The 130th Annual Meeting of APHA

Abstract #48099

Lené Levy-Storms, PhD, MPH¹, Verónica Gutiérrez, MPH², John F. Schnelle, PhD², and Sandra Simmons, PhD². (1) Assistant Professor, UCLA Department of Medicine/Geriatrics, Associate Director, Borun Center, UCLA School of Medicine/Borun Center for Gerontological Research, 7150 Tampa Avenue, Jewish Home for the Aging, Reseda, CA 91335, (818) 774-3348, llstorms@ucla.edu, (2) School of Public Health, UCLA, UCLA, LosAngeles, CA 90095-1772

The purpose of this paper is to use mixed-methods to assess nursing home (NH) residents’ perceived unmet needs with regard to activities of daily living (ADL) care delivery (e.g., help with bathing). Previous research has used closed-ended questions to assess unmet needs, but closed-ended questions have been limited to discrepancies based on comparing the preferred to the perceived frequency or occurrence of ADL care assistance. Out of 111 NH residents who had a range of cognitive impairment, 93 (84%) participated in a face-to-face interview with open-ended questions. In-depth qualitative analyses of residents’ open-ended responses enabled the identification of standardized criteria to define “interpersonal” and “technical” aspects of ADL care delivery. Using these qualitatively identified criteria, two independent raters quantitatively coded each open-ended response’s content as either an “interpersonal” (e.g., expression of feeling or affect from nursing aides) or “technical” (e.g., task-oriented assistance only from nursing aides) issue (average Kappa: .62) and whether it indicated the resident “wanted change” or not (average Kappa: .73). The proportions of residents who wanted a change in the interpersonal and technical aspects of ADL care delivery ranged from: 6-19% and 7-26%, respectively, across seven ADL care domains. A significantly larger proportion of residents wanted a change in interpersonal compared to technical aspects of care only within the walking ADL care domain (McNemar’s Test Statistic=6.23; p<.01). A mixed-method approach, thus, revealed additional qualitative dimensions of unmet needs that include subtle aspects of both interpersonal and technical ADL care delivery and that can be assessed quantitatively.

Learning Objectives:

• To identify residents’ perceptions of the quality of ADL care delivery in NHs.
• To develop a systematic, reliable approach to assessing the interpersonal and technical manner of ADL care delivery in NHs.
• To demonstrate the advantage of using qualitative and quantitative methods to assess a complex phenomenon.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.