As you may recall, evidence-based practice relies on best available evidence, which is drawn from current research studies. But, just because a research study is published, it doesn

1

Quantitative Research Study Critique

Student Name

Walden University

SOCW 6301: Social Work Practice Research I

Instructor Name

Month XX, 202X

2

Quantitative Research Study Critique

Include an introductory paragraph that names the research study you are evaluating and

previews the structure and focus of your critique. Provide your overall assessment of the study in

a brief statement.

Title and Authors

In this section, evaluate the article title and the authors’ credibility. Do you think the title

adequately describe the study and its key elements? Who are the authors and have they conducted

and/or published previous research? Are they affiliated with a research institution or university?

Literature Review

Consider the following questions in your critique of the article’s literature review: To

what extent does the cited literature help you understand the problem? How does the literature

reviewed put the problem in context? Be specific. Do the authors indicate how their research is

different from and/or similar to earlier studies? Summarize what this article intends to add to the

knowledge base.

Strategy of Research

Address the following questions in your critique of the research strategy: What is the

strategy/aim of this quantitative study—is it descriptive, exploratory, or explanatory? Does this

strategy align with the research question?

Methodological Approach and Design

Consider the following questions in your critique of the methodological approach and

design: How does a quantitative approach (as opposed to a qualitative approach) correspond with

the research questions and/or hypotheses? Is the specific research design appropriate? To what

extent can the design answer the research questions or address the stated hypotheses?

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Threats to Internal Validity

Consider the following questions in your critique of the internal validity: What have the

authors done to address threats to internal validity? How does the presence or absence of

information about validity affect your confidence in the quality of the study?

Application to Practice

Connect the information from the article to social work practice and provide your

recommendations. Based on your critique of this study, is this social work intervention or

knowledge safe to integrate into your practice? Why or why not?

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References

(Include full references here for any sources that you have cited within the research study

critique. Note that the following references are intended as examples only.)

American Counseling Association. (n.d.). About us. https://www.counseling.org/about-us/about-

aca

Anderson, M. (2018). Getting consistent with consequences. Educational Leadership, 76(1), 26-

33.

Bach, D., & Blake, D. J. (2016). Frame or get framed: The critical role of issue framing in

nonmarket management. California Management Review, 58(3), 66-87.

https://doi.org/10.1525/cmr.2016.58.3.66

Burgess, R. (2019). Rethinking global health: Frameworks of Power. Routledge.

Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival

times of terminally ill patients. Health Psychology, 24(2), 225–229.

https://doi.org/10.1037/0278-6133.24.2.225

Johnson, P. (2003). Art: A new history. HarperCollins. https://doi.org/10.1037.0000136-000

Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure and serious illness at end of life:

A national study of children in the U.S. foster care system from 2005 to 2015. Journal of

Pain and Symptom Management, 56(3), 309–317.

https://doi.org/10.1016/j.jpainsymman.2018.06.001

Osman, M. A. (2016, December 15). 5 do’s and don’ts for staying motivated. Mayo Clinic.

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/5-dos-and-donts-for-

staying-motivated/art-20270835

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Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.).

Wiley.

Walden University Library. (n.d.). Anatomy of a research article [Video].

https://academicguides.waldenu.edu/library/instructionalmedia/tutorials#s-lg-box-

7955524

Walden University Writing Center. (n.d.). Writing literature reviews in your graduate

coursework [Webinar].

https://academicguides.waldenu.edu/writingcenter/webinars/graduate#s-lg-box-18447417

World Health Organization. (2018, March). Questions and answers on immunization and vaccine

safety. https://www.who.int/features/qa/84/en/

Behavioral Science Section: Research Article

Gerontology

Social Disconnection and Living Arrangements among Older Adults: The Singapore Chinese Health Study

Jon Barrenetxea

a Yi Yang

a An Pan

b Qiushi Feng

c Woon-Puay Koh

a, d

aHealth Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore; bDepartment of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; cDepartment of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore; dHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Received: October 26, 2020 Accepted: April 8, 2021 Published online: June 16, 2021

Correspondence to: Qiushi Feng, socfq @ nus.edu.sg

© 2021 The Author(s) Published by S. Karger AG, Basel

[email protected] www.karger.com/ger

DOI: 10.1159/000516626

Keywords Social isolation · Social networks · Population-based design · Community-dwelling older adult · Social support

Abstract Introduction: Although living alone is associated with social disconnection, older adults could be socially disconnected despite living with others. Understanding the factors associ- ated with social disconnection by living arrangement could help identify vulnerable older adults in the community. We examined the sociodemographic and health factors associ- ated with social disconnection among two groups of older adults: those living alone and those living with others. Meth- ods: We used data from 16,943 community-dwelling older adults from the third follow-up of the Singapore Chinese Health Study (mean age: 73 years, range: 61–96 years). We defined social disconnection as having no social participa- tion and scoring in the lowest decile on the Duke Social Sup- port Scale of perceived social support. We ran logistic regres- sion models to study the sociodemographic (age, gender, and education) and health (self-rated health, instrumental limitations, cognitive function, and depression) factors asso-

ciated with social disconnection, stratified by living arrange- ment. Results: About 6% of our participants were socially dis- connected. Although living alone was significantly associat- ed with social disconnection (OR 1.93, 95% CI: 1.58–2.35), 85.6% of socially disconnected older adults lived with others, most of them (92%) with family. Lower education level, cog- nitive impairment, fair/poor self-rated health, instrumental limitations, and depression were independently associated with social disconnection. Among those living alone, men were more likely to experience social disconnection than women (OR 2.18, 95% CI: 1.43–3.32). Discussion/Conclusion: Though living alone is associated with social disconnection, most socially disconnected individuals lived with family. Community interventions could focus on those in poor health despite living with family and older men living alone.

© 2021 The Author(s) Published by S. Karger AG, Basel

Introduction

Social disconnection is an umbrella term to describe the lack of social, emotional, and physical engagement with other people, which covers structural and functional

This is an Open Access article licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense), applicable to the online version of the article only. Usage and distribution for com- mercial purposes requires written permission.

Barrenetxea/Yang/Pan/Feng/KohGerontology2 DOI: 10.1159/000516626

measurements such as social isolation and loneliness [1]. While structural measurements of social disconnection capture objective metrics of an individual’s social life such as living arrangements or network size, functional mea- surements are often subjective evaluations on the quality and meaning of social relationships. Among older adults, social disconnection is associated with poorer cognitive function [2], dementia [3], depression [4], disability [5], and higher mortality risk [6]. The relevance of social dis- connection has been further reinforced with the ongoing COVID-19 pandemic, since social distancing measures have placed older adults at higher risk of losing social connections [7]. As the proportions of older adults in- crease worldwide and family sizes shrink, older adults could have fewer sources from which to draw social sup- port and therefore be more likely to experience social dis- connection in the future. Hence, identifying groups of older adults at risk of social disconnection is necessary for developing more effective interventions that fill the gaps of social support.

It is well established that older adults who live alone are at higher risk for social disconnection [8–10]. Living alone may prevent older adults from receiving immediate support, which could explain the associations between living alone and worse cognitive function [11], higher risk of unplanned hospitalizations [12], and higher mortality [13]. Consequently, interventions addressing social dis- connection often target solo-living individuals as a straightforward strategy to identify vulnerable older adults [14, 15]. While living alone is a plausible indicator to identify vulnerable people, older adults who live alone are highly heterogeneous. Although some adults living alone may be socially disconnected, others may live alone and still be socially engaged [16]. Conversely, older adults could be socially disconnected despite living with others [17]. In fact, some previous research has shown that old- er adults who live alone could be more socially active than those living with others [18, 19].

This divergence between social disconnection and liv- ing arrangements could have various underpinnings. First, according to the social selection theory, those with mental, cognitive, and physical limitations are restricted in their capacity to maintain social relationships [20–23], which could explain why older people in poor health can be socially disconnected despite living with others. In ad- dition, good health is often the precondition for older adults to live independently [24], making those living alone more likely to engage in social activities. Second, individuals could differ in social interactions regardless of living arrangements due to personality, coping mech-

anisms, and many other psychological propensities [16]. Cultural norms may also increase or decrease the risk of social disconnection for certain living arrangements. Among older adults living alone, the risk of social dis- connection could be lower in societies where freedom and privacy in old ages are appreciated. Conversely, in societies that promote strong family support and multi- generational coresidence, living alone could increase the risk of social disconnection because of the expected closeness and frequency of family interactions [25]. Giv- en the complex relationship between living arrange- ments and social disconnection, living alone may not be a robust indicator to identify older adults at risk of social disconnection. If community interventions do not un- couple social disconnection from living alone, the extent of social disconnection in the community could be un- derestimated. This could result in misallocation of re- sources because social disconnection is not properly characterized.

The relationship between social disconnection and liv- ing arrangements is particularly complex in Asia, where multigenerational coresidence is common. Although Western older adults tend to pursue independence in lat- er life, Asian older adults are bound to their adult children by cultural norms of filial piety that demand coresidence and strong family support [26]. Additionally, Western older adults rely more on state-sponsored welfare and so- cial support beyond family, whereas the support sources of Asian older adults are mostly restricted to close family members [27]. Thus, covariates of social disconnection may vary markedly with living arrangements in Asia. For example, it has been observed that older adults living alone tend to be functionally independent and have more diverse networks of support, while those living with fam- ily often have poorer health and less social ties beyond family [28, 29].

Moreover, as older adults are predominantly cared for by coresiding family members in Asia, older people living alone are often considered a disadvantaged group and thus the target of policy interventions. This leads to the problematic assumption that older people living with family are at comparatively less risk of social disconnec- tion. However, living with family may not necessarily translate into sufficient social engagement and meaning- ful interactions to avoid social disconnection. Social se- lection due to health problems could pose a higher risk of social disconnection among those living with others than among those living alone. Conversely, cultural factors promoting family coresidence as the normative living ar- rangement could place those living alone at higher risk of

Social Disconnection and Living Arrangements

3Gerontology DOI: 10.1159/000516626

social disconnection than those living with others. Hence, both older adults living with others and older adults living alone could experience social disconnection, albeit for different reasons. Therefore, in the cultural context of Asia, it is necessary to examine the factors associated with social disconnection by living arrangement.

Singapore is a city-state in Southeast Asia with shrink- ing household sizes and a rising proportion of older adults [30]. While recent trends show a steady increase in 1-per- son households and a growing preference for living inde- pendently in the community, only 9% of older adults live alone, indicating a strong sense of familialism in the soci- ety [31]. In the public policy, the government promotes family as the first line of support for older adults, followed by support from the wider community, such as friends, voluntary welfare organizations, and other social groups [32]. The majority of older adults live with a spouse and/ or children and draw support mainly from family. This is particularly the case for older adults with health problems [28]. As a result, older adults who live alone are consid- ered disadvantaged and thus become the primary recipi- ents for government assistance, which aims to cover the gap in family support with a wide range of services such as befriending activities, instrumental help, day care at senior activity centers, and subsidies for assistive devices to remain ambulant in the community [33].

Using a cohort of community-dwelling older adults in Singapore, we aimed to uncouple social disconnection from living arrangements by studying the factors associ- ated with social disconnection among older adults who live alone and older adults who live with others. We op- erationalized social disconnection as scoring in the lowest decile on the Duke Social Support Scale (DUSOCS) of perceived social support and having no social participa- tion in group activities outside the household. We first studied the factors associated with social disconnection in the overall sample. We then ran an interaction analysis to identify associations modified by living arrangement sta- tus. Finally, we stratified the analysis by living arrange- ments and studied the factors associated with social dis- connection among older adults living alone and older adults living with others. Given that most older adults in Singapore live in multigenerational households, we ex- pect living alone to be associated with social disconnec- tion because of cultural expectations for intergeneration- al coresidence. However, we also consider that older adults in poor health who live with family could be at risk of social disconnection because of their possible difficul- ties maintaining social relationships outside of the house- hold.

Materials and Methods

Study Participants The Singapore Chinese Health Study (SCHS) is a population-

based cohort of 63,275 Singaporean Chinese aged 45–74 years at the time of recruitment (1993–1998). It is an ongoing prospective cohort study designed to evaluate the genetic, dietary, and envi- ronmental determinants of chronic diseases in Chinese adults liv- ing in Singapore [34]. Participants were recruited from residents living in government-built housing estates, where 86% of Singa- poreans resided at that time. After the baseline interview, consent- ing participants were recontacted for the first follow-up (1999– 2004, N = 52,322), second follow-up (2006–2010, N = 39,528), and third follow-up (2014–2016, N = 17,107) interviews for updates on lifestyle factors and medical history. In addition, the third follow- up included measurements on aging outcomes such as cognitive function, instrumental limitations, depression, and social support. All participants gave written informed consent. This study was ap- proved by the Institutional Review Board of the National Univer- sity of Singapore (Approval No. NUS 2108).

In this study, we used data obtained from the third follow-up interviews, which were administered by trained interviewers in person for 17,107 surviving participants aged 61–96 years (mean age of 73 years) from 2014 to 2016. Women accounted for 59.2% of the sample, and only 36.4% of participants achieved secondary education. After excluding participants with missing values on the cognitive test (n = 55) and self-rated health (n = 2) and who were mute (n = 1), blind (n = 55), deaf (n = 48), or living in nursing homes (n = 3), this study included 16,943 participants (6,912 men and 10,031 women).

Assessment of Social Disconnection Most older adults in Singapore live and frequently interact with

family members. Hence, to operationalize social disconnection, we used measurements that emphasize quality of social interactions over quantity and considered gatherings beyond the family net- work. We therefore defined social disconnection as scoring in the lowest decile on the Duke Social Support Scale (DUSOCS) of per- ceived social support and having no social participation in group activities outside the household. Both conditions must be met to be considered socially disconnected.

The DUSOCS defined perceived social support as “having someone who is helpful, who will listen to you, or who will back you up when you are in trouble” and measures the amount of sup- port in 4 different levels: “none,” “some,” “a lot,” and “there is no such person.” The scale identified 6 sources of family support (partners, children/grandchildren, parents, siblings, other rela- tives, and relatives by marriage) and 4 sources of nonfamily sup- port (neighbors, coworkers, religious group members, and friends). The questionnaire also asked if there was a special supportive per- son, that is, a “particular person whom you trust and to whom you can go with personal difficulties.” The scores were then summated to compute the total social support score, which ranged from 0 (no support) to 100 (most support) [35].

Social participation was assessed with this question: “How many hours each week do you participate in any groups (≥3 peo- ple) such as a social or work group, church-connected group, self- help group, charity, public service, or community group?” Those with <1 h of social participation per week were considered as hav- ing “no social participation.”

Barrenetxea/Yang/Pa

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