Using Clustering Methods to Map the Experience Profiles of Dementia Caregivers.

Background and Objectives: Caregivers of persons living with dementia report wide-ranging lived experiences, including feelings of burden and frustration but also positivity about caregiving. This study applies clustering methodology to novel survey data to explore variation in caregiving experience profiles, which could then be used to design and target caregiver interventions aimed at improving caregiver well-being. Research Design and Methods: The k-means clustering algorithm partitioned a sample of 81 caregivers from the Midwest region of the United States on the basis of 8 variables capturing caregiver emotions, attitudes, knowledge, and network perceptions (adversity: burden, anxiety, network malfeasance; network nonfeasance; positivity: positive aspects of caregiving, preparedness and confidence in community-based care, knowledge about community services for older adults, and network uplift). The experience profile of each segment is described qualitatively and then regression methods were used to examine the association between (a) experience profiles and caregiver demographic characteristics and (b) experience profiles and study attrition. Results: The clustering algorithm identified 4 segments of caregivers with distinct experience profiles: Thriving (low adversity, high positivity); Struggling with Network (high network malfeasance); Intensely Struggling (high adversity, low positivity); Detached (unprepared, disconnected, but not anxious). Experience profiles were associated with significantly different demographic profiles and attrition rates. Discussion and Implications: How caregivers respond to support interventions may be contingent on caregivers' experience profile. Research and practice should focus on identifying public health strategies tailored to fit caregiver experiences. Clinical Trial Registration: NCT03932812.

Effectiveness of implementing evidence-based approaches to promote physical activity in a Midwestern micropolitan area using a quasi-experimental hybrid type I study design.

BACKGROUND: Much evidence-based physical activity (PA) interventions have been tested and implemented in urban contexts. However, studies that adapt, implement, and evaluate the effectiveness of these interventions in micropolitan rural contexts are needed. The study aimed to evaluate the effectiveness of the Active Ottumwa intervention to promote PA in a micropolitan community. METHODS: Between 2013 - 2019, we implemented Active Ottumwa in a micropolitan setting, and subsequently implemented and evaluated its effectiveness using a Hybrid Type I design. In this paper, we describe the intervention's effectiveness in promoting PA. We collected PA data over 24 months from a cohort of community residents using accelerometers and PA data from two cross-sectional community surveys administered in 2013 and 2018, using the Global Physical Activity Questionnaire. RESULTS: From the cohort, we found significant change in PA over 24 months (P = 0.03) corresponding to a 45-min daily decrease in sedentary activity, a daily increase of 35-min in light PA and 9 min in moderate-to-vigorous PA. There was a statistically significant (P = 0.01) increasing trend at the population-level in the moderate-to-vigorous composition of 7 min between the two cross-sectional assessments (95% CI: 0.1%-1.34%). CONCLUSIONS: The study demonstrates that the adapted evidence-based PA interventions in a micropolitan context is effective.

Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs.

Background: Evidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities. Methods: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants. Results: After participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance. Conclusion: Future sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

An app to support oral hygiene care: Increasing attitudes, knowledge, and confidence in identifying oral health problems among caregivers of persons living with dementia.

PURPOSE: To develop and pilot test an App to help family and paid caregivers perform high quality oral hygiene care. METHODS: A prototype of the App was refined based on stakeholder feedback (e.g., dental care professionals, direct care providers, nursing home administrator, family caregivers). The refined App was pilot tested with 16 family caregivers and 15 paid care providers of persons living with dementia (PLWD). Participants completed a pre-test, watched an App demonstration, used it for 2 weeks, and completed a post-test. Surveys included both structured and open-ended questions. RESULTS: Phase 1 data informed the refinement of the App that led to high acceptability and usability by the Phase 2 participants. Both family and paid caregivers reported a significant increase in attitudes toward providing oral hygiene care to frail older adults (p = .05 and p = .02 for family and paid providers, respectively), knowledge about oral health and care (p = .01 and p = .02), and ability to identify oral health problems (p = .005 and p = .01). Additionally, paid caregivers reported increase in perceived support available in providing oral hygiene care (p < .001). CONCLUSION: Stakeholder engaged approach helped increase the acceptability and usability of the App that successfully increase caregivers' attitude, knowledge, and abilities in oral hygiene care provision.

Critical Elements of Care Coordination for Older Persons in Rural Communities: An Evaluation of the Iowa Return to Community Service Demonstration.

We evaluated the Iowa Return to Community, a service demonstration designed to coordinate care and reduce preventable healthcare utilization among at-risk older persons living at home in rural communities. During 2021, 262 older persons elected to participate in the IRTC program. Individuals who participated were more likely to live in micropolitan areas (OR = 2.30, 95% CI 1.34-3.95) relative to metropolitan locations. Individuals who used recommended services were more likely to be men (OR 3.65, 95% CI 1.16-11.51) and more likely to live in rural (OR 17.48, 95% CI 1.37-223.68) and micropolitan areas (OR 3.17, 95% CI 1.00-10.05). However, prevention of health care use corresponded more with consistent and prolonged IRTC program engagement rather than volume of service use. The IRTC constitutes a population aging and rural health strategy to reduce unnecessary health care use while supporting individual preferences to remain at home.

A scoping review of unpaid caregivers' experiences during older adults' hospital-to-home transitions.

The objective of this scoping review is to examine current evidence regarding unpaid/family caregivers' experiences during older adults' hospital-to-home transitions to identify gaps and opportunities to involve caregivers in transitional care improvement efforts. Eligible articles focused on caregiver experience, outcomes, or interventions during older adults' hospital-to-home transitions. Our review identified several descriptive studies focused on exploring the caregiver experience of older adult hospital-to-home transitions and caregiver outcomes (such as preparedness, strain, burden, health, and well-being). Qualitative studies revealed challenges at multiple levels, including individual, interpersonal, and systemic. Few interventions have targeted or included caregivers to improve discharge education and address support needs during the transition. Future work should target underrepresented and marginalized groups of caregivers, and caregivers' collaboration with community-based services, social networks, or professional services. Work remains in developing and implementing interventions to support both older adult and caregiver needs.

Perceptions of the Right to Food Among Adults Aged 60 Years and Older.

This study explores perceptions of the right to food and issues around food assistance and access among older adults. We conducted 20 semi-structured interviews with adults aged 60+ in Iowa, half of whom were food insecure. Most respondents expressed the right to food concerns freedom of choice rather than physical and financial access. The respondents said poor food access was due to improper choices or not accessing food assistance. While respondents believed food insecurity was morally wrong, they also believed current food assistance services are sufficient. These results have important implications for understanding how older adults think about food access.

Understanding Implementation of Evidence-Based Interventions to Address Human Papillomavirus Vaccination: Qualitative Perspectives of Middle Managers.

Engaging individuals in middle management positions (eg, nurse or clinic managers) could facilitate implementation of evidence-based interventions (EBIs) to improve uptake of human papillomavirus (HPV) vaccination. Our goal was to understand middle managers' role in and perspectives on implementation of EBIs for HPV vaccination. We conducted qualitative interviews with middle managers in pediatric and family practice clinics. We used constructs from the Consolidated Framework for Implementation Research (CFIR) to design the interview guide and as a coding framework. Participants (n = 19) reported overseeing implementation related to HPV vaccination. Across interviews, CFIR inner setting constructs (eg, structural characteristics and implementation climate) were identified as being both barriers and facilitators. As evidenced in this study, middle managers have a deep understanding of organizational factors, and they have the ability to facilitate implementation efforts related to HPV vaccination. Future efforts could focus on engaging middle managers and leveraging their expertise and understanding of barriers and facilitators.

A qualitative study of unpaid caregivers of persons living with dementia and their interactions with health and community-based services and providers.

BACKGROUND AND OBJECTIVES: Unpaid caregivers frequently feel underprepared and without adequate training, support, or access to services and resources to care for persons living with dementia. Health and community-based services and providers are critical to support persons living with dementia and their unpaid caregivers. The objective of this research is to understand how unpaid caregivers of persons living with dementia interact with health and community-based services and providers. RESEARCH DESIGN AND METHODS: We used a qualitative descriptive approach to analyze data from one-on-one semi-structured interviews with unpaid caregivers of persons living with dementia (N = 25). We used framework analysis to organize themes and sub-themes within the systems approach to healthcare delivery. FINDINGS: Participants described a need for additional guidance, information, and support from health and community-based services and providers. This need was described by participants at 4 levels: individual, care team, organization, and political and economic environment. Participants were active in proposing potential solutions to challenges at all 4 levels, including improving provider awareness and training in dementia, opportunities to provide resources and referrals upon dementia diagnosis, a central clearinghouse for information and resources for persons living with dementia and caregivers, and opportunities to close service gaps. DISCUSSION AND IMPLICATIONS: Findings of this study highlight the need for increased involvement of caregivers of persons living with dementia as community stakeholders for improving care and services. Recommendations to promote high quality care and better support unpaid caregivers by developing interventions to address multiple aspects of healthcare delivery are consistent with recent legislation and are important areas of future research.

A Qualitative Study of Factors Influencing Food Choices and Food Sources Among Adults Aged 50 Years and Older During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic affected food availability and accessibility for many older adults, especially those experiencing food insecurity. Food citizenship is a theoretical framework that encourages the use of alternate over industrial food sources and can characterize where foods are acquired and how food choices are made. OBJECTIVE: The purpose of this study is to explore how Iowans aged 50 years and older made choices about what foods to acquire and where to acquire foods during the coronavirus disease 2019 pandemic using food citizenship as a theoretical framework. DESIGN: We used in-depth interviews with Iowans aged 50 years and older (N = 60). PARTICIPANTS: We recruited respondents through Area Agencies on Aging, food banks, and food pantries. Individuals who contacted the research team, were aged 50 years and older, and spoke English were eligible. Half of the sample screened as food insecure. STATISTICAL ANALYSIS: We conducted a thematic analysis to identify recurring themes. RESULTS: Food costs, personal preferences, and the healthfulness of food were cited as the most influential factors. Respondents said that the pandemic had not changed how they make choices, but increased prices had made costs more salient. Respondents primarily got their food from industrial food retailers, government programs, or food pantries. More than half of the respondents also acquired food from an alternate food source, such as a farmers' market. Reasons for not using alternate food sources included cost and transportation barriers. CONCLUSIONS: It is essential to ensure that older adults have access to affordable, healthy foods, especially during crises such as the coronavirus disease 2019 pandemic. Alternate food sources provided supplementary, healthy food for many respondents, but there are opportunities to expand the use of these food sources. Incentivizing the use of alternate food sources through government programs and connecting the emergency food system to local producers could increase the consumption of healthy food.

Applying network analysis to assess the development and sustainability of multi-sector coalitions.

BACKGROUND: Accountable Communities of Health (ACH) models have been popularized through Center for Medicare and Medicaid Innovation (CMMI) grants, including the State Innovation Model (SIM), to encourage the development of community-based coalitions across medical, public health, and social service delivery systems. These models enhance care coordination for patients and are better equipped to address Social Determinants of Health (SDH) needs. METHODS: Network data was collected from participating organizations in seven ACH sites established across Iowa. The application of network analysis quantitatively characterized the relational context of the interorganizational, cross-sector networks which are foundational to achieving the ACH goal of systematic, comprehensive care. Our analysis primarily used logistic network regression modeling (LNRM) to identify network structures and characteristics of organizations that facilitate or impede sustainable connections. RESULTS: Our findings suggest that the ACH was effective at stimulating sustainable connections across sectors and disparate positions of centrality in the network. Factors associated with sustainable connections between organizations included the strength of relationships and the type of collaboration, namely data sharing and resource sharing. Leadership roles designated by the ACH structure were associated with stimulating connections during the grant, but not with sustainment. Network measures of density and transitivity, which peaked during the grant period (compared to pre- and post-grant networks), further implied possible attrition of the ACH intervention effects without incentive to maintain collaborations. CONCLUSIONS: Multi-sector care coordination networks were established, but our findings suggest depreciation of ACH intervention momentum and structure without incentive to maintain collaborations beyond the three-year duration of the grant. Sustainability could be bolstered and ACH goals actualized with reliable long-term funding.

Factors contributing to missed opportunities for human papillomavirus vaccination among adolescents, ages 11 to 13, in Iowa.

Introduction: Rates of human papillomavirus (HPV) vaccination remain low and missed opportunities for HPV vaccination are widespread. Researchers have identified factors related to HPV vaccination, but less is known about missed opportunities. Methods: We used medical claims data from a large Midwestern insurance provider to explore relationships between adolescent and provider characteristics and missed opportunities for HPV vaccination. We stratified models by initiation status with adolescents who had received one or more HPV vaccinations in one group (n = 6,123) and adolescents with no record of an HPV vaccination in the other (n = 8,107). Results: There were significant differences in comparisons of all variables between initiators and non-initiators. Notably, non-initiators had lower rates of vaccination for HPV and other adolescent vaccinations, and fewer well-child visits. For all adolescents, birth year, having other recommended vaccines, and number of well-child visits were significantly associated with missed opportunities. Additionally, among initiators, pediatrician as a primary care provider and being in a rural area were significantly associated. Discussion: Overall, adolescents with greater healthcare utilization had more missed opportunities, indicating that, despite increased numbers of visits, providers are not taking advantage of these opportunities to vaccinate. Future research should prioritize developing a deeper understanding of why these missed opportunities are occurring and implementing new and existing strategies to prevent them. Reducing missed opportunities will help to prevent future HPV-related cancers and the significant morbidity and mortality that they can cause.

The Use of Medical Claims Data for Identifying Missed Opportunities for HPV Immunization Among Privately Insured Adolescents in the State of Iowa.

BACKGROUND: Rates of adolescent human papillomavirus (HPV) vaccination remain low, despite decades of safety and effectiveness data. We sought to quantify the extent of missed opportunities (MOs) for HPV vaccination among adolescents ages 11 to 13 in Iowa and compare the number of these MOs by gender and rurality. METHODS: Medical claims data from a midwestern insurance provider were used to calculate total numbers of MOs for HPV vaccination for adolescents with continuous health insurance enrollment between ages 11 and 13 (n = 14,505). We divided MOs into several categories: total, among non-initiators, occurring before initiation, occurring after the first dose, and occurring between first and last dose. Finally, we used t-tests to perform subgroup comparisons (urban vs. rural; male vs. female). RESULTS: Over half of adolescents failed to initiate vaccination by age 13. The majority of MOs occurred prior to initiation. Urban adolescents had more MOs than rural counterparts and males tended to have more MOs than females. Females experienced significantly fewer overall MOs than males 5.98 (SD = 5.49) compared to 6.18 (SD = 6.04) for males. Additionally, among non-initiators, urban females had significantly more MOs overall (M = 7.13; SD = 6.41) compared to rural females (M = 6.58; SD = 5.51). CONCLUSIONS: Results highlight the extent of MOs that occur at the critical time period between ages 11 and 13. A lack of opportunity was not the barrier to HPV vaccination, particularly among both males and urban adolescents. It will be critical for providers to use known strategies to reduce MOs and utilize all adolescent visits to ensure vaccination is completed by age 13.

Cognitive factors influenced physical distancing adherence during the COVID-19 pandemic in a population-specific way.

Even early in the COVID-19 pandemic, adherence to physical distancing measures was variable, exposing some communities to elevated risk. While cognitive factors from the Health Belief Model (HBM) and resilience correlate with compliance with physical distancing, external conditions may preclude full compliance with physical distancing guidelines. Our objective was to identify HBM and resilience constructs that could be used to improve adherence to physical distancing even when full compliance is not possible. We examined adherence as expressed through 7-day non-work, non-household contact rates in two cohorts: 1) adults in households with children from Minnesota and Iowa; and 2) adults ≥50 years-old from Minnesota, one-third of whom had Parkinson's disease. We identified multiple cognitive factors associated with physical distancing adherence, specifically perceived severity, benefits, self-efficacy, and barriers. However, the magnitude, and occasionally the direction, of these associations was population-dependent. In Cohort 1, perceived self-efficacy for remaining 6-feet from others was associated with a 29% lower contact rate (RR 0.71; 95% CI 0.65, 0.77). This finding was consistent across all race/ethnicity and income groups we examined. The barriers to adherence of having a child in childcare and having financial concerns had the largest effects among individuals from marginalized racial and ethnic groups and high-income households. In Cohort 2, self-efficacy to quarantine/isolate was associated with a 23% decrease in contacts (RR 0.77; 95% CI 0.66, 0.89), but upon stratification by education level, the association was only present for those with at least a Bachelor's degree. Education also modified the effect of the barrier to adherence leaving home for work, increasing contacts among those with a Bachelor's degree and reducing contacts among those without. Our findings suggest that public health messaging tailored to the identified cognitive factors has the potential to improve physical distancing adherence, but population-specific needs must be considered to maximize effectiveness.

Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: "HPV Is Probably Not at the Top of Our List".

INTRODUCTION: The COVID-19 pandemic has prevented many adolescents from receiving their vaccines, including the human papillomavirus (HPV) vaccine, on time. However, little is known about the impact of the pandemic on implementation of clinic-level evidence-based interventions (EBIs) that help to improve HPV vaccine uptake. In this qualitative study, we explored the pandemic's impact on EBI implementation and HPV vaccine delivery. METHODS: During August-November 2020, we interviewed clinic managers in a rural, midwestern state about their experiences implementing EBIs for HPV vaccination during the COVID-19 pandemic. We used a multipronged sampling approach with both stratified and purposive sampling to recruit participants from Vaccines for Children clinics. We then conducted a thematic analysis of transcripts. RESULTS: In interviews (N = 18), 2 primary themes emerged: decreased opportunities for HPV vaccination and disruption to HPV-related implementation work. Most participants reported decreases in opportunities to vaccinate caused by structural changes in how they delivered care (eg, switched to telehealth visits) and patient fear of exposure to COVID-19. Disruptions to EBI implementation were primarily due to logistical challenges (eg, decreases in staffing) and shifting priorities. CONCLUSION: During the pandemic, clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations. To ensure these adolescents do not fall behind on this vaccine series, providers and researchers will need to recommit to EBI implementation and use existing strategies to promote vaccination. In the long term, improvements are needed to make EBI implementation more resilient to ensure that progress does not come to a halt in future pandemic events.

Interpersonal Correlates of Dementia Caregivers' Emotional Support Networks: Considering Family History.

Caregiving networks of individuals with Alzheimer's disease and related dementias (ADRD) are comprised of family and friends directly involved in caregiving activities and those supporting these activities. The purpose of this study was to investigate whether caregiving-related behaviors and interactions (i.e., uplift, malfeasance, and nonfeasance), kinship tie (i.e., friend, family), and family history of ADRD were associated with caregivers' emotional support networks. Seventy-one caregivers across 30 families provided information about 776 network members. Perceived emotional support and interactions representing uplift, malfeasance, and nonfeasance were assessed. Results indicated that uplift and friendship were associated with increased, whereas nonfeasance was associated with decreased, likelihood of perceived emotional support. Caregivers with a family history of ADRD were particularly more likely to report emotional support from friends and uplifting network members. Findings suggest the need for differential strategies based on families' prior caregiving experience to facilitate positive and minimize negative interactions within caregiving networks.

The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older.

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults' health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities.

Students' perceptions and attitudes about digital dental technology is associated with their intention to use it.

PURPOSE/OBJECTIVES: To investigate factors associated with predoctoral students' intention to use dental technology in future practice using the theory of planned behavior. METHODS: A comprehensive survey was developed consisting of 29 questions grouped in three main domains: knowledge, perception, and suggestions. After students had completed their digital dentistry didactic courses in 2019, the University of Iowa-College of Dentistry and Dental Clinics D2, D3, and D4 classes completed the survey. The D1 class was excluded because they had not finished their digital dentistry didactic courses. The survey data were tabulated for each class separately to compare trends among classes. Each response was analyzed individually before creating scores for the various subdomains. A linear regression analysis was used to create the final model for the outcome variable (intention to use technology). RESULTS: The response rate was 95% (n = 232). The mean age of participants was 25.7 years (SD = 2.7). There were significant differences between the classes in their knowledge (p < 0.0001), perceived quality of training (p < 0.0001), and all perceptions related to digital dentistry. Controlling for significant covariates among higher level students, there were significant associations between intention to use dental technology and greater knowledge scores (p = 0.05), attitude (p < 0.0001), subjective social norms (p = 0.02), and perceived control on the future use of technology (p < 0.0001). CONCLUSIONS: Students may be motivated to use digital technology when they have good knowledge, feel that others are using it or endorsing its use, and perceive that they have control in their future practice.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey.

PURPOSE/OBJECTIVES: To investigate dental students' perceptions and concerns regarding the COVID-19 pandemic, their coping strategies and support resources, and their perceived stress levels. METHODS: A customized 19-item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress RESULTS: A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID-19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went "smoothly with some troubles" for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID-19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores CONCLUSION: Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Social Interactions between Family and Community-Based Service Providers in Dementia Caregiving.

Objectives: This study aimed to evaluate the psychosocial experiences in community-based dementia caregiving by assessing the characteristics of social interactions between family caregivers and community-based service providers and associated psychological responses.Methods: Two independent groups of participants (family caregivers and community-based service providers) completed a one-time survey to report their social interactions and psychological states. A linear regression model was fit for each outcome (satisfaction, 10-item CES-D) while controlling for significant relevant covariates.Results: Higher perceived levels of collaboration were associated with higher job satisfaction and lower depression score among service providers, and higher satisfaction with providers among family caregivers. Higher perceived social support from the provider was associated with higher satisfaction among family caregivers.Conclusions: Participants reported varying levels of provider-family collaboration. The extent of collaborations and support exchange may have implications on the psychological well-being of those providing care to individuals with dementia including families and providers.Clinical implications: It may be beneficial to identify providers and families who perceive low levels of collaboration and implement intervention to facilitate positive social interactions. Developing organizational culture and payment systems that value high-quality social interactions may help enhance the psychological well-being of service providers and satisfaction among families who receive their services.