Barriers and facilitators to providing home-based care in a pandemic: policy and practice implications

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Abstract

Objective

The purpose of this study is to describe the experiences of home-based care providers (HBCP) in providing care to older adults during the pandemic in order to inform future disaster planning, including during pandemics.

Design

Qualitative inquiry using an abductive analytic approach.

Setting and participants

Home-based care providers in COVID-19 hotspots.

Methods

Telephone interviews were conducted with 27 participants (administrators, registered nurses and other members of the allied healthcare team), who provided in-home care during the pandemic in Medicare-certified home health agencies. Interviews focused on eliciting experiences from HBCP on challenges and successes in providing home-based care to older adults, including barriers to care and strategies employed to keep patients, and providers, safe in their homes during the pandemic.

Results

Data was distilled into four major themes that have potential policy and practice impact. These included disrupted aging-in-place resources, preparedness actions contributing to readiness for the pandemic, limited adaptability in administrative needs during the pandemic and challenges with unclear messaging from public health officials.

Conclusions

Home-based care plays an essential role in maintaining the health of older adults in disaster contexts, including pandemics. Innovative solutions, informed by policy that generate evidence-based best practices to support HBCP are needed to reduce barriers and increase protective factors, in order to maintain continuity of care for this vulnerable population during disruptive events.

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The Ecology of Human Development : Experiments by Nature and Design

Urie Bronfenbrenner (1979)

Here is a book that challenges the very basis of the way psychologists have studied child development. According to Urie Bronfenbrenner, one of the world’s foremost developmental psychologists, laboratory studies of the child’s behavior sacrifice too much in order to gain experimental control and analytic rigor. Laboratory observations, he argues, too often lead to “the science of the strange behavior of children in strange situations with strange adults for the briefest possible periods of time.” To understand the way children actually develop, Bronfenbrenner believes that it will be necessary to observe their behavior in natural settings, while they are interacting with familiar adults over prolonged periods of time. This book offers an important blueprint for constructing such a new and ecologically valid psychology of development. The blueprint includes a complete conceptual framework for analysing the layers of the environment that have a formative influence on the child. This framework is applied to a variety of settings in which children commonly develop, ranging from the pediatric ward to daycare, school, and various family configurations. The result is a rich set of hypotheses about the developmental consequences of various types of environments. Where current research bears on these hypotheses, Bronfenbrenner marshals the data to show how an ecological theory can be tested. Where no relevant data exist, he suggests new and interesting ecological experiments that might be undertaken to resolve current unknowns. Bronfenbrenner’s groundbreaking program for reform in developmental psychology is certain to be controversial. His argument flies in the face of standard psychological procedures and challenges psychology to become more relevant to the ways in which children actually develop. It is a challenge psychology can ill-afford to ignore.

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Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period

Konstantina Vasileiou, Julie Barnett, Susan Thorpe … (2018)

Background Choosing a suitable sample size in qualitative research is an area of conceptual debate and practical uncertainty. That sample size principles, guidelines and tools have been developed to enable researchers to set, and justify the acceptability of, their sample size is an indication that the issue constitutes an important marker of the quality of qualitative research. Nevertheless, research shows that sample size sufficiency reporting is often poor, if not absent, across a range of disciplinary fields. Methods A systematic analysis of single-interview-per-participant designs within three health-related journals from the disciplines of psychology, sociology and medicine, over a 15-year period, was conducted to examine whether and how sample sizes were justified and how sample size was characterised and discussed by authors. Data pertinent to sample size were extracted and analysed using qualitative and quantitative analytic techniques. Results Our findings demonstrate that provision of sample size justifications in qualitative health research is limited; is not contingent on the number of interviews; and relates to the journal of publication. Defence of sample size was most frequently supported across all three journals with reference to the principle of saturation and to pragmatic considerations. Qualitative sample sizes were predominantly – and often without justification – characterised as insufficient (i.e., ‘small’) and discussed in the context of study limitations. Sample size insufficiency was seen to threaten the validity and generalizability of studies’ results, with the latter being frequently conceived in nomothetic terms. Conclusions We recommend, firstly, that qualitative health researchers be more transparent about evaluations of their sample size sufficiency, situating these within broader and more encompassing assessments of data adequacy. Secondly, we invite researchers critically to consider how saturation parameters found in prior methodological studies and sample size community norms might best inform, and apply to, their own project and encourage that data adequacy is best appraised with reference to features that are intrinsic to the study at hand. Finally, those reviewing papers have a vital role in supporting and encouraging transparent study-specific reporting. Electronic supplementary material The online version of this article (10.1186/s12874-018-0594-7) contains supplementary material, which is available to authorized users.

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Theory Construction in Qualitative Research

Stefan Timmermans, Iddo Tavory (2012)

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Author and article information

Contributors

Sue Anne Bell: sabell@umich.edu

Lydia Krienke: lkohkrienke@gmail.com

Allyson Brown: brallyso@umich.edu

Jen Inloes: jinloes@umich.edu

Zoe Rettell: zrettell@umich.edu

Tamar Wyte-Lake: Tamar.wyte@va.gov

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 21 March 2022

Publication date PMC-release: 21 March 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 234

Affiliations

[1 ]GRID grid.214458.e, ISNI 0000000086837370, School of Nursing, , University of Michigan, ; Ann Arbor, MI USA

[2 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Johns Hopkins University School of Nursing, ; Baltimore, MD USA

[3 ]GRID grid.214458.e, ISNI 0000000086837370, University of Michigan, ; Ann Arbor, MI USA

[4 ]Veterans Emergency Management Evaluation Center, North Hills, CA USA

Article

Publisher ID: 2907

DOI: 10.1186/s12877-022-02907-w

PMC ID: 8936035

PubMed ID: 35313830

SO-VID: 2f9d6693-04e3-41f7-85db-a1ffbd31dc9d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 January 2022

Date accepted : 2 March 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000049, National Institute on Aging;

Award ID: K23AG059890

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: home-based care,disaster,covid-19,policy,practice

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: home-based care, disaster, covid-19, policy, practice

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The experiences of homecare workers in navigating the COVID-19 pandemic: a protocol for a qualitative study
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Barriers and facilitators to providing home-based care in a pandemic: policy and practice implications

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Most cited references 36

The Ecology of Human Development : Experiments by Nature and Design

Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period

Theory Construction in Qualitative Research

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