As a continuation of """"""""Supporting Home Care via a Community Computer Network"""""""" (AG8617), the aim of this project is to determine how technologically delivered social services substitute for, augment, or increase formal service use by AD caregivers (n=98) and how caregivers' uses of a specific service, Computer Link, directly and indirectly contributed to behavioral (subsequent service use) and caregivers need (caregiving impact, depression, isolation) outcomes. This proposal is a revision of the first continuation proposal. The ComputerLink experiment was a randomized field evaluation of a specialized computer network that provided information, communication, and decision support to AD caregivers. To discover the relationship between ComputerLink use and formal service use, and to relate use to outcomes, we propose a secondary analysis of data obtained in the original experiment. These data include daily logs of each caregivers uses of ComputerLink (n=606 days), records of each caregivers' ComputerLink access behavior (47 subjects; 4364 accesses), and transcripts of the public communications (n=749) posted in ComputerLinks open electronic bulletin board. The theoretical model guiding this exploration is an amalgam of the Andersen Framework of Service Use; graphical analyses, descriptive statistics, correlational matrices and ordinary least squares regression or logistic regression models will serve as the major methods. Because ComputerLink both provided direct service to caregivers, and served as a vehicle for caregivers to learn of other service, it is equally likely that caregivers who used ComputerLink may use more or less formal services than did other caregivers who did not have access to it. We propose to secondary analysis of the monthly service utilization logs (n=98 caregivers; 47 with access to ComputerLink and 51 comparison subjects) to discover how formal service use patterns vary depending on whether and how often subjects used ComputerLink, characteristics of their pattern of use (e.g. read only; post messages, look up information, etc), and the topical discussions from ComputerLink bulletin boards. This project offers two major contributions to the research on service use and caregivers: (1) the data upon which the exploration is planned resulted from a randomized trial, therefore a strong test of the impact of selected service use on outcomes can be made and (2) it evaluates a novel service in the context of all services used by caregivers. This project will contribute to an overall process of technology transfer, the goal of which is to determine where novel support services, like ComputerLink, can best improve the quality of home care while reducing its financial, emotional, and physical health costs to the patient and those providing the care.
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