Toward a Mixed-Methods Research Approach to Content Analysis in The Digital Age: The Combined Content-Analysis Model and its Applications to Health Care Twitter Feeds

BACKGROUND: Twitter’s 140-character microblog posts are increasingly used to access information and facilitate discussions among health care professionals and between patients with chronic conditions and their caregivers. Recently, efforts have emerged to investigate the content of health care-related posts on Twitter. This marks a new area for researchers to investigate and apply content analysis (CA). In current infodemiology, infoveillance and digital disease detection research initiatives, quantitative and qualitative Twitter data are often combined, and there are no clear guidelines for researchers to follow when collecting and evaluating Twitter-driven content. OBJECTIVE: The aim of this study was to identify studies on health care and social media that used Twitter feeds as a primary data source and CA as an analysis technique. We evaluated the resulting 18 studies based on a narrative review of previous methodological studies and textbooks to determine the criteria and main features of quantitative and qualitative CA. We then used the key features of CA and mixed-methods research designs to propose the combined content-analysis (CCA) model as a solid research framework for designing, conducting, and evaluating investigations of Twitter-driven content. METHODS: We conducted a PubMed search to collect studies published between 2010 and 2014 that used CA to analyze health care-related tweets. The PubMed search and reference list checks of selected papers identified 21 papers. We excluded 3 papers and further analyzed 18. RESULTS: Results suggest that the methods used in these studies were not purely quantitative or qualitative, and the mixed-methods design was not explicitly chosen for data collection and analysis. A solid research framework is needed for researchers who intend to analyze Twitter data through the use of CA. CONCLUSIONS: We propose the CCA model as a useful framework that provides a straightforward approach to guide Twitter-driven studies and that adds rigor to health care social media investigations. We provide suggestions for the use of the CCA model in elder care-related contexts

A Newly Identified Impairment in Both Vision and Hearing Increases the Risk of Deterioration in Both Communication and Cognitive Performance

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes

Combined Impairments in Vision, Hearing and Cognition are Associated with Greater Levels of Functional and Communication Difficulties Than Cognitive Impairment Alone: Analysis of interRAI Data for Home Care and Long-Term Care Recipients in Ontario

Objectives: The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada. Methods: Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments. Results: The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group. Conclusions: The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans

The Role of Cultural and Family Values on Social Connectedness and Loneliness among Ethnic Minority Elders

Objectives: Ethnic minority elders have high levels of social isolation and loneliness. Assumptions about the family providing enough social support exist in the literature, contradicting ethnic minority elders’ reported levels of isolation and loneliness. While structural barriers influence feelings of isolation and loneliness, limited information exists about the role of cultural factors such as acculturation and family values. Accordingly, this study investigated the roles of acculturation and family values on loneliness and social isolation among ethnic minority elders. Methods: Ethnic minority elders (N = 123) completed a questionnaire that assessed their social connectedness, measured by social network and levels of loneliness, and structural factors such as income.. Additionally, cultural and family values were assessed by acculturation and the ‘family as referents’ dimension of familism, which refers to the belief that family members’ behaviour should meet with familial expectations. Results: Statistical analysis using hierarchical regression indicated that ‘family as referents’ and acculturation predicted loneliness, but not social network. Conclusions: This study raises the importance of considering cultural values when investigating predictors of loneliness among ethnic minority elders. Clinical implications: The finding highlight the importance of addressing familial expectations in programs aimed at alleviating loneliness among ethnic minority elders

The role of cultural and family values on social connectedness and loneliness among ethnic minority elders

Objectives: Ethnic minority elders have high levels of social isolation and loneliness. Assumptions about the family providing enough social support exist in the literature, contradicting ethnic minority elders’ reported levels of isolation and loneliness. While structural barriers influence feelings of isolation and loneliness, limited information exists about the role of cultural factors such as acculturation and family values. Accordingly, this study investigated the roles of acculturation and family values on loneliness and social isolation among ethnic minority elders.Methods: Ethnic minority elders (N = 123) completed a questionnaire that assessed their social connectedness, measured by social network and levels of loneliness, and structural factors such as income. Additionally, cultural and family values were assessed by acculturation and the ‘family as referents’ dimension of familism, which refers to the belief that family members’ behaviour should meet with familial expectations.Results: Statistical analysis using hierarchical regression indicated that ‘family as referents’ and acculturation predicted loneliness, but not social network.Conclusions: This study raises the importance of considering cultural values when investigating predictors of loneliness among ethnic minority elders.Clinical implications: The finding highlight the importance of addressing familial expectations in programs aimed at alleviating loneliness among ethnic minority elders

Feasibility of a Dementia-Focused Person-Centered Communication Intervention for Home Care Workers

Objectives: This study assessed the feasibility of Be EPIC, a dementia-focused, person-centeredcommunication intervention for personal support workers (PSWs). Be EPIC’s foci includes theenvironment, person-centered communication, client relationships, and clients’ abilities, socialhistory and preferences.Methods: Feasibility was assessed using semi-structured interviews and focus groups with PSWs.We used a phenomenological approach to assess: acceptability, implementation, practicality,demand, and limited efficacy.Results: The theme supporting the criterion of acceptability was helpful/relevant training. Themessupporting implementation included realistic simulations, interactive training, and positive learningexperience at the adult-day center. The theme supporting practicality was support to attendtraining. Demand for Be EPIC revealed two themes: participants’ personal motivation and barriersto applying newly learned knowledge and skills. The theme reflecting limited efficacy wasapplying newly learned knowledge and skills with home care clients. Four themes emergedthat mapped onto Be EPIC’s foci.Conclusions: The findings support Be EPIC’s feasibility and highlight the need to address structuralbarriers from employers and government to ensure the delivery of person-centered dementiacare.Clinical Implications: The findings highlight the need for and positive impact of person-centeredcommunication training on home care workers, especially the value of learning by doing,reflective practice, and peer support

Receiving while giving: The differential roles of Receiving help and satisfaction with help on caregiver rewards among spouses and adult-children.

Objective: There is a growing body of literature on the rewards associated with caregiving and the utilityof these rewards on buffering the negative consequences of caring for a family member with Alzheimer’sdisease. Many psychoeducational interventions aim to empower caregivers to seek and obtain help fromtheir social support network, with the expectation that help will enable them to cope more effectively.Methods: This study investigated the impact of changes in help and changes in satisfaction with help onpositive aspects of caregiving for both spouse (N= 254) and adult-child (N= 208) caregivers whoattended a psychoeducational intervention.Results: Analyses using structural equation modeling revealed that increases in amount of help andsatisfaction with help were significantly linked with increases in caregiver rewards for adult-children.However, only increases in satisfaction with help were significantly related to increases in caregiverrewards for spouses.Conclusions: These group differences suggest that the quality of support is critical for spouses, whereasboth quality and receiving extra help are useful for adult-child caregivers. These findings are discussedin terms of the importance of understanding the differential needs of spouse and adult-child caregiversin practice

Testing Self-Efficacy as a Pathway that Supports Self Care among Family Caregivers in a Psychoeducational Intervention

This study investigated the extent to which a psychoeducational intervention supports family-centered care by influencing health risk and self-care behaviors of caregivers of individuals with Alzheimer\u27s disease (N = 325). Moreover, this study investigated the extent to which changes in self-efficacy explained changes in health risk and self-care behaviors. Data were analyzed using repeated measures and multivariate analysis of variance and multiple regression. Qualitative written accounts of the impact of the intervention augmented the quantitative findings. The study\u27s findings revealed that family caregivers experienced reductions in health risk behaviors and improvements in exercise, stress management, and relaxation activities as a result of participating in the psychoeducational intervention. Improvement in self-efficacy was linked with reductions in health risk behaviors and increased involvement in stress management and relaxation activities. Implications are discussed in terms of the need to understand the mechanisms by which interventions influence family caregivers and the role these mechanisms play in supporting family-centered care