Abstract
Many evaluations of long-term services and supports (LTSS) have approached these programs as a “black box,” and it remains unclear how LTSS operate to benefit older clients. Utilizing an exploratory sequential design (qualàQUAN), this mixed methods study developed new measures to better capture the mechanisms of adult day service (ADS) use. The first phase was an ethnographic study of the process of ADS use. Items were extracted from the qualitative data generated to develop items. In the quantitative phase, the psychometric qualities of this newly developed measure were tested in a national sample of family members of ADS clients (N = 250) utilizing descriptive, bivariate, and exploratory and confirmatory factor analyses. The qualitative component yielded four domains of ADS use (the policy/environmental context of ADS; reasons why ADS was used; how ADS is used; and pathways to positive or negative outcomes for families and clients). Content validity was established with expert review, and face validity was enhanced following pilot testing with 27 family members. Goodness of fit indices and factor loadings generated from principal components and confirmatory factor analyses suggested the empirical integrity of the empirical measure. The study of complex phenomena in gerontology continues in methodological silos. Rigorously designed evaluations of LTSS or other interventions cannot best inform practice if it is not understood how and why such approaches do or do not benefit older adults or their families. Mixed methods are well-positioned to address this critical scientific and practice gap.