Protocol for a Mixed-Methods Study to Understand Disparities and Identify Intervention Targets for Older Adults With Dementia Who Use Languages Other than English (ImPaCT Dementia)
Bibliographic Data
Older adults with Alzheimer’s Disease and related dementias (ADRD) and individuals who use languages other than English (LOE) represent rapidly growing populations in the United States. For those with ADRD who use LOE for healthcare, the intersection of cognitive impairment and language barriers creates communication and care challenges, placing this population at increased risk of poorer outcomes. Palliative care, with its focus on communication, support, and aligning care with patient values, may be particularly advantageous in addressing disparities. Yet, older adults with ADRD who use LOE continue to face barriers to accessing and benefiting from palliative care across multiple socioecological levels, including individual, clinical encounter, healthcare system, community, and societal/policy. Research is needed to better elucidate multi-level barriers and facilitators that will inform the development of effective culturally and linguistically responsive interventions. This protocol describes a mixed-methods study that integrates quantitative analyses of electronic health record data with qualitative data from interviews with Chinese, Spanish, and Vietnamese-speaking older adults with ADRD who use LOE and family members, healthcare professionals, and community-based organization staff. Guided by the socioecological model and a health disparities research framework, this study incorporates several methodological innovations: multilingual qualitative data collection, community-engaged research through language-specific workgroups, multi-stakeholder sampling to enable triangulation across perspectives, iterative co-design of study instruments, rigorous qualitative coding with structured reconciliation and community validation, and the use of a natural language processing algorithm to analyze electronic health record data. Convergent-parallel mixed-methods analyses will integrate quantitative and qualitative findings to identify and prioritize multi-level intervention targets. This study advances methods for multilingual, community-engaged, and intervention-focused research in historically marginalized populations. Findings will inform tailored palliative care interventions aimed at improving communication, reducing disparities, and enhancing quality of life for older adults with ADRD who use LOE and their family members.
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