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Advancing the Big Five of User-Oriented Elderly Care and Accounting for its Variations
University of Skövde, School of Health and Education. University of Skövde, Health and Education. (Socialpsykologi)ORCID iD: 0000-0003-0629-353X
University of Skövde, School of Health and Education. University of Skövde, Health and Education. (Socialpsykologi)ORCID iD: 0000-0001-7164-0433
2016 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 2, 162-176 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – Care process quality (i.e., how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The present research aims at describing the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

Design – Two municipalities were selected for in-depth field studies. First, in each municipality, we interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, we conducted interviews with care workers and care unit managers (Study 2).

Findings – A new taxonomy for categorising process quality variation, the Big Five of user-oriented care (Task-focus, Person-focus, Affect, Cooperation, and Time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality-level).

Value – The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Keywords elderly care, quality, satisfaction, person-centered care, individualised care, user-oriented care

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2016. Vol. 29, no 2, 162-176 p.
National Category
Social Work
Research subject
Humanities and Social sciences
URN: urn:nbn:se:his:diva-11678DOI: 10.1108/IJHCQA-03-2015-0040PubMedID: 26959896ScopusID: 2-s2.0-84960449710OAI: oai:DiVA.org:his-11678DiVA: diva2:869045
Available from: 2015-11-12 Created: 2015-11-12 Last updated: 2016-12-02Bibliographically approved
In thesis
1. An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
Open this publication in new window or tab >>An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The foundation for this thesis is an ongoing discussion about quality in Swedish elderly care: Which are the most important factors that contribute to elderly care in terms of satisfaction among older persons, and what are the primary reasons for their differences?

Aims. The principal aim was to examine what determines satisfaction with elderly care in home care and nursing homes, using the perspective of older persons (Studies I and II). The secondary aim was to analyze why these determinants differ, using the perspective of care workers, managers, and observers (Studies III and IV).

Methods. Study I analyzed aggregated statistical data from the level of municipalities and districts (N = 324) based on the Swedish elderly care quality reports “Open Comparisons”, while Study II analyzed individual data based on the original ratings in the annual, nationwide elderly surveys (N = 95,000). Study III describes field observations and interviews with care workers and managers in two municipalities, one with a high rating for user satisfaction and one with an average rating. Study IV describes investigations in these two municipalities concerning their organizing principles and departmental‑level management climate.

Results. The results relating to the principal aim showed that process factors (such as respect, information, and influence) are related considerably more closely than structural factors (such as budget, staffing levels, and training levels) to satisfaction with care. Other process factors (such as treatment, safeness, staff and time availability) were also able to alleviate person factors (such as health, anxiety, and loneliness). Moreover, the results relating to the secondary aim showed that differences in user-oriented elderly care are mainly due to interpersonal factors between the caregiver and the older person. Care workers, however, reported that other factors (such as organizing principles and leadership support) influence the quality of the care process. Overall, older persons who receive home care generally report higher satisfaction with care than those in nursing homes, and feeling less safe. It may be that differences in the process of aging explain this.

Value. This thesis shows that satisfaction with elderly care can be largely explained by psychological quality at the individual level. The sizes of structural resources and organizing principles at the municipal level have minimal effect (< 5%). The thesis also presents a theoretical multiple-level Quality Agents Model to explain the sources of differences in satisfaction with care, and it presents recommendations for elderly care practices. A renewed focus on the psychology of satisfaction may contribute to the development of quality in elderly care.  

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2015. 77 p.
, Doktorsavhandlingar vid Göteborgs universitet, ISSN 1101-718X
National Category
Psychology (excluding Applied Psychology)
urn:nbn:se:his:diva-11684 (URN)978-91-982353-9-5 (ISBN)
Public defence
2015-12-11, F1, Haraldsgatan 1, Göteborg, 18:21
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1200
Available from: 2015-11-23 Created: 2015-11-12 Last updated: 2016-12-15Bibliographically approved

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