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Yang M, Samper‐Ternent R, Volpi E, Green A, Lichtenstein M, Araujo K, Borek P, Charpentier P, Dziura J, Gill TM, Galloway R, Greene EJ, Lenoir K, Peduzzi P, Meng C, Reese J, Shelton A, Skokos EA, Summapund J, Unger E, Reuben DB, Williamson JD, Stevens AB. The dementia care study (D-CARE): Recruitment strategies and demographic characteristics of participants in a pragmatic randomized trial of dementia care. Alzheimers Dement 2024; 20:2575-2588. [PMID: 38358084 PMCID: PMC11032530 DOI: 10.1002/alz.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS Community-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients. RESULTS Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.
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Affiliation(s)
- Mia Yang
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Rafael Samper‐Ternent
- School of Public Healthand Institute on AgingThe University of Texas Health Science Center in HoustonHoustonTexasUSA
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
| | - Elena Volpi
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
- Sam and Ann Barshop Institute for Longevity and Aging StudiesThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Aval‐Na'Ree Green
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
| | - Maya Lichtenstein
- Department of NeurologyGeisinger Medical CenterWilkes‐BarrePennsylvaniaUSA
| | - Katy Araujo
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - Pamela Borek
- Department of NeurologyGeisinger Medical CenterWilkes‐BarrePennsylvaniaUSA
| | - Peter Charpentier
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - James Dziura
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Thomas M. Gill
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - Rebecca Galloway
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
| | - Erich J. Greene
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Kristin Lenoir
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Peter Peduzzi
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Can Meng
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Jordan Reese
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
| | - Amy Shelton
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Eleni A. Skokos
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Jenny Summapund
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Erin Unger
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - David B. Reuben
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Jeff D. Williamson
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Alan B. Stevens
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
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Jacobsen E, Lucas H, Moran C, Dixon RG, Ganguli M. Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project. Alzheimer Dis Assoc Disord 2024; 38:160-167. [PMID: 38748658 PMCID: PMC11178142 DOI: 10.1097/wad.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge. METHODS We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies. RESULTS Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups. CONCLUSIONS We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
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Affiliation(s)
- Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Heather Lucas
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Catherine Moran
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | | | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry
- University of Pittsburgh, School of Medicine, Department of Neurology
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology
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Davis R, Sikorskii A. Recruitment of older adults from long-term care settings for a longitudinal clinical trial. Res Nurs Health 2024; 47:82-92. [PMID: 38095101 PMCID: PMC10843827 DOI: 10.1002/nur.22360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Abstract
Recruitment of residents for research from long-term care settings is known to be difficult. The purpose of this study was to summarize the effectiveness and cost in terms of time and dollars of recruitment methods for a cluster-randomized controlled clinical trial conducted in long-term care settings. This study was a retrospective, exploratory, descriptive analysis of recruitment data. After recruitment of 15 independent and assisted living communities, residents at each site were recruited to participate in the study using combinations of 12 different recruitment methods. Recruitment methods, time spent screening, and enrollment data were collected. Recruitment data were analyzed at the levels of site, research staff member, and participant. Over the study period, 279 older adults were screened and 172 enrolled from the 15 sites. Many participants were cognitively impaired. Research staff spent 39-89 h recruiting at each site and utilized an average of four different recruitment methods per site. Introductions of participants by site contacts yielded the most consented participants compared to other recruitment methods. Sites that had a dedicated recruiter utilized more recruiting methods and enrolled more participants than those without a dedicated recruiter. The cost of recruiting averaged $1490 per site and $93-$258 per enrollee (mean $144, standard deviation $58), but was more costly in larger facilities. Recruitment of older adults from long-term care communities requires multiple methods of recruitment, skilled recruitment staff, and trust with the staff and potential participants.
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Affiliation(s)
- Rebecca Davis
- Grand Valley State University, Allendale, Michigan, USA
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4
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Cheon H, Song JA, Kim J, Jung S, Kim GJ. Virtual Reality-Based Education Program for Managing Behavioral and Psychological Symptoms of Dementia: Development and Feasibility Test. Comput Inform Nurs 2024; 42:118-126. [PMID: 38129321 DOI: 10.1097/cin.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This study aims to develop a virtual reality-based education program for managing behavioral and psychological symptoms of dementia for family carers of persons living with dementia and investigate the feasibility for users. The program was developed through literature review, interviews with family carers, surveys, and expert content validity assessment. User feasibility was evaluated quantitatively through a questionnaire on usefulness, ease of use, and satisfaction, and qualitatively through participant interviews. The program was produced in two parts, Type 1 and Type 2, consisting of three and six episodes, respectively. Participants showed a high level of satisfaction with overall program scores of 4.28 ± 0.66 and 4.34 ± 0.41 for the two evaluations. Participants also expressed that both programs were helpful, Type 1 for achieving changes in attitude associated with more understanding of persons living with dementia and Type 2 for acquiring coping methods through communication training. Use of the virtual reality device was not inconvenient and was identified as helpful due to the high immersion experience. Results of this study confirmed that family carers had no resistance to education using new technologies such as virtual reality devices and that virtual reality-based education could be effective for training family carers.
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Affiliation(s)
- Hongjin Cheon
- Author Affiliations: College of Nursing (Drs Cheon and Song) and BK21 FOUR R&E Center for Learning Health Systems (Dr Song), Korea University, Seoul; Department of Nursing, Seojeong University (Dr Kim), Yangju; College of Nursing, Chonnam National University (Dr Jung), Gwangju; and College of Informatics, Korea University (Dr Kim), Seoul, Republic of Korea
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Joshi S, Park T, Brody L, Cruz K, Mukhi P, Reid MC, Herr K, Pillemer K, Riffin C. Recruitment of family caregivers of persons with dementia: Lessons learned from a pilot randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1125914. [PMID: 37051457 PMCID: PMC10083411 DOI: 10.3389/fpain.2023.1125914] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Family caregivers play an essential role in supporting the health and well-being of older adults with dementia, a population projected to increase rapidly over the coming decades. Enrolling caregivers of people with dementia (PWD) in research studies is vital to generating the evidence necessary to support broader implementation of efficacious intervention programs in real-world care delivery, but a range of challenges impede recruitment and enrollment of sufficiently large and representative sample sizes. In this article, we characterize the challenges and lessons learned from recruiting caregivers of PWD to participate in a pilot randomized control trial. We utilize Bronfenbrenner's ecological model to categorize the challenges into three levels: individual (i.e., understanding caregivers' time constraints and motivations), community (i.e., reaching underrepresented populations and accessing caregiver support groups) and institutional (i.e., obtaining informed consent and navigating research registries). We found that establishing rapport and maintaining flexibility with participants was crucial for motivating individuals to enroll in our study. Building trust with local communities by collaborating with support group leaders, appointing a co-investigator who is already embedded within a given community, and establishing equitable partnerships with organizations increased recruitment rates. At the institutional level, engaging experts in regulatory affairs and geriatrics may help overcome barriers in obtaining approval from institutional review boards. We also recommend using research registries of individuals who offer their contact information to researchers. The lessons learned from our research-including the challenges and potential solutions to overcome them-may promote more effective and efficient recruitment in future research.
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Affiliation(s)
- Sama Joshi
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Kiana Cruz
- Hackensack Meridian School of Medicine, Seton Hall University, South Orange, NJ, United States
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, IA, UnitedStates
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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Petrovsky DV, Bradt J, McPhillips MV, Sefcik JS, Gitlin LN, Hodgson NA. Tailored Music Listening in Persons With Dementia: A Feasibility Randomized Clinical Trial. Am J Alzheimers Dis Other Demen 2023; 38:15333175231186728. [PMID: 37470678 PMCID: PMC10489003 DOI: 10.1177/15333175231186728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Introduction: This study examined the feasibility, acceptability, and preliminary efficacy of tailored music listening intervention on sleep disturbances in older adults with dementia and their caregivers. Methods: We randomly assigned 33 older adults with dementia (mean age 71.7 [SD: 7.1], 72.7% female, 81.8% African American/Black) and their caregivers (mean age 58.4 [SD: 16.7], 72.7% female, 84.8% African American/Black) to a wait-list control or intervention group (NCT04157244). Results: The music intervention was feasible as evidenced by high study measure completion and retention rates (>90%). Recruitment was stopped prematurely due to the COVID-19 pandemic. We found mixed acceptability results from the survey and qualitative interviews with the participants. Both groups improved on objective sleep outcomes of sleep latency and wake sleep after onset. We found a small effect size for sleep duration post-intervention. Discussion: The findings provide preliminary evidence for the feasibility of a tailored music intervention and identified ways to improve its acceptability.
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Affiliation(s)
| | - Joke Bradt
- Drexel University, Philadelphia, PA, USA
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Sehar U, Rawat P, Choudhury M, Boles A, Culberson J, Khan H, Malhotra K, Basu T, Reddy PH. Comprehensive Understanding of Hispanic Caregivers: Focus on Innovative Methods and Validations. J Alzheimers Dis Rep 2022. [DOI: 10.3233/adr-220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Alzheimer’s disease (AD) and Alzheimer’s disease-related disorders (ADRD) are late-onset, age-related progressive neurodegenerative disorders, characterized by memory loss and multiple cognitive impairments. Current research indicates that Hispanic Americans are at an increased risk for AD/ADRD and other chronic conditions such as diabetes, obesity, hypertension, and kidney disease, and given their rapid growth in numbers, this may contribute to a greater incidence of these disorders. This is particularly true for the state of Texas, where Hispanics are the largest group of ethnic minorities. Currently, AD/ADRD patients are taken care by family caregivers, which puts a tremendous burden on family caregivers who are usually older themselves. The management of disease and providing necessary/timely support for patients with AD/ADRD is a challenging task. Family caregivers support these individuals in completing basic physical needs, maintaining a safe living environment, and providing necessary planning for healthcare needs and end-of-life decisions for the remainder of the patient’s lifetime. Family caregivers are mostly over 50 years of age and provide all-day care for individuals with AD/ADRD, while also managing their health. This takes a significant toll on the caregiver’s own physiological, mental, behavioral, and social health, in addition to low economic status. The purpose of our article is to assess the status of Hispanic caregivers. We also focused on effective interventions for family caregivers of persons with AD/ADRD involving both educational and psychotherapeutic components, and a group format further enhances effectiveness. Our article discusses innovative methods and validations to support Hispanic family caregivers in rural West Texas.
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Affiliation(s)
- Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Moumita Choudhury
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - John Culberson
- Department of Family Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Hafiz Khan
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Keya Malhotra
- Hendrick Health System, Grace Clinic, Lubbock, TX, USA
| | - Tanisha Basu
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Hendrick Health System, Grace Clinic, Lubbock, TX, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Lassell RKF, Cross JE, Schmid AA, Davalos DB, Wood W. Feasibility of an adaptive riding pilot study and acceptability to dementia care partners: "Your spirits are lifted". Complement Ther Med 2022; 71:102897. [PMID: 36342022 DOI: 10.1016/j.ctim.2022.102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We sought to assess the feasibility and acceptability of an adaptive riding program with dyads (persons living with dementia, family care partners) and a gardening comparison condition. DESIGN This is a two-arm (adaptive riding and adaptive gardening), mixed methods, convergent, feasibility study that occurred February 2019-June 2019. INTERVENTIONS Upon enrollment, dyads (n=9) self-selected into either community-based adaptive riding (n=5) or adaptive gardening (n=4), two complementary interventions in Northern Colorado. Interventions occurred for hour-long, weekly sessions for eight weeks. OUTCOME MEASURES Feasibility was measured with recruitment (actual/planned, response rate, participants enrolled/month) retention, adherence to study procedures (attendance, retention, fidelity), and data collection processes (planned versus collected); and analyzed with descriptive statistics. Acceptability of adaptive riding was measured with pre/post care partner interviews and analyzed using thematic analysis. Afterwards, findings were converged. RESULTS We recruited n=10/24 dyads (6 dyads per month), with the highest response rates for referrals and in-person events, n=9 dyads enrolled. We adhered to study procedures with attendance (6/8 gardening, 8/8 riding), retention (100%), fidelity (100%) and data collected (98%). Care partners (n=5) found the adaptive riding intervention acceptable with two themes Overall hopes: "Joy in the present moment" and "Experience as a Whole: "Your spirits are lifted," affirming quantitative attendance and retention data. CONCLUSION Findings underscore the feasibility and acceptability of including care partners of persons living with dementia in complementary interventions involving horsemanship activities. Feasibility data can guide study designs and implementation processes for other nature-based complementary interventions for this population.
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Affiliation(s)
| | | | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, USA
| | | | - Wendy Wood
- Departments of Animal Science and Occupational Therapy, Colorado State University, USA
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Abstract
Recruitment of persons with dementia into research studies is essential to provide evidence for effective care and treatment. However, recruitment is known to be difficult for this population. The current integrative review was undertaken to synthesize evidence surrounding best practices for recruiting older adults with dementia into research. Fourteen studies were identified that examined recruitment strategies for persons with cognitive impairment over a 10-year time period. Most studies were retrospective and descriptive. Studies revealed three facilitators and three barriers for recruitment. Facilitators included community partnerships and trust, incentives, and use of multiple recruitment methods. Barriers included non-targeted recruitment methods, gatekeepers, and mistrust. Further studies, including randomized controlled trials, are needed to determine specific strategies that yield effective recruitment. Theoretically based recruitment strategies need to be defined and tested and the measures of recruitment efforts standardized to compare effectiveness and build a science of recruitment. [Research in Gerontological Nursing, 15(5), 255-264.].
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Kowe A, Köhler S, Klein OA, Lüthje C, Kalzendorf J, Weschke S, Teipel S. Stakeholder involvement in dementia research: A qualitative approach with healthy senior citizens and providers of dementia care in Germany. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:908-917. [PMID: 33355958 DOI: 10.1111/hsc.13238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/17/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
Engaging stakeholders in health-related research is becoming commonplace internationally and is increasingly considered best research practice to improve care management services. Many different groups have a stake in dementia care, but the evidence base for stakeholder involvement in dementia research is still small. The aim of this study was to explore views of two major stakeholder groups of dementia care in research priority setting and how they would want to be involved in dementia research. Group discussions were carried out with 47 participants divided into two groups: (a) healthy senior citizens and (b) providers of dementia care. Ensuing responses were analysed using descriptive content analysis. The main research interest of both groups was similar, but senior citizens and providers of dementia care varied in how they perceived the roles of researchers and stakeholders involved. Groups also differed with respect to the amount of time they would be willing to invest into research. The results contribute to our knowledge of group-specific stakeholder priorities and attitudes regarding participatory involvement in dementia research.
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Affiliation(s)
- Antonia Kowe
- Department "Ageing of Individuals and Society" (AGIS), Interdisciplinary Faculty, University of Rostock, Rostock, Germany
| | - Stefanie Köhler
- Rostock University Medical Center & German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Rostock, Germany
| | - Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Rostock, Germany
| | - Corinna Lüthje
- Institut für Medienforschung, University of Rostock, Rostock, Germany
| | - Judith Kalzendorf
- Rostock University Medical Center & German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Rostock, Germany
| | - Sarah Weschke
- Department "Ageing of Individuals and Society" (AGIS), Interdisciplinary Faculty, University of Rostock, Rostock, Germany
| | - Stefan Teipel
- Rostock University Medical Center, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald & Centre for Transdisciplinary Neurosciences Rostock, Rostock, Germany
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Deskins BP, Letvak S, Kennedy-Malone L, Rowsey PJ, Bedini L, Rhew D. The Experiences of African American Male Caregivers. Healthcare (Basel) 2022; 10:healthcare10020252. [PMID: 35206867 PMCID: PMC8871800 DOI: 10.3390/healthcare10020252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Aging of the population has led to an increasing number of caregivers. While research has been conducted on caregiver experiences, less is known about the experiences of African American males in the U.S. This qualitative descriptive study describes the experiences of 13 African American men who acted as caregivers to adult chronically ill or debilitated loved ones, the majority of whom provided care during the COVID-19 pandemic. The revised Sociocultural Stress and Coping Model (R-SSCM) guided this study. Individual interviews were conducted via the Zoom application. Content analysis revealed four themes: (1) “My time to take the reins”, (2) “It’s a male thang”, (3) “Caring amid a pandemic”, and (4) “Effects of the caregiver’s journey”. This study’s findings in relation to the literature provide overdue attention to the African American male caregiving experience, especially in relation to the COVID-19 pandemic. The implications of our findings include the need for more culturally congruent support services for African American male caregivers, as well as increased efforts to encourage trust in the healthcare system—especially in relation to vaccination for the SARS-CoV-2 virus.
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Affiliation(s)
| | - Susan Letvak
- School of Nursing, UNC Greensboro, Greensboro, NC 27402, USA; (L.K.-M.); (P.J.R.)
- Correspondence: ; Tel.: +1-336-256-1024
| | | | | | - Leandra Bedini
- School of Health and Human Sciences, UNC Greensboro, Greensboro, NC 27402, USA;
| | - Denise Rhew
- Cone Health, Greensboro, NC 27401, USA; (B.P.D.); (D.R.)
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Reuland M, Sloan D, Antonsdottir IM, Spliedt M, Johnston MCD, Samus Q. Recruitment of a diverse research cohort in a large metropolitan area for dementia intervention studies. Contemp Clin Trials 2022; 112:106622. [PMID: 34785304 PMCID: PMC8725208 DOI: 10.1016/j.cct.2021.106622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
The human and financial costs of dementia care are growing exponentially. Over five and a half million older Americans are estimated to be living with Alzheimer's disease and related dementia (ADRD). By 2050, this is expected to increase to over 13 million, and persons of color are at the highest risk. Considerable funds have been committed to research to prevent, treat, and care for persons at risk for ADRD. However, enrollment of research participants, particularly those coming from diverse backgrounds, is a perennial challenge and has serious implications. This paper quantitatively details the results of a community-based multi-modal outreach effort to recruit a racially diverse sample for non-pharmacological dementia intervention, including referral and participant sources and yield, total recruitment costs and cost per enrolled dyad, and a qualitative description of lessons learned, with particular attention to the recruitment of Black participants. The largest number of referrals and referrals converting to study participants, for both Black and White persons, were from a Maryland Department of Health mailing to Medicaid recipients. There was an important difference in the most effective strategies, proportionally, for white and Black participants. The MDH mailing had the highest yield for our Black referrals and participants, while professional referrals had the highest yield for white referrals and participants. The total estimated cost of recruitment was $101,058, or $156.19 per enrolled dyad. Ultimately 646 persons with dementia and care partner dyads were enrolled, 323 (50%) of whom were Black.
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Affiliation(s)
- Melissa Reuland
- Johns Hopkins Bayview Medical Center, SOM Department of Psychiatry, 5200 Eastern Avenue, Room 322E, Baltimore, MD 21224, United States of America.
| | - Danetta Sloan
- Johns Hopkins Bloomberg School of Public Health, Health Behavior and Society, Hampton House 904E, United States of America
| | - Inga Margret Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Morgan Spliedt
- Memory & Aging Services Innovation Center, Johns Hopkins Bayview Medical Center, SOM Department of Psychiatry and Behavioral Sciences, 5200 Eastern Ave., Room 319E, Baltimore, MD 21224, United States of America
| | - Mary C Deirdre Johnston
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Geriatrics Psychiatry and Neuropsychiatry, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave., East Tower, 3(rd) floor, Baltimore, MD 21224, United States of America
| | - Quincy Samus
- Division of Geriatrics Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5200 Eastern Ave, Mason F. Lord Building, East Tower #326, Baltimore, MD 21224, United States of America.
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Ma JE, Grubber J, Coffman CJ, Wang V, Hastings SN, Allen KD, Shepherd-Banigan M, Decosimo K, Dadolf J, Sullivan C, Sperber NR, Van Houtven CH. Identifying family and unpaid caregivers in the electronic health record: A descriptive analysis (Preprint). JMIR Form Res 2021; 6:e35623. [PMID: 35849430 PMCID: PMC9345058 DOI: 10.2196/35623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers. Objective Few health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers. Methods We selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening. Results During the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver. Conclusions The EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers. Trial Registration ClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380
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Affiliation(s)
- Jessica E Ma
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Janet Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Virginia Wang
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - S Nicole Hastings
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, United States
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Joshua Dadolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
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14
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Brown EL, Ruggiano N, Roberts L, Clarke PJ, Davis DL, Agronin M, Geldmacher DS, Hough MS, Muñoz MTH, Framil CV, Yang X. Integration of Health Information Technology and Promotion of Personhood in Family-Centered Dementia Care: Intervention Trial. Res Gerontol Nurs 2021; 14:225-234. [PMID: 34542347 DOI: 10.3928/19404921-20210825-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alzheimer's disease and related dementias (ADRD) often result in communication deficits that can lead to negative health outcomes as well as complications for caregiving and clinical care. Although augmentative and alternative communication (AAC) devices have demonstrated efficacy in assisting persons living with dementia (PLWD) in communicating, few devices offer customization for the person's care preferences (e.g., clothing, food, activities) or are designed for integration into clinical care and caregiving. To address this issue, our research team is developing a novel electronic AAC prototype with a touchscreen to promote communication and personhood for PLWD. The current article describes the development of this technology and uses the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement to describe the clinical trial that is planned to test its efficacy. TARGETS PLWD and their care partners. INTERVENTION DESCRIPTION Use of AAC Plus to promote communication and personhood for PLWD. MECHANISMS OF ACTION AAC Plus will provide PLWD and care partners a way to communicate PLWD's daily preferences and provide clinical data for health care providers. OUTCOMES Determine whether enhanced communication of daily preferences of PLWD will improve quality of life of PLWD and their care partners. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04571502 (Date of registration October 1, 2020). [Research in Gerontological Nursing, 14(5), 225-234.].
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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McPhillips MV, Petrovsky DV, Brewster GS, Li J, Gooneratne NS, Hodgson NA, Sefcik JS. Recruiting Persons with Dementia and Caregivers in a Clinical Trial: Dyads Perceptions. West J Nurs Res 2021; 44:557-566. [PMID: 33870784 DOI: 10.1177/01939459211008563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recruitment for dementia research is challenging and costly. Using Ajzen's Theory of Planned Behavior we explored attitudes, perceived norms, and perceived behavioral control of persons living with dementia (PLWD) and their caregivers who participated in one clinical trial to better understand factors that influence dyads' decisions to enroll. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers and utilized directed content analysis. Categories connected with positive attitudes about study enrollment were personal desires of wanting to learn and in-person meetings with knowledgeable staff. Additionally, participants said the money always helps in terms of the financial incentive. Participants reported enrolling to support another person (perceived norm). Study requirements were thought to be easy (perceived behavioral control). Participants highlighted the importance of flexible scheduling and study tasks being completed at their home. Findings can inform future recruitment efforts and should be investigated as effective recruitment methods in other clinical trials.
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Affiliation(s)
| | | | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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17
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Ramirez M, Duran MC, Pabiniak CJ, Hansen KE, Kelley A, Ralston JD, McCurry SM, Teri L, Penfold RB. Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral and Psychological Symptoms of Dementia: Interview Study. JMIR Aging 2021; 4:e24965. [PMID: 33565984 PMCID: PMC8081155 DOI: 10.2196/24965] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are associated with increased stress, burden, and depression among family caregivers of people with dementia. STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that trains family caregivers to manage BPSD. We used a human-centered design approach to obtain feedback from family caregivers about STAR-VTF. The program will be evaluated using a pragmatic randomized trial. OBJECTIVE The objective of the study was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs. METHODS Between July and September 2019, we conducted 15 semistructured interviews with family caregivers of people with dementia who receive care at Kaiser Permanente Washington in the Seattle metropolitan area. We identified participants from electronic health records, primarily based on a prescription for antipsychotic medication for the person with dementia (a proxy for caregivers dealing with BPSD). We showed caregivers low-fidelity prototypes of STAR-VTF online self-directed materials and verbally described potential design elements. We obtained caregiver feedback on these elements, focusing on their needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes. RESULTS The idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said health care providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the health care organization to offer programs such as STAR-VTF much sooner. Caregivers had already put considerable effort into problem solving challenging behaviors. They anticipated deriving less value from STAR-VTF at that point. Nonetheless, many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities (eg, face to face). Given caregivers' limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers were interested in having a STAR-VTF provider for additional support in managing challenging behaviors. Caregivers reported a preference for having the same coach for the program duration. CONCLUSIONS Caregivers we interviewed would likely accept a virtual training program such as STAR-VTF to obtain information about BPSD and receive help managing it. Family caregivers anticipated deriving more value if STAR-VTF was offered earlier in the disease course.
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Affiliation(s)
- Magaly Ramirez
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Miriana C Duran
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
| | - Chester J Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Kelly E Hansen
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Ann Kelley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - James D Ralston
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Susan M McCurry
- Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States
| | - Linda Teri
- University of Washington School of Nursing, Seattle, WA, United States
| | - Robert B Penfold
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Nagl‐Cupal M, Hauprich J. Invisible population: Understanding recruitment barriers of a nurse-led support programme for families with caregiving children in Austria. Nurs Open 2020; 7:1164-1172. [PMID: 32587736 PMCID: PMC7308670 DOI: 10.1002/nop2.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/17/2020] [Accepted: 03/09/2020] [Indexed: 11/08/2022] Open
Abstract
Aims To evaluate why no families could be recruited for a nurse-led and family-centred support programme in Austria which aimed to prevent an age-inappropriate caring role for young carers. Design A qualitative study incorporating qualitative e-interviews and telephone interviews. Method Twenty-one interviews were conducted with statistically significant project stakeholders (N = 17) and with adult family members of children with caring responsibilities (N = 4). Data collection and analysis were guided by the "Social Marketing Framework." Relevant statements were assigned to the main categories: product; price; promotion; place; and working with partners. Results The lack of awareness towards young carers, the unfamiliar, open outcome approach of the intervention, the inappropriate language used in promotional materials and the families' fear of stigma while seeking support were identified as central obstacles for successful recruitment of families and implementation of the support programme.
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Affiliation(s)
| | - Julia Hauprich
- Department of Nursing ScienceUniversity of ViennaViennaAustria
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19
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Gilmore-Bykovskyi AL, Jin Y, Gleason C, Flowers-Benton S, Block LM, Dilworth-Anderson P, Barnes LL, Shah MN, Zuelsdorff M. Recruitment and retention of underrepresented populations in Alzheimer's disease research: A systematic review. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:751-770. [PMID: 31921966 PMCID: PMC6944728 DOI: 10.1016/j.trci.2019.09.018] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Alzheimer's disease and related dementias (ADRD) disproportionately impact racial and ethnic minority and socioeconomically disadvantaged adults. Yet, these populations are significantly underrepresented in research. METHODS We systematically reviewed the literature for published reports describing recruitment and retention of individuals from underrepresented backgrounds in ADRD research or underrepresented participants' perspectives regarding ADRD research participation. Relevant evidence was synthesized and evaluated for quality. RESULTS We identified 22 eligible studies. Seven studies focused on recruitment/retention approaches, all of which included multifaceted efforts and at least one community outreach component. There was considerable heterogeneity in approaches used, specific activities and strategies, outcome measurement, and conclusions regarding effectiveness. Despite limited use of prospective evaluation strategies, most authors reported improvements in diverse representation in ADRD cohorts. Studies evaluating participant views focused largely on predetermined explanations of participation including attitudes, barriers/facilitators, education, trust, and religiosity. Across all studies, the strength of evidence was low. DISCUSSION Overall, the quantity and quality of available evidence to inform best practices in recruitment, retention, and inclusion of underrepresented populations in ADRD research are low. Further efforts to systematically evaluate the success of existing and emergent approaches will require improved methodological standards and uniform measures for evaluating recruitment, participation, and inclusivity.
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Affiliation(s)
- Andrea L. Gilmore-Bykovskyi
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Yuanyuan Jin
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Carey Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Flowers-Benton
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Laura M. Block
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Peggye Dilworth-Anderson
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Manish N. Shah
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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20
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Outcomes of art therapy and coloring for professional and informal caregivers of patients in a radiation oncology unit: A mixed methods pilot study. Eur J Oncol Nurs 2019; 42:153-161. [DOI: 10.1016/j.ejon.2019.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/15/2019] [Accepted: 08/20/2019] [Indexed: 12/26/2022]
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21
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Scerpella DL, Adam A, Marx K, Gitlin LN. Implications of Geographic Information Systems (GIS) for targeted recruitment of older adults with dementia and their caregivers in the community: A retrospective analysis. Contemp Clin Trials Commun 2019; 14:100338. [PMID: 30899836 PMCID: PMC6412022 DOI: 10.1016/j.conctc.2019.100338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/30/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
5.5 million Americans are living with Alzheimer's dementia (AD) or related dementias. Developing evidence-based interventions for these people and their caregivers (dyads) is a public health priority, and is highly dependent on recruiting representatives from the community. Precision recruitment methodologies are needed to improve the efficiency of this process. Geographic Information Systems (GIS) offer the potential to determine location trends of an older adult population of people living with dementia in the community and their caregivers. American Community Survey (ACS) 2015 5-year estimates were analyzed at the census tract level in ESRI ArcMap v. 10.5.1. Datasets included summarized estimates of age, gender, income, and education in Maryland. Using a two-step process, geographic regions were identified in ArcMap that contained various combinations of available data variables. These areas were compared to participant locations from a previously completed traditional recruitment effort to determine overlap (Dementia Behavior Study - R01AGO41781). The largest number of existing participants were identified in derived regions defined by combining age, education, gender, and income variables; predicting 184 (79%) of 234 participants regardless of the population density within census tracts. 208 (89%) were identified when matching this variable combination to the highest density census tracts (city/urban), and 66 (28%) in regions with the lowest population density (rural). This study successfully defined specific geographic regions in the state of Maryland that overlapped with a large number of known dementia dyad locations obtained via traditional recruitment efforts. Implications for these findings allow for more targeted recruitment efforts of difficult to recruit populations, and less utilization of resources for doing so.
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Affiliation(s)
- Danny L. Scerpella
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Baltimore, MD, 21205, USA
- Corresponding author.
| | - Atif Adam
- Johns Hopkins Bloomberg School of Public Health, Center on Aging and Health, 624 N. Broadway, Room 390, Baltimore, MD, 21205, USA
| | - Katherine Marx
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Drexel University, 1601 Cherry Street, 10th Floor, Room 1092, Philadelphia, PA, 19102, USA
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Leslie M, Khayatzadeh-Mahani A, MacKean G. Recruitment of caregivers into health services research: lessons from a user-centred design study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:17. [PMID: 31139432 PMCID: PMC6528243 DOI: 10.1186/s40900-019-0150-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/08/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND With patient and public engagement in many aspects of the healthcare system becoming an imperative, the recruitment of patients and members of the public into service and research roles has emerged as a challenge. The existing literature carries few reports of the methods - successful and unsuccessful - that researchers engaged in user-centred design (UCD) projects are using to recruit participants as equal partners in co-design research. This paper uses the recruitment experiences of a specific UCD project to provide a road map for other investigators, and to make general recommendations for funding agencies interested in supporting co-design research. METHODS We used a case study methodology and employed Nominal Group Technique (NGT) and Focus Group discussions to collect data. We recruited 25 family caregivers. RESULTS Employing various strategies to recruit unpaid family caregivers in a UCD project aimed at co-designing an assistive technology for family caregivers, we found that recruitment through caregiver agencies is the most efficient (least costly) and effective mechanism. The nature of this recruitment work - the time and compromises it requires - has, we believe, implications for funding agencies who need to understand that working with caregivers agencies, requires a considerable amount of time for building relationships, aligning values, and establishing trust. CONCLUSIONS In addition to providing adaptable strategies, the paper contributes to discussions surrounding how projects seeking effective, meaningful, and ethical patient and public engagement are planned and funded. We call for more evidence to explore effective mechanisms to recruit family caregivers into qualitative research. We also call for reports of successful strategies that other researchers have employed to recruit and retain family caregivers in their research.
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Affiliation(s)
- Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- School of Public Policy, University of Calgary, Downtown Campus, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta T2P 1H9 Canada
| | - Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Downtown Campus, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta T2P 1H9 Canada
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- IMAGINE Citizens Collaborating for Health, Calgary, Alberta Canada
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Kuchel GA. Inclusion of Older Adults in Research: Ensuring Relevance, Feasibility, and Rigor. J Am Geriatr Soc 2019; 67:203-204. [PMID: 30693942 DOI: 10.1111/jgs.15802] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/25/2022]
Affiliation(s)
- George A Kuchel
- University of Connecticut Health Center - UCONN Center on Aging, Farmington, Connecticut
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Dam AE, Christie HL, Smeets CM, van Boxtel MP, Verhey FR, de Vugt ME. Process evaluation of a social support platform 'Inlife' for caregivers of people with dementia. Internet Interv 2018; 15:18-27. [PMID: 30510911 PMCID: PMC6257912 DOI: 10.1016/j.invent.2018.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Informal caregivers of persons with dementia have an increased risk of facing social isolation. Online social media interventions might offer a new opportunity to increase access to social support. An online social support platform, 'Inlife', was developed and launched in the Netherlands to enhance social support, positive interactions and information sharing in informal support networks. OBJECTIVE A process evaluation was performed to evaluate the internal and external validity of the Inlife intervention. METHODS Implementation, sampling and intervention quality were evaluated by both qualitative and quantitative methods. Analyses were performed using descriptive statistics and inductive content analysis. Analyses were conducted following participants' completion of the intervention after 16 weeks. RESULTS The overall participation rate in the study was 27% (96/351). The Inlife intervention was generally well-received by the primary caregivers. Inlife facilitated empowerment, openness, involvement, and efficient care organization. Still, adherence was not optimal for all Inlife users. Determinants for Inlife use were identified on the level of the Inlife innovation, the users, and the socio-political context. CONCLUSIONS Inlife was evaluated as a useful instrument for efficient central care coordination and mutual involvement. This study emphasizes that the personal attitudes of the Inlife users to seek and provide support warrant attention, next to the characteristics of the actual Inlife innovation for optimal intervention uptake. Online and offline support might be integrated to raise awareness of caregiver social support needs and attitudes and provide insight into caregivers' available social capital. TRIAL REGISTRATION Dutch trial register NTR6131, Registered on 20 October 2016.
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Affiliation(s)
- Alieske E.H. Dam
- Corresponding author at: Department of Psychiatry and Neuropsychology/School for Mental Health and Neuroscience/Alzheimer Centre Limburg, Dr. Tanslaan 12 (level 3
- room 3G3.058), P.O. Box 616, 6200 MD Maastricht, the Netherlands.
| | - Hannah L. Christie
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Claudia M.J. Smeets
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Martin P.J. van Boxtel
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Pickering CEZ, Maxwell C. Recruitment, enrollment & data collection with victims of elder abuse and neglect identified from police incident reports. J Elder Abuse Negl 2018; 30:333-353. [PMID: 30211671 DOI: 10.1080/08946566.2018.1514342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study evaluated the success of researcher-generated recruitment, enrollment, data collection, and safety protocols for field research with victims of elder abuse and neglect (EAN) identified from police incident reports in terms of their success including cost-effectiveness, ability to generate a representative sample, and safety. After reviewing 492 police incident reports involving victims age 65 years or older to identify cases of EAN 62 victims were identified. Mail, phone, and in-person recruitment strategies were used. After 259 recruitment attempts, 52 (84%) eligible victims were contacted, of which 24 (46%) consented to participate. Phone calls were the least expensive mechanism to produce a successfully enrolled participant. Findings from a regression show completion of a research interview could not be predicted by victim, suspect, or offense characteristics, indicating that the recruited victims likely represent the population they were drawn from. No safety or adverse events occurred.
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Affiliation(s)
- Carolyn E Z Pickering
- a School of Nursing , University of Texas Health Science Center , San Antonio , TX , USA
| | - Christopher Maxwell
- b School of Criminal Justice , Michigan State University , East Lansing , MI , USA
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26
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Nkimbeng M, Roberts L, Thorpe RJ, Gitlin LN, Delaney A, Tanner EK, Szanton SL. Recruiting Older Adults With Functional Difficulties Into a Community-Based Research Study: Approaches and Costs. J Appl Gerontol 2018; 39:644-650. [PMID: 29991313 DOI: 10.1177/0733464818786612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial in Baltimore City tested whether an interdisciplinary team of occupational therapists, nurses, and handymen reduces disability and health expenditures in community-dwelling older adults with functional difficulties. This study describes methods and associated costs of recruiting 300 low-income, cognitively intact, older adults with functional difficulties into this study. Sources of participant enrollment included direct mailings (35%), government program referrals (19%), community-based organizations (16%), ambassador referrals (15%), and media (4%). Fifty six (30%) of 187 older adults referred through government organizations were enrolled, while 49 (7.6%) of 648 referred from community-based organizations were enrolled. Total recruitment costs were US$81,453.12. Costs per participant for mailings, media, ambassadors, and community-based organizations were respectively US$745.10, US$256.82, US$22.28, and US$1.00. Direct mailings yielded the most participants but was the most costly method per participant. Ambassadors were least expensive and may offer a low-cost addition to community outreach for recruitment of older adults into research.
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Affiliation(s)
| | | | - Roland J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Beattie E, Fielding E, O'Reilly M, Brooks D, MacAndrew M, McCrow J. Recruitment of Individuals With Dementia and Their Carers for Social Research: Lessons Learned From Nine Studies. Res Gerontol Nurs 2018; 11:119-128. [PMID: 29634849 DOI: 10.3928/19404921-20180308-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/15/2018] [Indexed: 11/20/2022]
Abstract
Many health and social care research studies report difficulties recruiting sufficient numbers of participants, adding to time and money expenditures and potentially jeopardizing the generalizability of findings. The current article reports the effectiveness and resource requirements of recruitment strategies used in nine dementia-related studies conducted in Australia. Articles, notices, or advertisements in targeted specialist newsletters were the most cost-effective method of recruitment. The use of service providers to aid recruitment yielded mixed results, but was lengthy in terms of research time. Online and social media were low cost but not reliably effective in terms of recruitment potential. Despite using multiple strategies to maximize recruitment, significant challenges were encountered achieving the required sample sizes; in most cases these challenges resulted in delays in the recruitment phase. Implications for researchers in the fields of dementia and general social/health research are discussed. [Res Gerontol Nurs. 2018; 11(3):119-128.].
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Boada M, Santos-Santos MA, Rodríguez-Gómez O, Alegret M, Cañabate P, Lafuente A, Abdelnour C, Buendía M, de Dios MJ, Morera A, Sanabria Á, Campo L, Ruiz A, Tárraga L. Patient Engagement: The Fundació ACE Framework for Improving Recruitment and Retention in Alzheimer's Disease Research. J Alzheimers Dis 2018; 62:1079-1090. [PMID: 29562541 PMCID: PMC5870013 DOI: 10.3233/jad-170866] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 01/06/2023]
Abstract
Alzheimer's disease (AD) research is at a critical time. The global society is increasingly aware of the frightening rate of growth of the human and financial burden caused by this condition and of the urgent need to halt its progression. Consequently, the scientific community holds great responsibility to quickly put in place and optimize the machinery necessary for testing new treatments or interventions. In this context demand for participants for AD research is at an all-time high. In this review, we will focus on a methodological factor that is increasingly recognized as a key factor that shapes trial populations and affects validity of results in clinical trials: patient engagement, recruitment, and retention. We outline specific problems relevant to patient engagement in AD including recruiting enough participants, difficulties in participant retention, ensuring the recruited sample is representative of the general AD population, the burden of screening failures, and new challenges related to recruiting in preclinical disease. To address the urgent need for more research studying the applicability and cost-effectiveness of different recruitment strategies across different settings and nationalities, we describe the Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project, a public-private partnership promoted by the Innovative Medicine Initiative (IMI), which will provide a large multinational quantitative analysis comparing different innovative recruitment models. We also discuss strategies that address each problem and draw on the experience of Fundació ACE to argue that focusing resources on comprehensive AD centers that offer coordinated clinical and social care and participate in basic and clinical research, is an effective and efficient way of implementing many of the discussed strategies.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miguel A. Santos-Santos
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, IDIBELL, Spain
| | - Octavio Rodríguez-Gómez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Cañabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Asunción Lafuente
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mar Buendía
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria José de Dios
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - América Morera
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ángela Sanabria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Laura Campo
- International Corporate Affairs, Alzheimer’s Disease, Eli Lilly and Co
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
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Perkins MM, Hart A, Dillard RL, Wincek RC, Jones DE, Hackney ME. A Formative Qualitative Evaluation to Inform Implementation of a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors: The DREAMS Program. J Appl Gerontol 2017; 38:959-982. [PMID: 29165036 DOI: 10.1177/0733464817735395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article reports on a formative qualitative evaluation conducted to identify potential barriers and facilitators prior to implementation of a two-part educational intervention designed to increase older adults' participation in clinical research. We conducted focus groups with 35 older adults from diverse racial, ethnic, and socioeconomic backgrounds (Mean age = 74.5 ± 7.4 years), and six clinical researchers involved in aging research. Two older adult patient stakeholder advisors participated as members of the research team. Findings from thematic analysis showed that common barriers to research participation included older adults' fear and mistrust of researchers and the medical community as well as misperceptions and negative attitudes about clinical research. A commonly held belief was that most clinical research is conducted by "greedy" pharmaceutical companies who are more interested in profits than finding cures for disease. Results provide useful insights regarding enrolling members of hard-to-reach older adult populations in clinical research.
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Affiliation(s)
- Molly M Perkins
- 1 Emory University School of Medicine, Atlanta, GA, USA.,2 Atlanta VA Medical Center, GA, USA
| | - Ariel Hart
- 1 Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - David E Jones
- 1 Emory University School of Medicine, Atlanta, GA, USA
| | - Madeleine E Hackney
- 1 Emory University School of Medicine, Atlanta, GA, USA.,2 Atlanta VA Medical Center, GA, USA
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Konnert C, Speirs C, Mori C. Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method. Clin Gerontol 2017; 40:352-361. [PMID: 28665772 DOI: 10.1080/07317115.2017.1338323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the daily diary method (DDM) for assessing family-staff conflicts in nursing homes, to provide descriptive information on conflict, and to examine the relationship between conflict and mood among family caregivers. METHODS Participants were nine caregivers that experienced conflict with staff on an ongoing basis. They were contacted daily by telephone for 14 days and were asked (1) whether a conflict had occurred, (2) to describe the severity and type of conflict, and (3) to rate their positive and negative affect. RESULTS Compliance was excellent with no attrition, and there were only 2 missing data points over 126 potential observations. Conflicts occurred on 22% of the days, were rated as moderately severe, and were related to poor resident care, lack of information, and staff attitudes. Participants reported significantly lower positive affect (p < .05) and higher negative affect (p < .001) on conflict versus no-conflict days. Exit interviews indicated positive attitudes towards the DDM. CONCLUSIONS These results support the feasibility of the DDM for providing an in-depth understanding of family-staff conflict and its relationship to caregivers' mood. CLINICAL IMPLICATIONS The DDM would ideally be used as an outcome measure in studies that assess interventions that target high-conflict family-staff relationships.
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Affiliation(s)
| | | | - Camille Mori
- a University of Calgary , Calgary , Alberta , Canada
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31
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Hansen D, Sheehan DK, Stephenson P. Family caregiver recruitment via social media: challenges, opportunities and lessons. Int J Palliat Nurs 2017; 23:84-87. [PMID: 28245165 DOI: 10.12968/ijpn.2017.23.2.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Illness blogs are a way seriously ill people communicate publicly about their illness journey. As communication about serious illness increases on social media, it is important to evaluate how this affects the family caregiver. However, identifying and accessing family caregivers remains challenging, especially via social media. PURPOSE The aim of this article is to report the opportunities, challenges and lessons learned from using social media to recruit family caregivers. METHODS Recruitment methods included posting study invitations on illness blogs, advertising through Facebook and placing study fliers in the community. RESULTS Using social media to recruit was inexpensive and provided a wide geographical reach. One important finding was discovering the importance of using language in the recruitment materials that family caregivers could identify with to help deem themselves as eligible to participate in the study.
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Affiliation(s)
- Dana Hansen
- Assistant Professor, Kent State University, College of Nursing, Ohio, US
| | | | - Pam Stephenson
- Assistant Professor, Kent State University, College of Nursing
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32
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Calamia M, Bernstein JPK, Keller JN. I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study. PLoS One 2016; 11:e0159664. [PMID: 27438465 PMCID: PMC4954686 DOI: 10.1371/journal.pone.0159664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.
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Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail:
| | - John P. K. Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jeffrey N. Keller
- Pennington Biomedical Research Center, Institute for Dementia Research and Prevention, Baton Rouge, Louisiana, United States of America
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Samus QM, Amjad H, Johnston D, Black BS, Bartels SJ, Lyketsos CG. A Multipronged, Adaptive Approach for the Recruitment of Diverse Community-Residing Elders with Memory Impairment: The MIND at Home Experience. Am J Geriatr Psychiatry 2015; 23:698-708. [PMID: 25771267 PMCID: PMC5226267 DOI: 10.1016/j.jagp.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To provide a critical review of a multipronged recruitment approach used to identify, recruit, and enroll a diverse community-based sample of persons with memory disorders into an 18-month randomized, controlled dementia care coordination trial. METHODS Descriptive analysis of a recruitment approach comprised five strategies: community liaison ("gatekeepers") method, letters sent from trusted community organizations, display and distribution of study materials in the community, research registries, and general community outreach and engagement activities. Participants were 55 community organizations and 63 staff of community organizations in Baltimore, Maryland. Participant referral sources, eligibility, enrollment status, demographics, and loss to follow-up were tracked in a relational access database. RESULTS In total, 1,275 referrals were received and 303 socioeconomically, cognitively, and racially diverse community-dwelling persons with cognitive disorders were enrolled. Most referrals came from letters sent from community organizations directly to clients on the study's behalf (39%) and referrals from community liaison organizations (29%). African American/black enrollees were most likely to come from community liaison organizations. CONCLUSION A multipronged, adaptive approach led to the successful recruitment of diverse community-residing elders with memory impairment for an intervention trial. Key factors for success included using a range of evidence-supported outreach strategies, forming key strategic community partnerships, seeking regular stakeholder input through all research phases, and obtaining "buy-in" from community stakeholders by aligning study objectives with perceived unmet community needs.
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Affiliation(s)
- Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
| | - Halima Amjad
- Department of Gerontology and Geriatric Medicine, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Betty S Black
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Community & Family Medicine, The Dartmouth Medical School, Lebanon, NH
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
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