Perceptions of Acute Care Telemedicine Among Caregivers for Persons Living with Dementia: A Qualitative Study

Journal of Applied Gerontology, Ahead of Print.
Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers’ perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication and digital literacy challenges. People from racial/ethnic minority groups reported lower comfort with the virtual format. In both sites, participants expressed uncertainty about illness severity that could preclude using telemedicine for acute complaints. Overall, respondents deemed acute care telemedicine acceptable, but caregivers describe specific roles as crucial intermediaries to facilitate virtual care.

A Relative Normed Effect-Size Difference Index for Determining the Number of Common Factors in Exploratory Solutions

Educational and Psychological Measurement, Ahead of Print.
Descriptive fit indices that do not require a formal statistical basis and do not specifically depend on a given estimation criterion are useful as auxiliary devices for judging the appropriateness of unrestricted or exploratory factor analytical (UFA) solutions, when the problem is to decide the most appropriate number of common factors. While overall indices of this type are well known in UFA applications, especially those intended for item analysis, difference indices are much more scarce. Recently, Raykov and collaborators proposed a family of effect-size-type descriptive difference indices that are promising for UFA applications. As a starting point, we considered the simplest measure of this family, which (a) can be viewed as absolute and (b) from which only tentative cutoffs and reference values have been provided so far. In this situation, this article has three aims. The first is to propose a relative version of Raykov’s effect-size measure, intended to be used as a complement of the original measure, in which the increase in explained common variance is related to the overall prior estimated amount of common factor variance. The second is to establish reference values for both indices in item-analysis scenarios using simulation. And the third aim (instrumental) is to implement the proposal in both R language and a well-known non-commercial factor analysis program. The functioning and usefulness of the proposal is illustrated using an existing empirical dataset.