PHE 327 Module 5 Project One Example

Project One: Hearing From Winter. A Plan to Assess Isolation Among Older Adults in an Upper Peninsula County

[Student Name]

Southern New Hampshire University

PHE 327: Research and Assessment in Public Health

Project One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project One: Hearing From Winter. A Plan to Assess Isolation Among Older Adults in an Upper Peninsula County

The county's area agency on aging believes many older adults spend the winter largely alone, but no one knows how many, who they are or what would help. This plan describes an assessment to find out. It draws together the work of the first four modules into a single design that the county health department, the area agency on aging and their partners can carry out between November and May. Each section explains a design choice and the reason for it.

Question and Partnership

The assessment asks: among county residents aged 65 and over, how common are loneliness and long periods without leaving home during winter, who is most affected, what needs result and what assets and services already reach them? An advisory group of six older residents, two from each of the county's three largest towns and one from a remote township, will review the survey, help interpret results and choose priorities. Israel et al. (1998) describe partnership with community members as a way to make research more relevant and its findings more likely to be used, and the advisory group gives older residents a real voice rather than a token seat.

Indicators and Data

Eight indicators will be used. Census data supply the size of the older population, the share living alone and the share with low income. Hospital records add cold-season emergency visits by seniors after falls or exposure to cold. Agency records supply the number receiving home-delivered meals or wellness calls and unmet volunteer driver requests. The new survey supplies loneliness and days without leaving home. An asset inventory, built with partners, will list congregations, clubs, businesses and services that support older residents in winter, following the asset approach of Kretzmann and McKnight (1993).

Survey Instrument

The two-page, large-print survey uses the three-item loneliness scale of Hughes et al. (2004), standard questions on health and living arrangement and four pretested new items on winter confinement, missed appointments, heating hardship and daily check-ins, plus an open question about what would help. A cover letter from the agency director explains the purpose and promises confidentiality.

Sample and Data Collection

From the merged property and voter files, 1,200 households containing someone aged 65 or over will be picked at random. Following the multiple-contact approach of Dillman et al. (2014), each household will receive a notice letter, the survey with a stamped return envelope and a meal pass, a reminder card a week later and a replacement survey two weeks after that. A phone number will let people answer with a trained senior center volunteer. Apart from that sample, meal delivery staff and a pair of rural carriers will invite older people living by themselves to answer a brief form, with consent; these responses will be analyzed separately because they are not a random sample. The target is a response rate of at least 40%, which would yield about 480 completed surveys.

Analysis Plan

The analysis will report the share of respondents who are lonely, defined as a score of six or more on the three-item scale, and the share who spent seven or more days without leaving home, each with a 95% confidence interval. Weights will bring respondents into line with census counts by age group, sex and household type. A chi-square test will compare loneliness for people in one-person households against everyone else, and between towns and remote townships. Open answers will be grouped into themes. The asset inventory will be summarized by type and by area. Agency and hospital data will be presented alongside survey results. With about 480 responses, a percentage near 30% will have a margin of error of roughly four percentage points.

Ethics and Protections

Participation is voluntary, and no identifying information will be kept with survey answers. Returned surveys will be stored in a locked cabinet and entered without names. Because the survey may identify someone in danger, the cover letter will list a phone number for immediate help, and volunteers taking phone responses will be trained to refer anyone who reports an emergency, with the person's consent. Before any form is mailed, the department's ethics officer will sign off on the plan.

How Results Will Be Used

An assessment that ends in a report on a shelf has failed. Before data collection begins, the partners will agree on how results will be used. The advisory group and partners will meet in June to review findings and choose no more than three priorities, using simple criteria: how many people are affected, how serious the effects are, whether the county has assets to build on and whether a partner is willing to lead. The agency's next annual plan, due in September, will cite the assessment, and the health department will include the priorities in its community health improvement plan. Results will be shared back with respondents through a one-page summary mailed with the agency's newsletter and posted at the senior center, so that people who took time to answer can see what came of it. Committing to these uses in advance also makes it easier to keep the survey short, because every question can be tested against whether its answer would change a decision.

Timeline and Budget

Weeks one to four: finalize the advisory group, survey and lists. Weeks five to twelve: mail contacts and phone responses. Weeks nine to sixteen: driver and carrier route. Weeks seventeen to twenty: data entry and analysis. Weeks twenty-one to twenty-four: advisory group review and report. Table 1 shows the budget.

Table 1. Assessment Budget

Note. Staff time from the health department and agency is contributed in kind.

Limitations

The sampling frame omits some renters, results reflect one winter and the most isolated residents will still respond less than others, even with a second route. The driver and carrier responses cannot be generalized. These limits will be stated in the report so readers interpret the findings correctly.

Conclusion

The plan answers a defined question with a modest budget, tested instruments, a sample designed to reach isolated people and a partnership that gives older residents a voice. Project Two will report what it finds.

References

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed.). Wiley.

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community's assets. ACTA Publications.