Jane B. Neese

Recruitment and retention of african american elders into community-based research: Lessons learned

Factors influencing the recruitment and retention of African Americans into research studies are not well understood. Studies show that their numbers continue to be low in clinical trials and other nursing studies. However, African Americans have disproportionately high incidences of disease, illness, and death, an important reason for their inclusion in ongoing research. Two urban, community-based intervention studies with elderly African American participants are used to show different issues and strategies in recruitment and retention. The sample selection and attrition experiences in the studies are examined using 3 theoretical approaches. Six concepts emerge as fundamental to successful recruitment and retention of diverse population groups: (1) historical cognizance; (2) sanctioning; (3) trust-building; (4) mutuality; (5) recognition of heterogeneity; and (6) researcher self-reflection and introspection.

Reliability, validity and factor structure of the Appraisal of Self‐Care Agency Scale – Revised (ASAS‐R)

RATIONALE, AIMS AND OBJECTIVESnSelf-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individuals health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R).nnnMETHODSnA cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data.nnnRESULTSnThe final 15-item three-factor ASAS-R had an overall Cronbachs alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbachs alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48).nnnCONCLUSIONSnThe 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.

Mental health services for rural elderly: Innovative service strategies

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.

Utilization of Mental Health Services Among Rural Elderly

Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt them to use mental health services, their use of these services remains low. This study developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by rural elders participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.

FactOr Analysis Of the Appraisal Of Self-care Agency Scale in American Adults With Diabetes Mellitus:

PURPOSEnThe purpose of this methodological secondary data analysis study is to examine the reliability, construct validity, and dimensionality of the Appraisal of Self-care Agency Scale (ASAS) in an American sample of adults with diabetes mellitus.nnnMETHODSnThe sample consisted of 141 insulin-requiring adults with diabetes mellitus recruited from a Diabetes Care Center in the southern United States. The ASAS, along with Hurleys Insulin Management Diabetes Self-efficacy and Insulin Management Diabetes Self-care Scales, was used in the study to determine convergent validity, thus contributing to the construct validity of the ASAS. Other data analysis consisted of internal consistency estimates of reliability, Pearson correlations, and factor analysis.nnnRESULTSnThe findings suggest that the ASAS consists of a single substantive dimension and has adequate construct validity and reliability.nnnCONCLUSIONnRevision of certain items and conducting further analysis of the scale, prior to its adoption in clinical practice, should be considered.

Psychogeriatric Outreach To Rural Families: The Iowa and Virginia Models

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnosed. Outreach programs are argued to be effective models of delivering services to geographically and/or socially isolated elderly populations. The experiences of our programs, though limited to rural populations, may be of relevance to any outreach program attempting to serve elderly presenting with or at risk for mental health problems.

Cluster Analysis of Psychogeriatric Characteristics and Service Use Among Rural Elders

In developing models of psychiatric service delivery, nurses must be able to target groups on the basis of their health status and service needs. This investigation attempted to develop profiles of rural elderly, a significant risk population, by subjecting data on the psychogeriatric nursing status and health services utilization of 125 subjects to cluster-analytic methods. The cluster analysis yielded a three-cluster model: Cluster 1 (n = 39) predominantly comprised unmarried women in moderate health, but with a high degree of health service utilization; Cluster 2 (n = 53) had rural elders with moderate physical impairments, self-perceptions of poor health, and moderate health service utilization; and Cluster 3 (n = 33) comprised elders with severe cognitive and physical impairments and high health service utilization. Cluster 2 subjects were judged to be mild users of services because they were younger and married without a regular source of health care. Because subjects in Cluster 1 tended to be unmarried women who lived alone, with mild to moderate physical impairments and a regular source of health care, these subjects were assessed as moderate users of services. Cluster 3, which comprised the oldest and most impaired, both physically and cognitively, were judged to be intensive users of services.

Risk profiles for nursing home placement of rural elderly: A cluster analysis of psychogeriatric indicators

In an effort to better understand the clinical and functional status of patients served by our Rural Elder Outreach Program, more effectively identify risk groups, and more efficiently target services, we performed a cluster analysis on 92 older adults served by our program. The first cluster included patients with very poor health, mild cognitive impairment, very high care demands, and migrating toward active risk for institutionalization. The second cluster included patients with poor physical but good mental health, intact cognition, high care demands, and at passive risk. The third cluster comprised patients with high functional, physical, and cognitive impairment, intensive care demands, moderate mental health problems, poor insight into their situation, and at active risk for institutionalization.

Mental Health of Rural Elderly: A Research Agenda for Nursing

Only recently have the health sciences, including nursing, begun to focus on the dynamics of mental health and aging. Reports on rural initiatives, are beginning to appear; these developments have occurred without the benefit of context and direction, however, especially in terms of how these issues apply in rural areas. The article reviews selected issues in the interface of aging and mental health in rural areas. It offers a research agenda comprising descriptive, intervention, and utilization studies as a context to guide research and knowledge development in mental health nursing of rural elderly.

Psychometric Properties of the Domestic Violence Survivor Assessment

Domestic Violence Survivor Assessment (DVSA) assesses the process of change using the Transtheoretical Model of Change for 12 issues conceptualized as relating to the relationship or the individual. This article presents the psychometric properties of the revised DVSA with a new item, Control of Money. The factor analysis was done for 119 survivors resulting in a three-factor solution explaining 65.06% of the variance with a Chronbachs alpha of .89 and Mental Health as a separate, third factor. The DVSAs use for counseling and implications of the differences in responses by women and their counselors is discussed.