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Appalachian Caregivers of Persons with Dementia Nonuse of Services Kristina M. Childers Background: Despite evidence indicating that supportive resources can improve the experience of caregivers (CG) and care recipients (CR), many underutilize available services or do not use services at all. Understanding the factors associated with service use, and barriers to using available resources is important for health care providers to improve caregiver and care recipient outcomes. To comprehensively address CG needs for support services, the factors that impact non-use of services must be identified in Appalachia. The purpose of this current study was to explain factors most strongly associated with caregivers’ non-use of formal and informal services in Appalachia. Methods: A correlational explanatory design using validated self-report surveys was used to explain the association of selected factors with Appalachian caregiver’s non-use of formal and informal services. The design followed a substruction of Andersen’s Behavioral Model for Health Services Research. The purposive sample of family caregiver/person with dementia (PWD) dyads was recruited from the Appalachian region, primarily West Virginia, via caregiver support groups, geriatric clinics, primary care clinics, contact lists from geriatric associations, county agencies on aging, home health agencies, and senior centers within Appalachia. Data were collected via an in-person or mailed survey that participants completed in writing. Data were analyzed using descriptive statistics and ANOVA tests, calculating for medium effect size, considering two to four independent variables (eight in total) from the Andersen model entered into each research question, using a sample of 43 CG/CR dyads. Results: The results of the analyses were used to answer the four research questions: 1) What estimate of the variance in the non-use of services in Appalachia can be explained by predisposing characteristics of demographic variables, social variables, and (health and service) belief variables? Data support that the Social Provisions Scale (SPS) explained 8.3% of variance in the dependent variable Non-Use of Services (R Square 0.107 10.7%; Adjusted R Square 0.83 8.3%). 2) What estimate of the variance in the non-use of services in Appalachia can be explained by enabling factors of financial and organizational resource variables? Data support that Caregiving Service Availability explained 11.7% of the variance for Non-Use of Services (R Square 0.14 14.1%; Adjusted R Square 0.117 11.7%). 3) What estimate of the variance in the non-use of services in Appalachia can be explained by the need factors, both perceived and evaluated needs variables? Evaluated Need, a calculated variable that included having a primary care provider, the health care provider recommending services for the person with dementia (PWD), added to Paid and Volunteer hours of help received per week, explained 7.9% of the variance for Non-Use of Services (R Square 0.102 10.2%; Adjusted R Square 0.079 7.9%). 4) What combination of predisposing, enabling, and need factors constitutes the strongest explanatory or associative model of non-use of services? The Non-use of services final regression analysis entering the three significant variables of the Social Provisions Scale, Caregiving Service Availability, and Evaluated Need explained 40% of non-use of services. A theory-based forced-entry logistic regression on a dichotomous variable, User/Non-User of services, found the same variables significant. Linear Regression provided more explanatory strength. Implications: In order to reduce non-use of services, more caregiving support services need to be available for CGs of PWD, and health care providers’ recommendation of the use of support services would be helpful for CGs of PWD. APPCGNONUSESERVICES iv

Appalachian Caregivers of Persons with Dementia Non Use of Services