Cleaning Study Data and Descriptive Analysis
Introduction
This chapter outlines the data analysis and findings from the 76 Family Involvement Questionnaire-Long Term Care (FIQ-LTC) and World Health Organization Quality of Life- Bref (WHOQOL-BREF) questionnaires completed by the eligible respondents. A combination of descriptive analysis correlation analysis and regression analysis were used to determine whether the relationship between the quality of life of elders in nursing homes and family involvement in their care. Two research questions were addressed: 1) what the family member’s role or function in the care of their elder in the nursing home, and 2) how does the quality of life of the elderly change with the involvement of the family in their caregiving. The research findings were interpreted by assessing the correlation coefficient, r to assess the strength of association between the family involvement score and the elder’s quality of life, and the statistical significance of the association assessed with the p-value for rejecting the null hypothesis at the 0.05 level of significance. In addition, regression analysis was used to assess the prediction of the elder’s quality of life score based on the family involvement score and the demographic variables, and the regression coefficients, standard errors, and variance explained (R2) reported.
Instrumentation
The Elder QoL survey consisted of four domains: physical, psychological, social relations and environment. The scores on the domains related to the physical health, psychological health, social relations and environment for the participants. The instrument has 26 items (WHO, 2017), touching on the four domains of health, and prior studies have demonstrated satisfactory reliability and validity scores (Najafi et al., 2011; Izutsu et al., 2005). Najafi et al. (2009) reported a high reliability for the instrument with a Cronbach’s α of 0.701, while Krageloh et al., (2011) reported the reliability of 0.89. Using the test-retest reliability, Izutsu et al. (2005) reported satisfactory results for the instrument. Generally, the instrument has been acknowledged as a critical tool in the evaluation of healthcare that explores an individual’s perception of their position in the context of the culture and value system (Vahedi, 2010).
The FIQ-LTC was also adopted to measure family involvement in the care of their elderly relative. The instrument was used based on the findings of the study by Fast (2017) which found the instrument to be highly reliable (Cronbach’s α = .965) and a high validity score based on an expert panel review (Fast, 2017). The tool is composed of 40 items, which are scored on a four-point Likert scale with the overall summative score describing the nature of family involvement.
Sample
A sample of 76 elderly people in long-term care facilities and one of their family members involved in their care was drawn. The inclusion criteria for the study was that one had to participate in the study was that the elderly people had to be mentally and physically capable, aged 60 years and above, in a long-term care facility, and had a family member willing to take part in the study. The elderly subjects with mental and physical disabilities were excluded from taking part in the study. The total number of participants who took part in the study was 76 pairs of elderly people and family members. This was representative of the target sample required to maintain a statistical power of 80% based on the family members’ involvement score and their related elder’s quality of life score.
The attrition rate in the present study was 60% and was associated with various participant characteristics and high baseline symptom burden. Some of the most common reasons were the deterioration of the participant’s mental or physical health, given that most of the patients were sick at the time of the study, hospital admission, disease progression among other factors.
Out of the 76 participants who took part in the study, a majority were females (80.3%), and the males consisted of just below a fifth of the total participants. Their ages ranged from 68 years to 104 years, with the average age of 84.31 (±9.78) years. The participants’ demographics revealed that most of the elderly people living in the long-term care facilities were either widowed (46%), single (26%), or married (19%). Those living as married or separated were very few (3.8% each). Most of the participants did not have any educational background (34.2%). However, about 26 percent indicated that they had the university education. About 84.2 percent of the elderly people reported of being currently ill. Table 1 below gives a detailed overview of the participants’ descriptive demographics.
Table 1
Descriptive demographics
| Elder n (%) | ||
| Gender | Males | 15 (19.7) |
| Females | 61 (80.3) | |
| Marital Status | Single | 20 (26.3) |
| Separated | 3 (3.8) | |
| Married | 15 (19.7) | |
| Living as married | 3 (3.8) | |
| Widowed | 35 (46.1) | |
| Education | None | 26 (34.2) |
| Primary | 15 (19.7) | |
| Secondary | 15 (19.7) | |
| University | 20 (26.3) | |
| Participant currently ill | Yes | 64 (84.2) |
| No | 12 (15.7) | |
Descriptive Analysis
The data collected through the questionnaires were entered into SPSS for cleaning and analysis. The cleaning involved consistency checks and treatment of missing values. The consistency checks involved checking for data that was out of the range, or logically inconsistent data, or data with extreme values. The missing responses were treated carefully to reduce the adverse effects by assigning a value 99 to avoid problems that might emerge if their proportion is significant. The appropriate values were coded for the responses in each questionnaire item to give meaning to the responses.
Elderly People’s Quality of Life
The quality of life variable was a major variable used to address the research questions. The variable was measured by the WHOQOL-BREF instrument, where various combinations of the 26 items of the instrument touched on the domains related to the physical health, psychological health, social relations and environment for the participants. The scores for the physical health, psychological health, social relations and environment for the participants were computed using the equations provided by the WHOQOL-BREF instrument. The instrument has five-Likert style response scales ranging from: “very poor” to “very good”, “very satisfied” to “very dissatisfied”, “none” to “extremely” “none” to “complete”, and “never” to “always” (Silva et al., 2014). Therefore, each of the four domains is based on the items for which items vary from 1 to 5.
The mean score for each domain shown in Table 2 below is an indication of an individual’s perception of their satisfaction with each of the four domains of their life relating it with the quality of life (Silva et al., 2014). In this case, higher scores indicated a better-perceived quality of life, while lower scores indicated a lower perceived quality of life. The present study indicates that the social relations’ domain had the highest mean score, averaging 47.07 with a standard deviation of 0.80, while their psychological health domain had the least score, averaging 21.11 with a standard deviation of 3.01. The mean score for the elderly people’s quality of life score was 29.72, with a standard deviation of 2.30. Therefore, elderly people have better social relations and environment.
Table 2
Mean, Median, and Standard Deviations for the Four Health domains of the Participants
| Physical Health | Psychological Health | Social Relations | Environment | ||
| Mean | 22.42 | 21.11 | 47.07 | 28.27 | |
| Median | 22.00 | 20.50 | 47.00 | 28.00 | |
| Range | 19.00 | 11.00 | 2.00 | 14.00 | |
| Std. Deviation | 4.78 | 3.01 | 0.80 | 4.12 | |
Family Involvement
The variable of family involvement in the caregiving of the elderly people in the nursing homes was assessed using the Family Involvement Questionnaire in Long-Term Care (FIQ-LTC). The instrument used a 4-point Likert scale ranging from 1 for “never” to 4 for “Often” to collect responses for the 40 questions in the instrument. The questions related to visits, direct care, emotional support, and financial support combined to give the corresponding scores for the variables, whose average gave the overall score for family involvement.
The mean score for each domain shown in Table 3 below is an indication of an individual’s perception of their satisfaction with each of the four domains related to their involvement in the elderly person’s care (Fast, 2017). In this case, higher scores indicated better-perceived family involvement, while lower scores indicated lower perceived family involvement. The present study indicates that the emotional support domain had the highest mean score, averaging 58.31 with a standard deviation of 16.63, while their financial support domain had the least score, averaging 5.42 with a standard deviation of 1.45. The mean family involvement score for the sample family involved in the caregiving for the elderly people was 28.20, with a standard deviation of 7.64. Therefore, families provide more emotional support and direct care to their elderly relatives.
Table 3
Mean, Median, and Standard Deviations for the Family Involvement
| Visits | Direct Care | Emotional Support | Financial Support | ||
| Mean | 20.23 | 28.84 | 58.31 | 5.42 | |
| Median | 21.00 | 31.00 | 62.50 | 5.00 | |
| Range | 22.00 | 27.00 | 57.00 | 6.00 | |
| Std. Deviation | 6.20 | 7.55 | 16.63 | 1.45 | |
Research Findings
Quantitative Research
Quantitative analysis techniques were used to address the research questions. Pearson’s product moment correlation coefficient (Pearson correlation coefficient) was used to determine the strength of association between the elderly people’s quality of life and their family involvement in their care. Adherence to parametric assumptions for Pearson’s correlation was tested to meet the five necessary assumptions, which include the dependent variable is interval or ratio, and is normally distributed, there is a linear relationship between the two variables, there are no significant outliers, and homoscedasticity exists (Laerd Statistics, n.d.).
The dependent variable, the elderly people’s quality of life is an interval, measured on a scale of 0 to 100. To test whether a linear relationship between the quality of life variable and the family involvement variable, a scatterplot was created using SPSS v. 24 before visually inspecting the scatterplot to check for linearity. The scatterplot in Figure 1 below shows that a linear relationship is possible between the two variables.
Figure 1: Scatterplot of Quality of life and Family Involvement
To test whether the data is normally distributed, the Shapiro-Wilk test, which is mostly preferred by researchers handling small samples of less than 50 participants, was used. Given that the p-value is 0.19 for Quality of life and 0.053 for Family involvement, we can conclude that the assumption of normality has been met for the sample. This is further demonstrated by the normal Q-Q plots in Figure 2 and 3 below.
Figure 2: Normal Q-Q plot for Quality of Life Variable
Figure 3: Normal Q-Q plot for Family Involvement Variable
Research Question 1: What is the family member’s role or function in the care of their elder in the nursing home?
To address the first research question exploring the role of the family member in the care of their elderly person in the nursing home, a linear regression analysis was conducted with the raw scores of the various family involvement roles. The dependent variable was the quality of life, while the independent variables were visiting, providing direct care, providing emotional, support, and providing financial support. The Pearson’s correlation analysis indicated that the four roles of family involvement were strongly associated with the elderly person’s quality of life. Table 4 below summarizes the correlation analysis.
Table 4
Pearson’s Correlation Coefficients
| Visiting | Direct care | Providing emotional support | Providing financial support | |
| Pearson’s Correlation | 0.920 | 0.985 | 0.989 | 0.676 |
| P-value | < .05 | < .05 | < .05 | < .05 |
The findings of the multiple regression analysis indicated that the four roles predicted 100 percent of the variation in the quality of life experienced by the elderly people in long-term care facilities (R2 = 1.00, F(4, 21) = 0, p < 0.05). It was established that visiting significantly predicted the elderly person’s quality of life (β = 0.25, p < 0.05), and so did providing direct care (β = 0.25, p < 0.05), providing emotional support (β = 0.25, p < 0.05), and providing financial support (β = 0.25, p < 0.05).
Research question 2: How does the quality of life of the elderly change with the involvement of the family in their caregiving?
To determine how the quality of life of an elderly person changes with the involvement of the family in their caregiving, a regression analysis was conducted. The dependent variable was the elderly person’s quality of life, while the independent variable was the family involvement score, which was the average of the four roles of family involvement, namely visiting, direct care, emotional support and financial support. The Pearson’s correlation coefficient indicated a strong statistically significant positive association between the average score of the family involvement roles and the elderly person’s quality of life, r = 1.00, p < 0.05. The regression analysis findings indicated that family involvement singly explained 100 percent of the variance in the quality of life among the elderly community living in long-term care facilities (R2 = 1.00, F(1, 24) = 0, p < 0.05). It was established that family involvement significantly predicted the elderly person’s quality of life (β = 1.00, p < 0.05).
Summary
This chapter discussed the data analysis and interpretation of the data with reference to the study objectives. The study had sought to determine the relationship between the quality of life of the elderly people in long-term facilities, and the involvement of their families. The specific research questions had sought to determine what the family member’s role or function in the care of their elder in the nursing home is, and how does the quality of life of the elderly change with the involvement of the family in their caregiving. The findings herein indicate that the role of family members in the care of their elderly person in a nursing home included visiting, providing them with direct care, emotional support and financial support. Further the results indicate that an increase in the family member’s involvement in the care of their elderly person in a long-term care facility increases the elderly person’s quality of life significantly. The findings provided strong evidence that exhaustively the research questions. The next chapter discusses the implications of the study findings, discusses its limitations and also suggests recommendations for future research.
References
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Silva, P. A. B., Soares, S. M., Santos, J. F. G., & Silva, L. B. (2014). Cut-off point for WHOQOL-bref as a measure of quality of life of older adults. Revista de Saude Publica, 48(3), 390-397.
Vahedi, S. (2010). World Health Organization Quality-of-Life Scale (WHOQOL-BREF): Analyses of their item response theory properties based on the graded responses model. Iranian journal of psychiatry, 5(4), 140 – 153.
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