Petri J. Kajonius

Structure and process quality as predictors of satisfaction with elderly care

The structure versus process approach to quality of care presented by Donabedian is one of the most cited ever. However, there has been a paucity of research into the empirical validity of this framework, specifically concerning the relative effects of structure and process on satisfaction with elderly care as perceived by the older persons themselves. The current research presents findings from a national survey, including a wide range of quality indicators for elderly care services, conducted in 2012 at the request of the Swedish National Board of Health and Welfare in which responses from 95,000 elderly people living in 324 municipalities and districts were obtained. The results revealed that the only structural variable which significantly predicted quality of care was staffing, measured in terms of the number of caregivers per older resident. More interestingly, process variables (e.g. respect and access to information) explained 40% and 48% of the variance in satisfaction with care, over and above the structural variables, in home care and nursing homes respectively. The findings from this large nationwide sample examining Donabedians model suggest that quality in elderly care is primarily determined by factors pertaining to process, that is, how caregivers behave towards the older persons. This encourages a continued quality improvement in elderly care with a particular focus on process variables.

User-oriented elderly care : a validation study in two different settings using observational data

Purpose – User-oriented care, defined as individualized assisting behaviors, is the dominant approach within elderly care today. Yet, there is little known about its conceptual structure. This paper proposes that user-oriented care has a bi-partite structure which may be decomposed into the two dimensions of task and relation. Design/methodology/approach – Care workers were “shadowed” (i.e. observed) at their work (n=391 rated interactions). User-oriented care was assessed along ten process quality indicators targeting the acts of caregiving (i.e. task focus, relation focus, involvement, time-use, body language, autonomy, respect, warmth, encouragement, and information) in two elderly care settings, i.e. home care and nursing home. Observations added up to 45 hours. Findings – Principal component analyses confirmed the proposed two-factor structure of user-oriented care. Specifically, the user-oriented care indicators loaded on two distinct factors, i.e. task and relation. The underlying structure of user...

Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction With Elderly Care

Maximizing satisfaction among the older persons is the goal of modern individualized elderly care and how to best achieve this is of relevance for people involved in planning and providing elderly care services. Purpose of the Study: What predicts satisfaction with care among older persons can be conceived as a function of process (how care is performed) and the older person. Inspired by the long-standing person versus situation debate, the present research investigated the interplay between person- and process-related factors in predicting satisfaction with elderly care. Design and Methods: A nationwide sample was analyzed, based on a questionnaire with 95,000 individuals using elderly care services. Results: The results showed that person-related factors (i.e., anxiety, health, and loneliness) were significant predictors of satisfaction with care, although less strongly than process-related factors (i.e., treatment, safeness, and perceived staff and time availability). Among the person-related factors, loneliness was the strongest predictor of satisfaction among older persons in nursing homes. Interestingly, a path analysis revealed that safeness and treatment function as mediators in linking loneliness to satisfaction. Implications: The results based on a large national sample demonstrate that the individual aging condition to a significant degree can be countered by a well-functioning care process, resulting in higher satisfaction with care among older persons.

Personality traits across countries : Support for similarities rather than differences

In the current climate of migration and globalization, personality characteristics of individuals from different countries have received a growing interest. Previous research has established reliable differences in personality traits across countries. The present study extends this research by examining 30 personality traits in 22 countries, based on an online survey in English with large national samples (NTotal = 130,602). The instrument used was a comprehensive, open-source measure of the Five Factor Model (FFM) (IPIP-NEO-120). We postulated that differences in personality traits between countries would be small, labeling this a Similarities Hypothesis. We found support for this in three stages. First, similarities across countries were observed for model fits for each of the five personality trait structures. Second, within-country sex differences for the five personality traits showed similar patterns across countries. Finally, the overall the contribution to personality traits from countries was less than 2%. In other words, the relationship between a country and an individual’s personality traits, however interesting, are small. We conclude that the most parsimonious explanation for the current and past findings is a cross-country personality Similarities Hypothesis.

Cost and Satisfaction Trends in Swedish Elderly Home Care

There is a widespread belief among the public and policy makers that quality of care in terms of user satisfaction can be improved with increased spending. However, recent research indicates that structural resources (e.g., budget per elderly) in elderly home care do not predict quality of care in terms of older persons’ satisfaction with care. In the present study, we analyzed the longitudinal trends in costs and perceived quality of care across 3 years using nationwide data in Swedish elderly home care. The results showed that although costs have been steadily increasing, perceived quality of interpersonal treatment in care has remained at the same level. An important implication is that future research and policy efforts to improve quality should more directly target the mechanisms generating satisfaction.

Sex differences in personality are larger in gender equal countries: Replicating and extending a surprising finding

Sex differences in personality have been shown to be larger in more gender equal countries. We advance this research by using an extensive personality measure, the IPIP-NEO-120, with large country samples (N > 1000), from 22 countries. Furthermore, to capture the multidimensionality of personality we measure sex differences with a multivariate effect size (Mahalanobis distance D). Results indicate that past research, using univariate measures of effect size, have underestimated the size of between-country sex differences in personality. Confirming past research, there was a strong correlation (r = .69) between a countrys sex differences in personality and their Gender Equality Index. Additional analyses showed that women typically score higher than men on all five trait factors (Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness), and that these relative differences are larger in more gender equal countries. We speculate that as gender equality increases both men and women gravitate towards their traditional gender roles.

Conceptualizations of Personality Disorders with the Five Factor Model-count and Empathy Traits

Previous research has long advocated that emotional and behavioral disorders are related to general personality traits, such as the Five Factor Model (FFM). The addition of section III in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) recommends that extremity in personality traits together with maladaptive interpersonal functioning, such as lack of empathy, are used for identifying psychopathology and particularly personality disorders (PD). The objective of the present study was to measure dispositions for DSM categories based on normal personality continuums, and to conceptualize these with empathy traits. We used a validated FFM-count method based on the five personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), and related these to 4 empathy traits (emphatic concern, perspective-taking, fantasy, and personal distress). The results showed that FFM-based PD scores overall could be conceptualized using only two of the empathy traits, low emphatic concern and high personal distress. Further, specific dispositions for personality disorders were characterized with distinct empathy traits (e.g., histrionic with high fantasy, and paranoid with low perspective-taking). These findings may have both theoretical and practical implications in capturing potential for personality disorders with ease and efficiency.

Variations in user-oriented elderly care: a multilevel approach

Purpose National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality). Design/methodology/approach Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM). Findings The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance. Practical implications Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level. Originality/value The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.