Gaining entrance

One of the first and most crucial steps in conducting an intervention or training program is gaining entrance to the communities in which the project will take place. Administrators and activity directors must see the value in your training program for their residents before they will grant you access to their communities. And, if you are testing the efficacy of a particular device, training program, or other technological tool, it will often be necessary to test out these materials in a range of different communities to effectively discern whether and when they produce the outcomes being examined. To gain access to communities, preparation is key.

During the preparation phase, we reached out to all the assisted living communities within 2 hours of Birmingham, Alabama (Dr. Cotten moved to the University of Alabama, Birmingham [UAB] from UMBC in August 2005). At times, it was hard to get our foot in the door at some communities. It is critical to be able to connect with people in charge in the communities to gain their buy-in for your activities. They have to see the value that your project will bring to their residents and the impact that it will have on their communities. They can also aid in connecting you to the best people in the specific communities to help ensure the success of your program. Oftentimes, the CEOs, administrators, owners, and so forth are very busy and may not be easily available to meet with you.

In times like these, it is important to have someone who can help connect you with top administrators in the communities you are hoping to partner with. We were fortunate to have someone who was well connected with many of the communities in the greater Birmingham, Alabama, area. The initial contact for some of the communities was facilitated by Dr. Richard Allman, at that time the director of the UAB Center for Aging. Many of the communities had a good relationship with the Center for Aging; thus, an introduction from Dr. Allman helped to open the doors for our working with them.

We identified all communities that had 40 or more residents, a criterion chosen because we needed to have a sufficient number of potential participants at each site for the intervention. The majority of these communities expressed interest in the study, and many wrote letters of support when the initial grant proposal was submitted to the National Institutes of Health (National Institute on Aging [NIA]) for funding.

After the study was funded, we recontacted the communities to determine whether they were still interested in participating in the randomized controlled trial. We visited the communities to meet with directors, CEOs, activity directors, and other key personnel who helped make decisions about allowing outside entities to conduct community events. We randomized the communities that were interested in participating into three groups: (1) the ICT training group of communities; (2) the attention control group of communities, which comprised communities that received the same level of interaction as the ICT group through activities other than ICT training; and (3) a true control group of communities to which only a survey (which was identical to a survey participants in the other two groups received) was administered.

We conducted the project activities in waves to control, in part, for timing effects. This is most important when conducting research or comparison studies; it is of less concern for deployment of a technology or implementation of an intervention. For instance, we conducted the specific activities within all three groups during the same 8 weeks (e.g., an ICT training, an attention control activity, and true control community receiving only the survey), as close together in time as was feasible given project personnel and community constraints. Once the activities and assessments were completed for the three groups of communities, we began working with a second wave of communities, one from each group. This method of working continued until we completed the study. By conducting all three groups at the same time, we could attempt to control for any events occurring at a local, regional, or national level that might affect the groups.

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