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Due to the descriptive approach of the quantitative analysis, we do not see the necessity of a comprehensive statistical validation process. However, for a further use of the questionnaires this is inevitable. All institutions providing low-threshold support services in the two project regions will be invited to participate in the survey. The next step will be to present the project at regional healthcare conferences, where usually all the institutions are represented.

Project region 1, the Heinsberg district, has a population , people living in ten communities and nine low-threshold support services, according to local descriptions. This region has a rural structure. Project region 2, the Ennepe-Ruhr-Kreis district, has about , people living in nine cities and the structure is more urban.


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According to a current list there are 33 low-threshold support services, of which 18 are care services exclusively for people with dementia or general services where people with dementia are included [ 7 ]. There are no official descriptions of the number service users. We will include services in rural and urban settings. We have contacts to gatekeepers in the two project regions who are involved into the regional policy of elderly care. We will call the institutional representatives in advance for having an approximately number of the different questionnaires and after a personal appointment we will provide them the questionnaires.

They will disseminate the questionnaires. With this procedure we expect a high response rate. The volunteers or the coordinators will give some background information regarding the study when handing out the questionnaires. The questionnaires will be accompanied by a prepaid self-addressed envelope which is expected to ensure a high response rate. Descriptive statistical analyses will be carried out to describe the frequencies of personal characteristics of the involved persons part A , structural data part B and evaluation part C.

Furthermore, data will be compared according to the questions: Which characteristics do users of low-threshold support services have and what kind of services do they use? How do institutions offering low-threshold support services differ and how is the general situation of these services? Do the evaluations of characteristics of low-threshold support services differ between the different perspectives? The qualitative data collection will be conducted after the survey.

In accordance with the research questions, two qualitative methods have been chosen group discussions, guided interviews. The group discussions will be carried out with people with dementia, family caregivers, volunteers and coordinators. In addition, guided expert interviews with institution representatives and guided interviews with people with dementia using home social care are planned. The aim is to get an in-depth insight into the subjective experience with low-threshold support. We want to know what people with dementia and family caregivers think about the services they use, what problems as well as positive aspects they see.

Furthermore, we want to find out how the providers institutional representatives, coordinators organize the services and how volunteers experience the care for people with dementia and low-threshold support services. Also, two different approaches of data analysis documentary method [ 35 ], coding according to the Grounded Theory [ 36 ] will be used.

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We want to contact the qualitative study population in two ways. Firstly, the introduction of the questionnaire contains an invitation to a group discussion. Secondly, we will address potential participants directly.


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The cooperating institution will be highly involved in this process. Therefore, good and intensive cooperation with the institutions and explicit information beforehand are necessary. We aim to conduct two group discussions per perspective coordinators, volunteers, people with dementia, family caregivers , about four expert interviews and four to five guided interviews with people with dementia. Furthermore, additional interviews with individual people from the group discussions are planned separately to focus on special themes. Family caregivers and people with dementia will be assessed as to whether they are afflicted by dementia or not by the coordinators or volunteers who know the people.

Therefore we will also include people without a medical diagnosis of dementia and their relatives. People with dementia who are not able to communicate anymore have to be excluded. The first group discussions focus on the perspective of coordinators of low-threshold support services, volunteers, family caregivers and people with dementia using group services. They are oriented on the model of collective framework of orientation [ 37 , 38 ].

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The aim is, therefore, to find out the opinion of the entire group; the discussion does not focus on single opinions. There will be two kinds of groups, one consists of people who know each other from former meetings in the same group but for another purpose volunteers, people with dementia and the second will be groups who do not necessarily know each other but who have common experiences family caregivers, coordinators [ 35 , 37 ]. A moderator will coordinate the discussion and an assistant will be present to write down important notes.

Both will also write postscripts after each discussion. The discussion will be led using a flexible guide. The topics are different for each different perspective. Themes for the coordinators are recognition, invoicing, instructions, supervision of volunteers and competences of coordinators. For the volunteers the topics are experience in caring, problems with job, family and voluntary engagement, attributes of volunteers, low-threshold care, reimbursement, burdening aspects.

The guide for the discussion with family caregivers includes relief through the service, problems during care, contact person, attributes of volunteers, motivation for using the service, availability of the service, organisation of the service, invoicing. Themes for the people with dementia are experience in the group, staff member, activities, knowing each other, drop-out of group members. The guides will be used flexibly and openly to ensure a smooth discussion between the participants.

All group discussions will be taped and transcribed literally. There are different steps described by Bohnsack [ 35 , 40 ]. The first is the formulating interpretation where the transcripts are divided into themes and subthemes. The reflecting interpretation is the second step. A reference frame will be created by contrasting and comparing cases. Afterwards case analysis will be conducted where the results of step one and two will be connected and imbedded into the context. The last step is the typification where the results will be put into contrast so that they oppose each other.

This process will be accompanied by memos.

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Memos are all notes taken during all phases of analysis passages in the text, codes, feelings and thoughts. They are used to get an analytical distance to the collected data but also to stimulate creativity [ 41 ]. The interviews will be guided expert interviews [ 42 ]. That means experts are people who have responsibility for concepts or implementations or who have access to information about people involved and about decision processes.

The authors differentiate expert knowledge into procedural knowledge, interpretative knowledge and contextual knowledge. In the organization part of this study the research interest is in that knowledge area. Therefore topics for the guidelines are: advantages and disadvantages of low-threshold support services relating to the organisation, authorization of services, benefits for users, barriers for service use, financing, invoicing, competences of coordinators, personal suitability of volunteers. The second kind of interview is the guided interviews [ 44 ] with people with dementia who use home social care.

The interview topics are: well-being, how the visits from volunteers are experienced, activities, determination of activities, fun, conversations, help provided by the volunteer, acceptance of the volunteer, relationship between the volunteer and the relative. It is also planned to interview more people from the group discussion in additional individual interviews. The interviews will be coded according to open and axial coding of the Grounded Theory. The Grounded Theory generates data of the natural setting and develops strategies for handling challenges [ 45 ].

Social processes and social structures from the perspective of the individual constitute the theoretical background [ 46 ]. This kind of coding seems adequate for the theoretical background. It is open and could produce new aspects from the transcripts. Within open coding, passages are separated and given a title [ 45 ]. In-vivo -codes are appropriate and keep the proximity to the data. Thus more abstract terms will be found and conceptualized. Afterwards the concept will be classified. Axial coding is used to find the connections between the categories and subcategories.

The recommendations are based on the combination of quantitative and qualitative results [ 47 ]. Data sets are analysed as described before within the single perspective and qualitative and quantitative results are compared. The results can be convergent, divergent or complementary [ 32 ]. We expect complementary results in such a way that the quantitative data can be enriched by the qualitative data.

GMS German Medical Science — an Interdisciplinary Journal

Therefore the general results of the survey can be explained in depth by the qualitative results. We also expect the qualitative results to identify interpretative frameworks and emphases. The next step will be the integration and comparison of the perspective with the focus on similarities and differences between the perspectives.

Then, we will develop recommendations on how low-threshold support services should be constructed and implemented in a region. The focus will be on the practical realisation of the services and will take the results into account. The finished recommendations will be presented at the healthcare conferences in the two project regions in order to get validation of the results and feed-back.

The ethical committee of the German Association of Nursing Science approved the study proposal and gave its clearing. IZA discuss paper no. Deutschen Wirtschaft Deutschland in Zahlen Assessing financial gaps in private German care provision. Ruhr Economic Paper Google Scholar. Muurinen JM The economics of informal care: labor market effects in the national hospice study. Pezzin LE, Schone BS Intergenerational household formation, female labor supply and informal caregiving: a bargaining approach.

Campus-Verlag, Frankfurt Google Scholar. Kohlhammer, Stuttgart Google Scholar. Z Soziol — Google Scholar. Soldo BJ, Hill MS Family structure and transfer measures in the health and retirement study: background and overview. Econometrica 65 3 : — CrossRef Google Scholar.

Stern S Estimating family long-term care decisions in the presence of endogenous child characteristics. Schmollers Jahrb 1 : — Google Scholar. Wooldridge JM Econometric analysis of cross section and panel data. Reinhold Schnabel Essen Germany. Personalised recommendations. Female cockroaches have dozens of offspring in a three-month reproductive cycle. Should amateurs play sports in a heatwave? Incidences of professional athletes collapsing while performing seem to have become all too common of late.

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