Targeting intermediaries to recruit older women for qualitative, longitudinal research

A Qualitative Evidence Synthesis Review of Longitudinal Qualitative Research in Gerontology

BACKGROUND AND OBJECTIVES

Gerontologists have long been interested in longitudinal qualitative research (LQR), yet ambiguity remains about best practices. The purpose of this review was to conduct a qualitative evidence synthesis to identify strengths and limitations in existing gerontological LQR.

RESEARCH DESIGN AND METHODS

We searched for studies published in English before September 2017, using longitudinal qualitative methods and focusing on gerontology. We searched the following databases: PubMed and ProQuest. This was followed up by a snowball search to identify additional LQR articles that were not gerontologically focused but provided conceptual or methodological information to enhance gerontological LQR. Article titles and abstracts were reviewed, and selected articles were independently evaluated by all authors and summarized in a descriptive matrix based on design, analysis, and strengths and limitations.

RESULTS

Our literature search resulted in 225 articles, which was then narrowed to 71 articles from 47 different journals based on our inclusion/exclusion criteria. LQR in gerontology varies considerably by study design and analysis approach. LQR design considerations involve number of time points and duration; rapport and retention; and consistent or different sampling, data collection, and measures. LQR analysis considerations involve synchronic and diachronic approaches, consistent or evolving coding, and individual- or group-level analysis. Gerontological LQR articles vary in the extent to which they address special aging considerations.

DISCUSSION AND IMPLICATIONS

This review indicates that there are areas where gerontological LQR can be strengthened going forward. We provide researchers with strategies to improve LQR rigor in our field and beyond.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

An innovative approach to recruiting homebound older adults

Recruiting older adults to participate in intervention research is essential for advancing the science in this field. Developing a relevant recruitment plan responsive to the unique needs of the population before beginning a project is critical to the success of a research study. This article describes our experiences in the process of recruiting homebound older adults to test a community-based health empowerment intervention. In our study, the trust and partnership that existed between the research team and Community Action Agency facilitated the role of the home-delivered meal drivers as a trusted and untapped resource for study recruitment. Researchers can benefit from thinking creatively and developing meaningful partnerships when conducting research with older adults.

Problems with preparing food reported by frail older women living alone at home

Although nutritional risk is a critical health concern for older persons, there are few data about day-to-day problems with nutrition-related tasks. Such data were reported by 18 frail women during a longitudinal descriptive phenomenological study of the home care experience. Six problems were understood as elements of the life-world of older women, including having trouble figuring out what to fix, having trouble getting the food cooked right, and struggling with moving and standing while cooking. The results suggest topics for research and underscore the need for partnership between frail older women and helpers relative to food preparation.

Handling the "people who are trying to get to you": incidents with troublesome visitors reported by older women living alone

Older women have been viewed as vulnerable and fearful of crime, but little is known about how they try to reduce the risk of intrusion relative to encounters with troublesome visitors at home. During a phenomenological study of the home care experience, 6 women (aged 82-93 years) reported such an encounter with someone they knew. Our purpose was to describe intentions relative to encounters and the relevant personal-social context. Because the women were trying to keep a particular person at arm's length, the new concept of focused fear was proposed. Six contextual elements were discerned and understood as facets of vulnerability.

Filling In the Helper-Gap

Despite marked interest in continuity of care and transitions experienced by older persons, there is little information available about the intentions of older women regarding changes that occur in their support networks. This article reports the findings of a descriptive phenomenological study of older widows' experience of home care and describes the experiences of 10 women who lost a key helper during the 3-year study. Compared with theories of continuity of care or transition, the findings are in keeping with the focus of nonequilibrium systems theory: bringing order out of disorder. Findings imply the need for holistic nursing interventions with older women who hope to continue living alone for as long as possible.

Recruitment strategies for conducting research on women's retirement

Currently, little information is available to inform new or returning researchers about designing and conducting research on the topic of women and retirement. Few published studies describe how to access non-probability samples of retired women, yet preliminary evidence suggests women possess distinctive characteristics that affect their retirement as well as complicate the recruitment process. In this article, certain challenges and benefits of conducting research with women in retirement are presented. Next, important issues to consider prior to sampling retired women are described. Finally, specific strategies for identifying and recruiting community-dwelling retired women are presented and discussed.

A new typology of home-care helpers

PURPOSE

The formal-informal dichotomy of home care, which has been a theoretical framework in quantitative and qualitative research, might not be descriptive of older persons' views about their home-care providers. This qualitative study explores the perspectives of older women about the characteristics of their home-care providers.

DESIGN AND METHODS

Three interviews were conducted with each of 25 women (aged 80-94 years) during the first 4 months of participation in a 3-year phenomenological study. The women described their helpers. We differentiated helper types on the basis of the nature of the help, and we explored variations in compensation arrangements.

RESULTS

We delineated a new typology of home-care helpers: regular helpers, on-call helpers, can-will doers, and mainstays.

IMPLICATIONS

When home-care helpers are categorized by type of assistance provided, the potential value of their efforts is more evident. The association of formal care with paid help and informal care with nonpaid help limits the effectiveness of the dichotomy as a basis for home-care-payment policies. The new home-care-helper typology cuts across the dimensions of the dichotomy, providing an alternative theoretical framework for further research.

Patient recruitment to a randomized clinical trial of behavioral therapy for chronic heart failure

Background

Patient recruitment is one of the most difficult aspects of clinical trials, especially for research involving elderly subjects. In this paper, we describe our experience with patient recruitment for the behavioral intervention randomized trial, "The relaxation response intervention for chronic heart failure (RRCHF)." Particularly, we identify factors that, according to patient reports, motivated study participation.

Methods

The RRCHF was a three-armed, randomized controlled trial designed to evaluate the efficacy and cost of a 15-week relaxation response intervention on veterans with chronic heart failure. Patients from the Veterans Affairs (VA) Boston Healthcare System in the United States were recruited in the clinic and by telephone. Patients' reasons for rejecting the study participation were recorded during the screening. A qualitative sub-study in the trial consisted of telephone interviews of participating patients about their experiences in the study. The qualitative study included the first 57 patients who completed the intervention and/or the first follow-up outcome measures. Factors that distinguished patients who consented from those who refused study participation were identified using a t-test or a chi-square test. The reason for study participation was abstracted from the qualitative interview.

Results

We successfully consented 134 patients, slightly more than our target number, in 27 months. Ninety-five of the consented patients enrolled in the study. The enrollment rate among the patients approached was 18% through clinic and 6% through telephone recruitment. The most commonly cited reason for declining study participation given by patients recruited in the clinic was 'Lives Too Far Away'; for patients recruited by telephone it was 'Not Interested in the Study'. One factor that significantly distinguished patients who consented from patients who declined was the distance between their residence and the study site (t-test: p < .001). The most frequently reported reason for study participation was some benefit to the patient him/herself. Other reasons included helping others, being grateful to the VA, positive comments by trusted professionals, certain characteristics of the recruiter, and monetary compensation.

Conclusions

The enrollment rate was low primarily because of travel considerations, but we were able to identify and highlight valuable information for planning recruitment for future similar studies.

Moments of apprehension in the midst of a certainty: some frail older widows' lives with a personal emergency response system

The author's aim is to describe older frail widows' experience of having a personal emergency response system (PERS). Over 3 years, she interviewed 8 frail widows during a study of the home care experience using a phenomenological method to describe the context and the phenomena of the experience. "Being certain that I can get help here quickly" was a context for the phenomena of "deciding whom to put on my list (of first responders)" and "keeping the connection intact." However, the women also experienced apprehension. Being shocked by unexpected voices and visits was a context for "figuring out why a stranger is talking in my house" and "finding that they show up to check on me." The findings are a basis for considering the potential influences of having a PERS on elders' well-being.

Recruitment issues in healthcare research: the situation in home care

A global shift in the setting of healthcare from hospitals and long-term care institutions to homes and communities has been accompanied by the growth of interest in the home as a site of healthcare research. Home care researchers have identified the recruitment of research subjects as a significant concern. The present descriptive, exploratory study used qualitative, semi-structured interviews with home care researchers (n = 9) to illuminate the challenges related to recruitment. The results suggest that while home care research shares recruitment issues common to other forms of health research, it has unique concerns. Factors affecting recruitment in home care studies include non-dedicated recruiters, the current context of healthcare restructuring, and gatekeeper and participant feelings about the home as a setting for care and research. Reasons for refusal to participate may be more complex in home care research given the meanings care recipients attribute to their 'homes'. Home care researchers may also face unique ethical and/or moral dilemmas. This paper recommends the routine reporting of recruitment problems, increased inclusion of minority subjects to ensure sample representativeness and further studies of the subjective meanings of 'home' as it is associated with healthcare treatment.