Adult Day Service Utilization and Outcomes: A Mixed Methods Approach

DESCRIPTION (provided by applicant): There are two developmental objectives in this proposed K02 award: 1) to obtain expertise in qualitative and mixed-methods design to advance the principal investigator's (Pi's) research program on informal and formal long-term care, and 2) to gain knowledge and experience in the development and administration of large-scale, collaborative research initiatives based on the innovation of mixed methods designs. To achieve both objectives, a detailed career development plan is proposed that will offer extensive training in qualitative and mixed-methods research approaches via textbook reading, university-based courses, attendance at institutes, and collaboration with a number of senior colleagues. These activities will allow the candidate to integrate methodological viewpoints and will also provide valuable guidance as he transitions to the administration of research initiatives that rely on multiple R01-level projects and effective mentorship of junior researchers. Research activities based on these training aims will offer the candidate extensive experience in the conduct of complex, mixed methods research in long-term care. Using complementary quantitative and qualitative approaches, the proposed pilot study will: ascertain how various programmatic aspects of adult day service (ADS) programs facilitate the development of strong client-family-staff relationships; determine how ADS program environment and client-family-staff relationships operate independently and in concert to influence outcomes across key stakeholders (i.e., clients, families, and ADS staff); and test and refine a conceptual model of ADS utilization. Quantitative pilot data will be collected from a random sample of 20 ADS programs and 200 elderly ADS clients (65 years of age or over) as well as primary family caregivers and ADS staff persons most closely involved in the supervision and care of each client. The qualitative component will involve in-depth ethnographic research at two ADS sites and 20 client-family-staff constellations embedded in the quantitative component. Case study and thematic analyses will facilitate integration of the qualitative findings with those from the quantitative protocol. This study, an innovative analysis of the process of ADS programmatic and social contexts, will help to develop new conceptual models to aid in the evaluation of ADS and other community-based long-term care services. Moreover, the integrated training and research activities will provide a strong foundation for future, large-scale initiatives revolving around the integration of multiple methodologies in the study of process and outcome trajectories of long-term care utilization.