A Mixed Methods Study of Older Adults in a Lifestyle Redesign® Program

Background: Two randomized controlled trials, the USC Well Elderly 1 Study (WE1) and USC Well Elderly 2 Study (WE2), established the efficacy, effectiveness, and cost-effectiveness of an occupational therapy intervention called Lifestyle Redesign® (LRD) in reducing age-related declines and promoting health and well-being in community-dwelling older adults1,2. In addition, a conceptual model was tested in WE2, depicting hypothesized relationships between LRD and well-being outcomes, as mediated through several key variables3. Purpose: The purpose of this study was to examine how a subset of participants from the WE2 sample viewed the impact of the LRD intervention and the relationships between several study constructs4. A second objective was to confirm the WE2 findings at the level of participants’ perceptions, and reveal additional constructs and relationships not hypothesized in WE2. Methods: Quantitative methods were used to generate a sample comprised of 22 WE2 participants, based on the principle of maximum variation. Qualitative data including semi-structured interviews and fieldnotes were collected and analyzed using modified analytic induction. These data were condensed into case summaries of the 22 participants, showing how each participant construed the effects of LRD, and illustrating his or her individual perspectives on the relationships between the study constructs. Findings were compared to WE2 intent-to-treat findings regarding the impact of LRD, and preliminary structural equation modeling findings regarding the mechanisms through which this occurred. Results: Participants perceived that the intervention positively impacted some of the mediators hypothesized in WE2, including occupation and healthy activity, social support/social networks, perceived control, and stress. Some participants indicated that positive changes in these mediating constructs led to improvements in the hypothesized outcomes (perceived physical health, psychosocial well-being, and cognitive functioning). Finally, several themes emerged, some of which suggest areas of intervention impact that had not been anticipated in WE2 (e.g., death/dying, transportation, “slipping,” risk, and fear of relocation to a nursing home). Conclusions: The findings add depth to current understandings of the centrality of healthy activity in elders’ lives, the complexity of the relationships between health indicators and psychosocial constructs, and the pathways through which older adults perceive their health and well-being are impacted. These findings can inform the development of future interventions for elders. Future research is needed to more deeply explore some of the emergent themes. Discussion Questions: I would like to involve the audience in a lively discussion about the following questions, or any others that the audience finds compelling: What are some of the potential contributions of using mixed-methods in intervention research? What are the implications for the varied ways that healthy activity is linked to the other study constructs? How can we as occupational scientists learn from and further explore the unanticipated themes that emerged from the qualitative data collected