When They Say No_Older Adults Perspectives on Home and Community Based Service

当他们说不时_老年人对家庭和社区服务的看法

• 批准号: 8773267
• 负责人: Frances Kathleen Wen
• 金额: $ 39.55万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8773267
• 关键词: African American; Aging; Area; Award; Behavior; Behavioral Model; Caregivers; Caucasoid Race; Communities; Development; Dimensions; Education; Elderly; Environment; Family; Family Practice; Focus Groups; Foundations; Future; Gender; Genetic Transcription; Goals; Health; Health Professional; Health Services; Health Services Research; Healthcare; Home environment; Individual; Influenza vaccination; Institution; Intervention; Interview; Methods; Minority; Nature; Patients; Preventive; Public Health; Research; Research Project Grants; Risk; Services; Staging; Structure; Students; Surveys; Testing; Woman; Work; base; community based participatory research; community based service; doctoral student; experience; group intervention; health care service utilization; health disparity; informant; interest; member; patient oriented; preference; public health relevance; research in practice; service utilization; social stigma; theories; therapy development

DESCRIPTION (provided by applicant): Home- and community-based services (HCBS) are crucial to helping older adults maintain health and independence in the community. However, HCBS are underutilized, with unmet needs greatest among women, minorities, and other vulnerable older adults (e.g., those with less education). This community-based participatory research project (CBPR) is driven by community interest in enhancing understanding of individuals who decline the use of HCBS from which they could benefit. This, in turn, perpetuates unmet needs, and increases risks to older adults and strain on informal supports. The ultimate goal of the CBPR team is to devise and test a patient-centered intervention, but there is little research on this type of underutilization to inform intervention development. We propose a new construct to describe this phenomenon, contrautilization of HCBS (CU-HCBS). Individuals who are contrautilizing HCBS have unmet needs for services, are aware of available services that they can access, but refuse or decline services. CU- HCBS is a refinement of underutilization and may form a basis for enhancing equitable access to needed services for older adults. The CBPR team proposes to conduct descriptive research through a qualitative, phenomenological study to explore CU-HCBS. Study aims are to: 1) identify and describe dimensions (e.g., passive/active avoidance, duration) and correlates (e.g., mistrust, stigma, autonomy) of CU-HCBS drawn from the perspectives of older adult contrautilizers in 12-20 semi-structured focus groups (FGs) (n=6-10 each), segmented by gender and race (White, African American); 2) distinguish among CU-HCBS dimensions and correlates in terms of importance and patient-centeredness (i.e., respectful and responsive to preferences, needs, values) by convening 3 to 5 FGs (n=6-10 each) of older adult contrautilizers, and 6 to 9 FGs (n=6-10 each) of key stakeholders (i.e., caregivers, agency leaders); and 3) assess the modifiability of CU-HCBS dimensions and correlates using semi-structured interviews with a subsample (n=12-18) of older adults who participated in Aim 1 FGs and, de-novo, a group (n=12-18) of older adults who recently changed from CU- HCBS to HCBS utilization. In accord with the Area Research Enhancement Award, this project will significantly strengthen the grantee institution's research environment. Students participated in study development and their involvement will expand with project implementation.

描述（由申请人提供）：基于家庭和社区的服务（HCB）对于帮助老年人维持社区的健康和独立性至关重要。但是，在妇女，少数群体和其他弱势群体中，HCB的充分利用不足，未满足的需求最大（例如，受过教育较少的人）。这项基于社区的参与研究项目（CBPR）是由社区兴趣驱动的，这是对拒绝使用HCB的个人的理解，从而使他们受益。反过来，这可以使未满足的需求永久化，并增加了对老年人的风险，并限制了非正式的支持。 CBPR团队的最终目标是设计和测试以患者为中心的干预措施，但是对于这种利用不足以告知干预开发的研究很少。我们提出了一种新的结构来描述这种现象，即HCB（CU-HCB）的相反。与HCB相反的个人对服务有未满足的需求，知道他们可以访问的可用服务，但拒绝或拒绝服务。 Cu-HCB是利用不足的改进，可能是增强公平获得老年人所需服务的基础。 CBPR小组建议通过定性的现象学研究进行描述性研究，以探索Cu-HCB。研究目的是：1）识别和描述尺寸（例如，被动/主动避免，持续时间）和相关性（例如，从12-20个半结构焦点组（FGS）（n = 6-10）中的12-20个半结构焦点组（n = 6-10）的cu-hcbs的Cu-hcbs（不信任，刻板，自主权），从12-20个半结构的焦点组（n = 6-10）中，均为和smandagan corame and Semprece and Semporce and Semporce and corame。 2）通过召集3至5 fgs（n = 6-10个）的老年人对逆变化剂（n = 6-10），将Cu-HCB的维度和相关性（即，对偏好，需求，需求，价值）的相关性（即，尊重和响应良好，对偏好，需求，价值观）进行区分，以6至9 fgs（n = 6-10个）的态度（n = 6-10），6至9 fgs（n = 6-10）（n = 6-10） 3）评估Cu-HCBS维度的可修改性，并使用半结构式访谈与参与AIM 1 FGS的子样本（n = 12-18）的子样本（n = 12-18）以及最近从Cu-HCBs to HCBS利用率变化的老年人（n = 12-18）的老年人（n = 12-18）。根据区域研究增强奖，该项目将大大增强受赠人机构的研究环境。学生参与研究发展，他们的参与将随着项目实施而扩展。