Alison S. Gottlieb

Choosing Among Residential Options: Results of a Vignette Experiment

Older people who experience declining health are often faced with difficult decisions about possible residential relocation. The research aim was to determine how five distinct dimensions—functional status, features of current housing, social networks, features of retirement communities, and financial considerations—affect decisions to relocate to a retirement community. A vignette experiment with a factorial design was conducted involving both older people and adult children who were concerned with an aging parent. Use of the Internet for administration of the experiment made it possible to deliver information to research participants through video clips. Research participants were influenced by each of the dimensions; however, functional status of the vignette persons had the greatest impact, and financial considerations the least. Adult children were more likely to recommend moves than were older people. The research is suggestive of the potential for use of vignette experiments for a fuller understanding of relocation decisions.

Using the Internet to Administer More Realistic Vignette Experiments

This article illustrates an innovative method of administering stated choice studies (or vignette experiments) using computers and the Internet. The use of video clips to deliver information to research participants makes vignettes more realistic, helps to engage interest of research participants, and can reduce framing effects. The method also provides research participants with interactive options before making judgments. A study to determine the views of older people regarding residential options is used to illustrate the method. Even older people with limited experience in using computers participated successfully. The study findings showed that research participants responded both to the audiovisual characteristics of vignette persons and to the variables in the vignette structure.

Residential Adjustment of Elders: Learning from Experiences With Parents and Peers

The ways elders learn from the experiences of their parents and peers in coping with declining health can affect residential adjustments they make themselves to minimize their exposure to long-term-care risks. Experiences of parents and peers can affect predisposition toward residential options, and parental and peer experiences sometimes can have major influences in elder residential choices. Drawing on qualitative interviews with community-residing elders, we illustrate how elders critically assess how their own parents and peers responded to declining health. We then show how these assessments influence the residential thinking and adjustments of these elders in anticipation of their own declining self-care capacity.

Contributions of Second Opinions, Outcome Forecasts, and Testimonials to Patient Decisions about Knee Replacement Surgery

Background. Decision aids are now a well-established means of supporting patients in their medical decision making. The widespread use of decision aids invites questions about how their components contribute to patient decisions. Objective. The objective of this study was to measure the importance of second opinions, patient-specific outcome forecasts, and patient testimonials relative to patient clinical and socioeconomic factors and the primary physician recommendation on the decision to undergo full knee replacement surgery to treat knee osteoarthritis. Methods. Middle-aged and older members of the RAND American Life Panel (N = 1616) chose whether to recommend surgery as a treatment for each of 3 hypothetical patients (vignettes) presented in a video-enhanced internet survey. Vignettes randomly sampled levels of scenario attributes. Results. Second opinions, person-specific outcome forecasts, and 2 consistent patient testimonials strongly affected respondents’ decision making; a single testimonial, however, did not significantly affect decisions. Conclusions. Information provided in a decision aid, including person-specific outcome forecasts and testimonials, can affect patient choices. The strong effect of testimonials and respondents’ interest in reviewing them reinforces concerns about unwanted influence when testimonials are biased.

A field experiment in aging services: opportunities and obstacles in the pursuit of internal and external validity

Abstract Researchers do not often have an opportunity to integrate a strong experimental design within a natural service-delivery setting. Funding from the Robert Wood Johnson Home Care Research Initiative made it possible to use a quasi-experimental design to test the effects of an intervention aimed to benefit community-residing elders within a publically-funded home care program. The intervention, which required collaboration among the state agency on aging, two independent home care agencies, and the research team, involved training case managers to distribute low-cost assistive equipment to home care clients with functional disabilities. One home care agency served as the experimental site, while the second agency, for which the intervention was delayed 6 months, served as the control site. The experiment was designed to maximize generalizability: It was mild and benign for both clients and agencies, was expected to unfold naturally, and required minimal data collection by program staff. Although adhering to the basic design, the project was compromised seriously by the manner in which it unfolded. Difficulties resulted from the lack of opportunity to perfect the service-delivery system before undertaking the experiment and from the inability to elicit full commitment to the project from the participating agencies. Based on experiences with the project, we offer several recommendations to design and implement field experiments to test the effectiveness of innovative services.