Older adults' motivations to participate or not in epidemiological research. Qualitative inquiry on a study into dementia in Switzerland

The participation of hard-to-reach older people in the research and development process of health technologies from the perspective of multipliers-A qualitative analysis

Introduction

The participation of older people in research and development processes has long been called for but has not been sufficiently put into practice. In addition, participation is often late and not particularly intensive, so that certain older groups of people are underrepresented in the development of health technologies (HT). Heterogeneity, e.g., between urban and rural populations, in access to and motivation for participation is also rarely taken into account. The aim of this study was to investigate form and phases of participation for hard-to-reach older people in the research and development process of HT.

Methods

The qualitative study among multipliers was conducted using focus groups and telephone interviews and took place in a city and an adjacent rural area in northwestern Lower Saxony, Germany. A content analysis of the data was undertaken using deductive-inductive category formation.

Results

Seventeen participants (13 female) took part in the study (median age 61, 33-73). Participants from both areas identified particular forms and phases of participation in the research and development process. Longer forms of participation for hard-to-reach groups and the development process of technologies for older people from the rural area were viewed as challenges. Passive and active access strategies are needed to achieve sufficient heterogeneity in the research and development process. Trusted multipliers can play an important role in gaining access to hard-to-reach older people, but also during the research process. Apart from facilitating factors (e.g., age-specific study materials), inhibiting factors such as contact anxieties are also indicated. Only urban participants mention financial/material incentives and community as possible motivations.

Conclusions

The results provide important insights from the perspective of multipliers. They show specificities in access and participation for rural areas and for hard-to-reach older people. Many older people may have uncertainties about research projects and HT. Multipliers can assume a key role to help reduce these uncertainties in the future.

A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II

Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.

PROCare4Life lessons learned

PeRsOnalised Integrated CARE Solution for Elderly (PROCare4Life) was an EU-funded project that ran from January 2020 until June 2023, whose focus was to further develop and integrate previous ICT solutions developed by several previous EU-funded projects into a unique modular system able to support the autonomy and empowerment and to increase the Quality of Life (QoL) of elderly people living with Parkinson's, Alzheimer's, or similar dementia, having also tested the system for elderly people living with comorbidities. This article focuses on the methodology and results used to identify the internal lessons learned. PROCare4Life was developed using a codesign approach involving more than 2,000 participants whose input has been listened to and transformed into valuable changes of the system and also into lessons learned included in this case study report. Since the beginning of the implementation of PROCare4Life, there has been a commitment to make invisible knowledge visible through open discussion and including our lessons learned in each of our deliverables. In the last six months of implementation, qualitative research has been implemented by the PROCare4Life consortium to identify and select our most relevant challenges and recommendations for future projects and initiatives. PROCare4Life was highly impacted by the COVID-19 pandemic, and it is acknowledged in the lessons learned. However, the consortium has focused on the recommendations that could be more valuable for ordinary implementation of future projects and initiatives developing eHealth tools for elderly citizens living with conditions that might affect their cognitive or mobility capacities.

An innovative approach to recruiting participants for dementia research: primary care and researcher perspectives

Aim: To describe clinician and researcher perceptions of a new, patient preference focused approach to recruiting patients for research from primary care-based memory clinics. Methods: Memory clinic clinicians completed a survey and key informants completed an individual interview to gather their perceptions of this new program. Results: The majority of clinicians were 'satisfied' or 'very satisfied' with this recruitment approach and indicated that this approach would have minimal negative impact on patient care or create conflict of interest. Key informants valued the program for its patient-centred approach, the integration of research into care and potential for increased recruitment. Discussion: These findings are suggestive of support for this recruitment approach. Pilot testing will inform feasibility, effectiveness and process improvements.

Helping themselves and helping others: how the passage of time influences why mothers with addictions take part in research

Introduction

Women with addiction issues are under-researched, despite previous evidence that women's needs are less understood than men's and that services can overlook gender-specific issues. The majority of women in treatment are mothers and a significant number have contact with child welfare services. The voices of these women are needed to shape and influence evidence-based treatment and service development.

Aim

To examine reasons and rationale for participation in research in mothers with addiction issues and involvement with the child welfare system.

Method

Reflexive thematic analysis was used on interview transcripts from two qualitative studies. Individual themes from each study were combined and analysed to develop themes covering both studies and at different timepoints in process of child welfare assessment or removal of child/ren.

Results

Three themes were identified (1) altruism; (2) personal benefit; and (3) empowerment. These mothers wanted to help with research. However, they also participated with the hope that this might facilitate the return of their children or help them to access support or services. A change over time was evident and, in those further down the line from child removal, there was a stronger want for their voices to be heard in order to advocate for other women and create change in services.

[Motivational Reasons and Perceptions about Future Participation of Older People in the Research and Development Process of Health Technologies: a Mixed Methods Study]

BACKGROUND

Although digital approaches for disease prevention in older people have a high potential and are being used more often, there are still inequalities in access and use. One reason could be that in technology development future users are insufficiently taken into consideration, or involved very late in the process using inappropriate methods. The aim of this work was to analyze the motivation of older people participating, and their perceptions of future participation in the research and development process of health technologies aimed at health care for older people.

METHODOLOGY

Quantitative and qualitative data from one needs assessment and two evaluation studies were analyzed. The quantitative data were analyzed descriptively and the qualitative data were analyzed content-analytically with inductive-deductive category formation.

RESULTS

The median age of the 103 participants (50 female) was 75 years (64-90), most of whom were interested in using technology and had prior experience of study participation. Nine categories for participation motivation were derived. A common motivation for participation was to promote and support their own health. Respondents were able to envision participation both at the beginning of the research process and at its end. In terms of technique development, different ideas were expressed, but there was a general interest in technological development. Methods that would enable exchange with others were favored most.

CONCLUSIONS

Differences in motivation to participate and ideas about participation were identified. The results provide important information from the perspective of older people and complement the existing state of research.

Caregivers' perception of adults with Down syndrome willingness to participate in research

BACKGROUND

Historically, individuals with Down syndrome have been excluded from clinical research. Our objective was to assess the degree of interest adults with Down syndrome have in participating in research from the perspective of the caregivers who care for them.

METHODS

We conducted an online survey of N = 390 caregivers of adults with Down syndrome and asked about interest in research participation and demographics.

RESULTS

Caregivers were mostly family members, older than 55 years, and White. Caregivers reported that the adult with Down syndrome that they cared for would be more comfortable participating in research that was physiological, such as research involving fit bits (70.2% would participate), exercise (63.3%) or diet apps (53.9%), whereas they would be less likely to participate in clinical trials involving more invasive procedures such as injections (10.9%) and laboratory exams like MRIs (32.0%). We found little difference by age or gender of the adult with Down syndrome or by caregiver education level.

CONCLUSIONS

Our survey identified high interest for less invasive studies, illustrating acceptability of observational and lifestyle studies. More effort may be needed to understand fear and barriers to participation and to create tools and methods to increase interest in more invasive studies.

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults-An Exploratory Home-Based Study of an Underserved Group in Research

BACKGROUND

Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments.

METHODS

Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS).

RESULTS

The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research.

CONCLUSIONS

Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.

Why Vaccinate Against COVID-19? A Population-Based Survey in Switzerland

Objectives: This study examined factors associated with COVID-19 vaccination intention at the very beginning of the vaccination campaign in a representative sample of the population in southern Switzerland.

Methods: In March 2021, we measured vaccination intention, beliefs, attitudes, and trust in a sample of the Corona Immunitas Ticino study.

Results: Of the 2681 participants, 1933 completed the questionnaire (response rate = 72%; 55% female; meanage = 41, SD = 24, rangeage = 5–91). Overall, 68% reported an intention to get vaccinated. Vaccination intention was higher in social/healthcare workers, and increased with age, trust in public health institutions, and confidence in the vaccine efficacy. Prior infection of a family member, predilection for waiting for more evidence on the safety and efficacy of the vaccine, and for alternative protective means were negatively associated with intention.

Conclusion: In view of needs of COVID-19 vaccine boosters and of suboptimal vaccination coverage, our results have relevant public health implications and suggest that communication about vaccine safety and efficacy, and aims of vaccination programs, should be bi-directional, proportionate, and tailored to the concerns, expectations, and beliefs of different population subgroups.

Feasibility and Acceptability of a Dietary Intervention to Reduce Salt Intake and Increase High-Nitrate Vegetable Consumption in Malaysian Middle-Aged and Older Adults with Elevated Blood Pressure: Findings from the DePEC-Nutrition Trial

The DePEC-Nutrition trial is a complex dietary and behavioural intervention of salt intake reduction combined with increased high-nitrate vegetable consumption among Malaysian middle-aged and older adults with elevated blood pressure. This study aimed to assess the feasibility and acceptability of the trial. Participants were recruited from the South East Asia Community Observatory (SEACO) database and randomised into one of four groups: (1) low salt; (2) high-nitrate vegetable; (3) combined high-nitrate vegetable and low salt; and (4) control. The intervention included a combination of group counselling sessions, information booklets, reinforcement videos and text messages to modify dietary behaviour. The primary outcomes evaluated were the measures of feasibility and acceptability of (1) recruitment, follow-up attendance and retention; (2) data collection procedures and clinical outcome measures; and (3) individual and combined multi-modal dietary interventions. A total of 74 participants were recruited, and the 10-month retention rate was 73%. Data collection procedures were acceptable with minimal missing data. All intervention strategies were feasible and acceptable, with group counselling being the most acceptable strategy. This study provides important insights into improving the screening process of participants, facilitating their access to the research facilities and refining the measurement protocols and dietary recommendations, which are instrumental in formulating the design of a full-scale definitive DePEC-Nutrition trial.