-two elderly (45.9%) completed the questionnaires. Dry mouth (11.7%) and oral pain (6.2%) were most frequently reported. Among the elderly reporting oral pain, most were registered at a local dentist and could go there when needed (84.3%). Robust elderly visited the dentist independently (87%), frail (55.6%) and complex (26.9%) elderly more often required assistance from caregivers.

Conclusions

Dry mouth and oral pain are most reported oral health problems among community-dwelling elderly. Elderly with complex care needs report most oral health problems. In case an elderly seeks dental treatment to alleviate an oral pain complaint, most elderly in this study were able to organize dental care and transport to the dentist. Frail and complex elderly often need assistance from caregivers to visit the dentist. Therefore caretakers should keep in mind that when frailty progresses, visiting a dentist may become more and more difficult and the risk for poor oral health increases.

Self-Reported Cognitive Frailty Predicts Adverse Health Outcomes for Community-Dwelling Older Adults Based on an Analysis of Sex and Age

OBJECTIVES

The present study examined whether the combination of self-reported mobility decline (SR-MD) and cognitive decline (SR-CD) was associated with mortality and new long-term care insurance (LTCI) service certifications based on sex and age.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

We analyzed cohort data from a sample of older adult residents in Kami Town, Japan. The response rate was 94.3%, and we followed 5,094 older adults for 3 years. Full analyses were conducted on 5,076 participants.

MEASURES

A total of four groups were determined through self-reported responses on the Kihon Checklist for SR-MD (a score of 3 or more on 5 items) and SR-CD (a score of 1 or more on 3 items): non-SR-cognitive frailty, non-SR-MD and SR-CD, SR-MD and non-SR-CD, and SR-cognitive frailty.

RESULTS

Main outcomes included mortality (n = 262) or new certifications for LTCI services (n = 708) during the 3-year period. Excluding overlapping, this included 845 older adults (16.6%). Among men, prevalence of non-SR-cognitive frailty, non-SR-MD and SR-CD, SR-MD and non-SR-CD, and SR-cognitive frailty (SR-MD and SR-CD) was 48.2%, 26.4%, 11.5%, and 13.8%, respectively. Respective rates for women were 45.7%, 15.5%, 23.1%, and 15.7%. Multivariate analyses revealed that for men, SR-MD and non-SR-CD significantly affected adverse health outcomes, leading to earlier negative outcomes relative to the non-SR-MD and SR-CD group. For women, non-SR-MD and SR-CD and SR-MD and non-SR-CD had similar slopes.

CONCLUSIONS

The impact of SR-MD or SR-CD on adverse health outcomes differed as a function of age and sex. Thus, we need to consider preventive approaches according to these specific target group features.

Factors Associated With Older Adults' Enrollment in Balance Classes to Prevent Falls: Case-Control Study

Balance training decreases fall risk among older adults, but few participate in such training. We examined the association of exposure to social marketing to promote balance classes, personal characteristics and other factors, with older adults' balance class participation. Adults aged ⩾60 years were eligible for this case-control study if they attended any church enrolled in a trial testing the effect of social marketing on balance class participation. Cases attended balance classes during the study period; controls were randomly sampled congregants who did not join a class. Cases were more likely to attend churches that received the social marketing program, and were older, more often female, and more frequently experienced "near falls" than controls. Participation was also associated with increasing age of the church's leader and rural church attendance. Programs to promote balance classes may need to be tailored to target some risk groups, including men and urban and suburban congregants.

Nutritional and physical exercise programs for older people: program format preferences and (dis)incentives to participate

Purpose

A growing number of studies in older people have been examining the beneficial effects of non-pharmacological interventions, such as physical exercise (PE) and nutritional supplementation, to target age-related syndromes such as sarcopenia and frailty. This study evaluated interpersonal, intrapersonal, and community (dis)incentives, concepts of motivation, and preferred program formats toward a PE or nutritional program in older people, with or without frailty or risk of sarcopenia.

Methods

A questionnaire was developed and filled in by 115 community-dwelling older adults (≥65 years of age) after content (n=7 experts) and face validation (n=8 older adults). We assessed 1) the agreement with a statement (a statement with which ≥70% of the participants agree or strongly agree is considered as a common statement), 2) concepts of motivation by an exploratory factor analysis, and 3) program preferences by nonparametric Wilcoxon or Friedman’s analysis of variance and post hoc Wilcoxon signed-rank tests.

Results

Intrapersonal motivators (eg, health benefits) were the most common motivators to participate in a PE or nutritional program. Identified concepts to participate in a PE intervention were intrinsic health beliefs, fear of falling or injuries, influence of significant others and environment, and (para)medical encouragement (Cronbach’s alpha: 0.75; 72% variance explained). Intrinsic health beliefs, influence of significant others and (para)medical encouragement were identified as concepts that motivate older people to participate in a nutritional intervention (Cronbach’s alpha: 0.77; 78% variance explained). No favorability of exercise location was identified; however, older people preferred protein supplement intake in a tablet form compared to liquid or powder form and in a pulsed timing compared with a spread intake.

Conclusion

Program preferences of older people toward nutritional interventions need to be taken into account in future clinical trials and implementation programs, to increase recruitment and adherence to interventions.

Most response-inducing strategies do not increase participation in observational studies: a systematic review and meta-analysis

OBJECTIVES

To evaluate response-inducing strategies for observational studies using health-related questionnaires or interviews.

STUDY DESIGN AND SETTING

We searched PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science up to December 28, 2017. Studies evaluating the effect of a response-inducing strategy on participation rates of observational studies were included. For each strategy, we estimated pooled response ratios with 95% confidence intervals (CIs) in a Hartung-Knapp/Sidik-Jonkman random effects model with the final participation rate as outcome, stratified for type of participants and method of data collection.

RESULTS

The search yielded 168 eligible studies involving 367,616 potential participants and 33 strategies. Among patients, response-inducing strategies for paper-based questionnaires included unconditional monetary incentives (response ratio 1.15; 95% CI 1.09-1.21) and shorter questionnaires (1.04; 1.02-1.06). Among nonpatients, a personalized mode of delivery (1.47; 1.24-1.74), more expensive mailing type (1.25; 1.00-1.56), unconditional monetary incentives (1.24; 1.12-1.38), prenotification (1.12; 1.03-1.22), unconditional scratch lottery tickets (1.09; 1.01-1.18), and shorter questionnaires (1.06; 1.02-1.11) increased response rates to paper-based questionnaires. For Web-based questionnaires and interviews among nonpatients, response rates were increased by conditional lottery tickets (1.17; 1.02-1.34) and conditional monetary incentives (1.39; 1.01-1.91), respectively.

CONCLUSION

Although the majority of strategies evaluated were unsuccessful, some may increase response rates to observational studies, particularly among nonpatients.

A mixed methods study of the experience of older adults with multimorbidity in a Care Coordination Program

Introduction

Care Coordination Programs are designed to streamline services for older adults with multimorbidity. The Triple Aim, a conceptual model for the design and evaluation of healthcare models, stipulates that a balance of three aims—reducing costs, improving population health, and improving patient experience—are needed for high-quality, value-based care. Research is beginning to show that coordinating care across the continuum of care reduces costs and improves the health of the multimorbid older adult population. Yet little is known about older adults’ experience of care and their overall assessment of interactions with healthcare providers across the length of time of these interactions in a Care Coordination Program.

Methods

To gain a deeper understanding of older adults’ experience with a Care Coordination Program, this concurrent mixed methods research study analyzed 201 older adults’ assessment of their chronic illness care using the Patient Assessment of Chronic Illness Care (PACIC+). A subset of 30 older adults also participated in a telephone interview to collect qualitative data.

Results

The experience of older adults with multimorbidity in a Care Coordination Program was related to two factors: (1) professional actions and (2) professional attitudes. Actions that improved patients’ experience of care were communication, coordination, and addressing fundamental problems. Professional attitudes that improved their experience of care included being compassionate, knowledgeable and professional, mutually respectful, and positive and encouraging.

Discussion

To improve patient experience, Care Coordination Programs must design and measure their efforts related to the actions and the attitudes of their care team, especially primary care physicians and care coordinators.

Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care: a cross sectional study

Objective

To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care.

Materials and methods

For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed.

Results

One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72–85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all.

Conclusions

Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly.

Clinical relevance

Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

Prevalence of Health App Use Among Older Adults in Germany: National Survey

Background

Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services.

Objective

The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany.

Methods

A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status.

Results

In total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis.

Conclusions

Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users’ demographics were revealed.

An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service

BACKGROUND

Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed.

OBJECTIVE

To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors.

THEORY

The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability.

METHODS

A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables.

RESULTS

Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important.

CONCLUSIONS

Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.

Risk Factor Knowledge, Perceived Threat, and Protective Health Behaviors: Implications for Type 2 Diabetes Control in Rural Communities

Purpose The purpose of this study was to explore how perceived threat of type 2 diabetes (T2D) is shaped by risk factor knowledge and promotes the engagement of protective health behaviors among rural adults. Methods Participants (N = 252) completed a cross-sectional mixed-mode survey. Chi-squared analyses were computed to examine differences in perceived threat by demographic factors and knowledge of T2D risk factors. Logistic regressions were conducted to examine the relationship between T2D perceived threat and engagement in physical activity and health screenings. Results Perceived threat and knowledge of T2D risk factors were high. Perceived susceptibility was significantly higher among women, whites, and respondents with high body mass index (BMI). Respondents reporting physical activity most/almost every day had low perceived susceptibility to T2D. Perceived severity was significantly higher among respondents with high BMI. Blood cholesterol and glucose screenings were associated with greater T2D perceived susceptibility and severity. Higher BMI was associated with receiving a blood glucose screening. Conclusion Health education specialists and researchers should further explore the implications of using audience segmented fear appeal messages to promote T2D control through protective health behaviors.

The self-care practices of family caregivers of persons with poor prognosis cancer: differences by varying levels of caregiver well-being and preparedness

PURPOSE

Little is known about the impact of family caregiving for adults with poor prognosis cancer on caregivers' own individual self-care practices. We explored differences in caregivers' discrete self-care practices associated with varying levels of caregiver well-being, preparedness, and decision-making self-efficacy.

METHODS

Cross-sectional survey within eight community-based southeastern U.S. cancer centers was conducted. Family caregivers of Medicare beneficiaries ≥65 years with pancreatic, lung, brain, ovarian, head and neck, hematologic, or stage IV cancer completed measures of individual self-care practices (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and sleep), well-being (anxiety, depression, and health-related quality of life [HRQoL]), preparedness, and decision-making self-efficacy.

RESULTS

Caregivers (n = 294) averaged 66 years, were mostly female (72.8%), white (91.2%), Protestant (76.2%), retired (54.4%), and patients' spouse/partner (60.2%). Approximately, half were rural-dwellers (46.9%) with incomes <$50,000 (53.8%). Most provided support 6-7 days/week (71%) for >1 year (68%). Nearly a quarter (23%) reported high depression and 34% reported borderline or high anxiety. Low engagement in all self-care practices was associated with worse caregiver anxiety, depression, and mental HRQoL (all p values < .05). Caregivers with lower health responsibility, spiritual growth, interpersonal relation, and stress management scores had lower preparedness and decision-making self-efficacy.

CONCLUSIONS

A significant proportion of caregivers simultaneously report low engagement in all forms of self-care practices, high depression and anxiety, and low HRQoL mental health scores. Caregiver well-being, preparedness, and decision-making self-efficacy might be optimized through interventions targeted at enhancing health responsibility, stress management, interpersonal relationships, and spiritual growth self-care practices.

Diagnostic accuracy of the Gerontological Personality Disorder Scale (GPS) in Dutch general practice

OBJECTIVE

Personality disorders (PDs) often remain unrecognized in older adults by doctors in general practice. Therefore, this study evaluated the diagnostic accuracy of a screening instrument, the Gerontological Personality Disorder Scale (GPS), in a Dutch general-practice population of older adults.

METHOD

The psychometric properties of the GPS patient (GPS-pv) and informant (GPS-iv) versions were assessed in a sample of 302 (144 male) patients (average age: 69.9 years) and 302 (124 male) informants (average age: 64.7 years), respectively, using an informant-based personality questionnaire (the Hetero-Anamnestische Persoonlijkheidsvragenlijst ) as a reference criterion.

RESULTS

The internal consistency (average item correlation) of the subscale and total scores of the GPS-pv and GPS-iv were .12 (HAB), .16 (BIO), and .10 (total); and .16 (HAB), .15 (BIO), and .12 (total), respectively. The test--retest reliability was strong for both the GPS-pv (rs = .56 [HAB], rs = .67 [BIO], rs = .66 [total]) and the GPS-iv (rs = .52 [HAB], rs = .65 [BIO], rs = .68 [total]) versions. The sensitivity and specificity of the GPS-pv were .83 and .27, respectively, with a cutoff score of ≥1. Raising the cutoff score to ≥2, the sensitivity dropped to .59, whereas the specificity rose to .57. For the GPS-iv, a cutoff score of ≥3 maximized the sensitivity (.78) and specificity (.65).

CONCLUSION

The diagnostic accuracy of the GPS-iv was preferable to that of the GPS-pv. This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs.

Older People's External Residential Assessment Tool (OPERAT): a complementary participatory and metric approach to the development of an observational environmental measure

Background

The potential for environmental interventions to improve health and wellbeing has assumed particular importance in the face of unprecedented population ageing. However, presently observational environmental assessment tools are unsuitable for ‘all ages’. This article describes the development of the Older People’s External Residential Assessment Tool (OPERAT).

Methods

Potential items were identified through review and consultation with an Expert Advisory Group. Items were ranked according the importance ascribed to them by older people who responded to a survey distributed by 50+ forum in Wales (N = 545). 40 highly ranked items were selected for the OPERAT pilot. An observational assessment was conducted in 405 postcodes in Wales. Items validated with data from a survey of older residents (N = 500) in the postcode areas were selected for statistical modelling (Kendall’s Tau-b, p < .05). Data reduction techniques (exploratory factor analysis with Geomin rotation) identified the underlying factor structure of OPERAT. Items were weighted (Thurstone scaling approach) and scores calculated for each domain. Internal consistency: all items were tested for scale-domain total correlation (Spearman’s rank). Construct validity: correlation analysis examined the associations between domains and the extent to which participants enjoyed living in the area, felt that it was a desirable place to live, or felt safe at night or during the day (Spearman’s rank). Usability: analysis of variance compared mean OPERAT domain scores between neighbourhoods that were homogenous in terms of (a) deprivation (quintiles of the Townsend Index) and (b) geographic settlement type. Inter-rater reliability: Krippendorff’s alpha was used to evaluate inter-rater consistency in ten postcode areas.

Results

A four factor model was selected as the best interpretable fit to the data. The domains were named Natural Elements, Incivilities and Nuisance; Navigation and Mobility; and Territorial Functioning. Statistical tests demonstrated good internal consistency, convergent validity, utility and inter-rater reliability.

Conclusions

Participatory approaches to research and robust statistical testing are not mutually exclusive. OPERAT can be used to assess the suitability of external residential environments for older people with different physical and cognitive capacities, living in rural or urban areas. OPERAT can be used to help plan residential environments that are friendly for all ages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3681-x) contains supplementary material, which is available to authorized users.

Association of intimate partner violence and health-care provider-identified obesity

The association of physical and nonphysical intimate partner violence (IPV) with obesity was examined. Women (N = 1,179) were surveyed regarding demographics, obesity, and IPV exposure using humiliate-afraid-rape-kick (HARK), an IPV screening tool. A three-level lifetime IPV exposure variable measured physical, nonphysical or no IPV. Health-care provider-identified obesity was defined if participants were told by a medical provider within the past 5 years that they were obese. Bivariate analyses examined obesity by IPV and demographics. Multivariable logistic regression assessed odds of obesity by IPV type, adjusting for age, race/ethnicity, education, and marital status. Among participants, 44% reported lifetime IPV (25% physical, 19% nonphysical), and 24% reported health-care provider-identified obesity. In unadjusted analyses, obesity was more prevalent among women exposed to physical IPV (30%) and nonphysical IPV (27%), compared to women without IPV (20%, p = .002). In multivariable models, women reporting physical IPV had 1.67 times greater odds of obesity (95% confidence interval [CI] 1.20, 2.33), and women reporting nonphysical IPV had 1.46 times greater odds of obesity (95% CI 1.01, 2.10), compared to women reporting no exposure. This study extends prior data by showing, not only an association between physical IPV and obesity, but also an association between obesity and nonphysical IPV.

Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study

Background

To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among older adults reporting chronic pain.

Methods

Demographics, pain characteristics (duration, intensity), physical activity, kinesiophobia (excessive fear of movement/(re) injury), self-efficacy and self-rated health were measured with questionnaires at baseline and 12-months later. Logistic regression analyses were done to identify associations at baseline and predictors of physical activity 12-months later during follow-up.

Results

Of the 1141 older adults (mean age 74.4 range 65–103 years, 53.5 % women) included in the study, 31.1 % of those with chronic pain were sufficiently active (scoring ≥ 4 on Grimby’s physical activity scale) compared to 56.9 % of those without chronic pain. Lower age (OR = 0.93, 95 % CI = 0.88-0.99), low kinesiophobia OR = 0.95, 95 % CI = 0.91–0.99), and higher activity level at baseline (OR = 10.0, 95 % CI = 4.98–20.67) significantly predicted higher levels of physical activity in individuals with chronic pain.

Conclusion

The level of physical activity was significantly lower among those with chronic pain and was significantly associated with kinesiophobia. Our findings suggest that fear- avoidance believes plays a more important role in predicting future physical activity levels than pain characteristics. Thus our findings are important to consider when aiming to increase physical activity in older adults that have chronic pain.

The impact of a support centre for people with sensory impairment living in rural Scotland

Aim The overall aim of this study was to evaluate whether attendance at a Sensory Support Centre for people with a sensory impairment living in the Western Isles of Scotland had an impact on their lives.

BACKGROUND

Demographic forecasts show that the prevalence of sensory impairment in the population will increase, as a significant proportion of sensory loss is age related. People with sensory impairments are more likely to experience social exclusion, and are more at risk of injury and physical and mental illness. Therefore, strategies to improve service access and provision for people with sensory impairments are important to reduce the disability associated with sight and/or hearing loss.

METHODS

All clients who accessed the service during a six-month period were invited to complete a postal questionnaire about their service experience. Semi-structured individual interviews with clients (n=12) described their experience of living with a sensory impairment and the impact (if any) that access to the Sensory Centre had on their lives. Individual interviews were also conducted with healthcare and social-care professionals (n=7) to ascertain their level of service awareness. Findings Clients who experienced sensory impairment described how the impairment negatively impacted on their activities of living, safety and independence. Following Sensory Centre assessment and support, some clients were able to identify ways in which interventions had reduced their sense of social isolation, impacted positively on self-confidence and sense of self-esteem and safety. Importantly, interventions had supported greater functional independence in their own homes.

CONCLUSION

This study provides evidence that access to sensory services are important to people with sensory impairments living in remote areas, and should be considered when planning healthcare services, as they are one way of ameliorating health inequalities in this population group.

Conducting Community Health Needs Assessments in rural communities: lessons learned

The Affordable Care Act of 2010 requires all nonprofit hospitals in the United States to conduct a Community Health Needs Assessment (CHNA) at least every 3 years. With this law in its infancy, the best practice to conduct an assessment that complies with the law is unknown. Research designs vary across states and agencies, and little is known about the reliability or representativeness of results. The rural community group model (RCGM) is a newly developed model designed for conducting assessments in rural communities. Key components of the model are disseminating surveys, conducting key informant interviews, facilitating focus groups, and integrating secondary data of county-level health behaviors and outcomes. It has been used to conduct CHNAs on more than half the critical access hospitals in North Dakota (58%). Given this large sample size, which used the same methodology, this article provides an evaluation of the model focusing on lessons learned and challenges encountered in the conduct of CHNAs. Particular strategies for assessment planners are warding off group think, monitoring against bias creep in data collection, and integrating multiple data sources to inform decision making. The model is recommended for replication in rural settings to provide meaningful feedback that allows a hospital to match long-term planning with community needs.

Family Caregivers' Knowledge of Delirium and Preferred Modalities for Receipt of Information

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult's usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers' knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters.