Home- and community-based services (HCBS) are crucial to helping older adults maintain health and independence in the community. However, HCBS are underutilized, with unmet needs greatest among women, minorities, and other vulnerable older adults (e.g., those with less education). This community-based participatory research project (CBPR) is driven by community interest in enhancing understanding of individuals who decline the use of HCBS from which they could benefit. This, in turn, perpetuates unmet needs, and increases risks to older adults and strain on informal supports. The ultimate goal of the CBPR team is to devise and test a patient-centered intervention, but there is little research on this type of underutilization to inform intervention development. We propose a new construct to describe this phenomenon, contrautilization of HCBS (CU-HCBS). Individuals who are contrautilizing HCBS have unmet needs for services, are aware of available services that they can access, but refuse or decline services. CU- HCBS is a refinement of underutilization and may form a basis for enhancing equitable access to needed services for older adults. The CBPR team proposes to conduct descriptive research through a qualitative, phenomenological study to explore CU-HCBS. Study aims are to: 1) identify and describe dimensions (e.g., passive/active avoidance, duration) and correlates (e.g., mistrust, stigma, autonomy) of CU-HCBS drawn from the perspectives of older adult contrautilizers in 12-20 semi-structured focus groups (FGs) (n=6-10 each), segmented by gender and race (White, African American); 2) distinguish among CU-HCBS dimensions and correlates in terms of importance and patient-centeredness (i.e., respectful and responsive to preferences, needs, values) by convening 3 to 5 FGs (n=6-10 each) of older adult contrautilizers, and 6 to 9 FGs (n=6-10 each) of key stakeholders (i.e., caregivers, agency leaders); and 3) assess the modifiability of CU-HCBS dimensions and correlates using semi-structured interviews with a subsample (n=12-18) of older adults who participated in Aim 1 FGs and, de-novo, a group (n=12-18) of older adults who recently changed from CU- HCBS to HCBS utilization. In accord with the Area Research Enhancement Award, this project will significantly strengthen the grantee institution's research environment. Students participated in study development and their involvement will expand with project implementation.

R15AG048535

2014-09-15

2018-08-31