PREDICTORS OF PARTICIPATION IN AN ANIMAL-ASSISTED ACTIVITY PROGRAM
Stacie Lynn Davison
B.A., San Diego State University, 2003
THESIS
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
PSYCHOLOGY
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2010
PREDICTORS OF PARTICIPATION IN AN ANIMAL-ASSISTED ACTIVITY PROGRAM
A Thesis
by
Stacie Lynn Davison
Approved by:
__________________________________, Committee Chair
Dr. Oriel Strickland
__________________________________, Second Reader
Dr. Caio Miguel
__________________________________, Third Reader
Dr. Larry Meyers
____________________________
Date
ii
Student: Stacie Lynn Davison
I certify that this student has met the requirements for format contained in the University format
manual, and that this thesis is suitable for shelving in the Library and credit is to be awarded for
the thesis.
__________________________, Graduate Coordinator ___________________
Dr. Lisa M. Bohon
Date
Department of Psychology
iii
Abstract
of
PREDICTORS OF PARTICIPATION IN AN ANIMAL-ASSISTED ACTIVITY PROGRAM
by
Stacie Lynn Davison
The purpose of this study was to assess the significance of demographic variables, depression,
and pet attitude as predictors of willingness to participate in animal-assisted activity (AAA)
programs. The final sample included 57 residents at assisted-living centers in California, most of
whom were Caucasian (91%), with a mean age of 82, and a college education (44%). The Pet
Attitude Scale (PAS), Center for Epidemiological Studies Depression Scale (CES-D), and a
newly developed scale to measure interest in an AAA program were used in this study. PAS
scores and gender were found to predict willingness to participate in an AAA program. These
results contribute to the literature surrounding AAA, which has not yet documented predictors of
participation among senior citizens. Gaining information about factors that influence participation
could be helpful to care providers to address the needs and interests of residents at assisted-living
centers.
_______________________, Committee Chair
Dr. Oriel Strickland
_______________________
Date
iv
DEDICATION
In memory of my parakeet, Bubbles:
The comfort, joy, and love you brought into my life was the inspiration for this thesis. I love you
little bird.
To my family:
Mom, Dad, Vicki, Neno, Matt, and Lucas, thank you for your unconditional love and support. I
could not have done it without you. I love you.
v
ACKNOWLEDGMENTS
Thank you to the staff and residents at Carlton Plaza, Sunrise Assisted Living, Aegis and The
Palms for allowing me to conduct my study, especially to those that took me in, unannounced.
Thank you to Marilyn Royce at Carlton Plaza for taking time out of your busy schedule to help in
planning times to collect data, for introducing me to the residents, and for being the first to
approve my data collection.
Thank you to my graduate committee Dr. Strickland, Dr. Miguel, and Dr. Meyers.
Thanks to Mom and Neil Moore for buying me computers.
A special thanks to all of my cheerleaders: Mom, Dad, Vicki, Neno, Matt, Lucas, Kendra, Brad,
Nick, Cheryl, Becky, Deborah, Mary K, Remy, Neil, Debbie, Jason, Chris, Heather, Chicca,
Nancy, Lesley, Barbara, Terry, Judy, Uncle Joe, Aunt Marie, Uncle Albert, Aunt Jenny, and
anyone else that contributed in any way. Your unbelievable generosity, encouragement, and your
love and support mean the world to me. I am so lucky to have you in my life.
Thank you!
vi
TABLE OF CONTENTS
Page
Dedication ...................................................................................................................................... v
Acknowledgments........................................................................................................................ vi
List of Tables ............................................................................................................................. viii
Chapter
1. INTRODUCTION ....................................................................................................................1
Animal-Assisted Activity and Well-being .........................................................................3
Attitude Toward Pets .........................................................................................................7
Gender ..............................................................................................................................9
Depression .......................................................................................................................10
2. METHOD ...............................................................................................................................12
Participants ........................................................................................................................12
Materials............................................................................................................................12
Procedure ..........................................................................................................................13
Agency Settings ................................................................................................................14
3. RESULTS ...............................................................................................................................16
Data Screening .................................................................................................................16
Descriptive Statistics and Correlations Among Study Variables.....................................17
Tests of Hypotheses .........................................................................................................18
4. DISCUSSION .........................................................................................................................21
Strengths and Limitations ................................................................................................22
Directions for Future Research ........................................................................................23
Appendix A. Center for Epidemiological Studies Depression Scale .........................................27
vii
Appendix B. Pet Attitude Scale .................................................................................................28
Appendix C. Participation Scale ................................................................................................29
References .....................................................................................................................................30
viii
LIST OF TABLES
Page
1.
Table 1 Means, Standard Deviations, and Correlations for Study Variables ……….. 18
2.
Table 2 Regression Analysis for Predictors of Participation ………….……………...20
ix
1
Chapter 1
INTRODUCTION
In the United States, advancements in the medical field such as improved medications,
exercise, health education, and nutrition have helped to extend the expected human life span
(Serpell, Kruger, Katcher, et al., 2006). According to a report by the US Census Bureau (2009),
the global population of people aged 65 or older is expected to triple by the year 2050, and for the
first time the elderly population will outnumber children under 5 years old. In the United States
alone there are close to 40 million senior citizens (people 65 years and older) that comprise
12.8% of the population. As we watch the elderly population grow, our attention should focus not
only on living longer, but also on living well. Although what it means to live well varies from
person to person, living well into old age may include factors such as independence, having a
social support network, physical mobility, low incidents of stress, depression, and being relatively
free of chronic ailments.
Many elderly Americans live in long-term care facilities. According to a 2002 estimate,
there were more than 600,000 elderly Americans living in assisted-living facilities, and that
number projected to increase by 15 to 20 percent each year (Cummings, 2002). In 1987, Ronald
Reagan signed the Omnibus Budget Reconciliation Act (OBRA) in response to concerns over the
quality of nursing home conditions and services. The main goal of OBRA was for residents to
“attain and maintain her highest practicable physical, mental, and psychosocial well-being” (U.S.
Congress, 1987). One of the provisions of the act mandated all nursing homes to provide
activities that meet the residents’ interests and that help to reach the goal of providing a higher
quality of life. The findings of several empirical studies provide clear justification for OBRA’s
mandate to provide activities of interest to nursing home residents (Voelkl, Fries, & Galecki,
1995). Results from various studies have shown that activities can improve physical function by
2
increasing flexibility and ambulation, as well as psychological factors such as improved affect,
mental status, morale, and self-esteem (Wolfe, 1983; McGuire, 1984; Iso-Ahola, 1989). A
common and important goal of activities at long-term care facilities is to provide residents with
social interactions, which can decrease loneliness, maintain or stimulate mental functioning, and
increase awareness and connection with the external environment (Bernstein, Friedmann, &
Malaspina, 2000).
According to Lawton (1983), activity preferences in older adults develop from previous
experience, familiarity with the activity, assessment of the present situation, and estimated
outcomes of participation in the activity. Mannell (1980) defines satisfaction in participating in an
activity as a transient psychological state characterized by decreased awareness of surroundings
and the passage of time, and accompanied by positive affect. The satisfaction derived from
participating in activity is directly linked to the affect or from the personal meaning associated
with performing an activity (Lawton, 1983). Lawton’s Activity Model shows that meaning,
expectations, and familiarity determine activity preference and the positive affect derived from
satisfaction leads to well-being (Lawton, 1983).
Many long-term care facilities utilize animal-assisted activities (AAA) as a way to
improve the quality of life for their residents. The Delta Society defines AAA as recreational
interactions between people and animals that may provide, “motivational, educational,
recreational, and/or therapeutic benefits to enhance the quality of life” (Standards of Practice,
1996). Elderly care centers frequently offer both animal-assisted activity and animal-assisted
therapy programs. AAA differs from animal-assisted therapy in that animal-assisted therapy is
goal directed, provided by specially trained professionals, and progress is measured (Standards of
Practice, 1996). In animal-assisted therapy, the animal is used to facilitate learning and to
improve conditions. For example, someone with mobility difficulties might take a therapy dog for
3
a walk to help improve ambulation or one could learn sequencing by learning the steps in
brushing a dog.
AAA allows for spontaneous visits, a wide array of settings, and a focus on the
recreation and emotion associated with the animals. People with a variety of skill levels, from
professionals to volunteers, may deliver AAA because it is not goal-directed and they are not
required to take notes on an individual’s progress in the program (Serpell et al., 2006). Although
AAA covers a wide range of human-animal interactions, in this study AAA specifically entails
volunteers bringing a trained dog for either one-on-one or group visits. The participants control
each visit’s length and activities. For instance, some may choose to view the animal from a
distance, while others may prefer to pet or brush the animal.
The Selective Theory of Aging states that as individuals move into old age, they take
stock of their life and decide which activities they find satisfying and can successfully maintain.
The activities that they are no longer able to maintain are abandoned (Maynard, 1974,
1986).While it is common for residents to be fond of pets, many are unable or unwilling to care
for a pet on their own. Through AAA, elderly people can experience the enjoyment and benefits
of interacting with an animal without the responsibility of owning a pet. AAA was selected for
the current study instead of AAT, because it covers a wide range of human-animal interactions, it
can be provided by most anyone, it is frequently available in assisted-living centers, and people of
all physical and mental capabilities may participate.
Animal-Assisted Activity and Well-Being
Kahana, Liang, and Felton (1980), found that nursing home residents prefer environments
that are socially active and stimulating. The quality and quantity of an individual’s social network
affects the ability to handle stress, as well as, level of life satisfaction. Studies have shown that
the mere presence of an animal can facilitate person-to-person interactions (Wells, 2007). One
4
study mentioned an increase in social interactions among residents in the AAA treatment group
where they noted that the residents talked to each other about the dog (LeRoux & Kemp, 2009).
In a study by Bernstein, Friedmann, and Malaspina (2000), the researchers used
naturalistic observation to compare aspects of social interaction during both animal and nonanimal activities at long-term care facilities. The categories for observation were type of activity
(animal activity and non-animal activity), type of social interaction (brief conversation, long
conversation, and touch), and cognitive status of the resident (alert, semi-alert, non-alert). The
researchers observed similar patterns of social behavior for all cognitive status levels. Although
the residents in the non-animal activity group engaged in more brief conversations, the residents
in the AAA alert group engaged in more long conversations during the animal activity. The
animals seemed to serve as facilitators for human socialization by giving the residents something
novel with which to talk and interact. Having an animal present not only added to the quality of
the social interaction, but also increased the resident initiation of social interactions even with the
least alert residents.
Additionally, the results of the study showed that while neither the animal nor the nonanimal activities were effective at increasing touching behaviors among residents, the animal
activity provided significant amounts of touch if petting the animals was included. Touching the
animals provided participants of all alertness levels significant amounts of tactile stimulation and
physical contact. Touching cats has been rated as important as touching another human and has
been shown to have beneficial health effects (Zasloff & Kidd, 1994).
Allostatic load is the cumulative effects of the body’s repeated adaptations to stressors
and has been associated with overall physical and cognitive decline in the elderly (Seeman,
Singer, Rowe, Horwitz, & McEwen, 1997). Long-term and repeated stress has been linked to
high blood pressure, diabetes, and heart disease (Baun. Johnson, & McCabe, 2006). Reducing
5
one’s allostatic load is essential in preventing and minimizing illness, as well as, maintaining
physical and cognitive function (Baun et al., 2006).
Research has demonstrated that physiological arousal indicators lower in response to
human-animal interactions (Baun et al., 2006). According to Serpell (2006), human-animal
interactions provide stimulation for all five senses; this stimulation leads to greater well-being by
changing neurochemicals in the brain. Some of these chemicals, such as dopamine and
epinephrine, can produce positive moods and relaxation, which allows for a decrease in blood
pressure. Interacting or merely being in the same room as a dog can reduce the human heart rate
and blood pressure by lowering the human body’s autonomic responses to stressful situations
(Wells, 2007).
The results of a study by Barker, Knisely, McCain, Shcubert, & Pandurangi, (2010),
showed a trend of relaxation associated with interacting with an unfamiliar dog (AAA group).
Whereas dog owners tended to report less perceived stress, the AAA group showed greater
reductions in physiological measures. Heart rate, diastolic blood pressure, and cortisol levels all
lowered below baseline for sixty minutes after the dog interaction for the AAA group. The
conclusions that can be drawn from this particular study are limited due to the small sample size
(dog owners; n = 5, and AAA group; n = 5) and due to lack of a control group. However, the
effects appear to be substantial because the measurements of all variables (except for amylase and
systolic blood pressure) dropped and stayed below baseline after the interaction, suggesting a
buffering effect.
In an experiment by Francis (1991), puppies were brought into an adult home for elderly
patients with chronic psychiatric conditions to see if the animal visitors would increase health
self-concept, life satisfaction, psychological well-being, social competence, social interest,
personal neatness, psychosocial function, and mental function, and reduce depression. In this
6
study, seven of the nine factors studied showed statistically significant improvement. The only
two areas that did not improve were personal neatness and health self-concept. At the beginning
of the study, when the researcher asked the residents if they wanted to participate, only a small
number enrolled. On a hunch, the researchers brought crates containing puppies and let them
loose in the nursing home; consequently, the number of participants instantly tripled. Even
residents with mobility difficulties and those who were formerly withdrawn came out of their
rooms to greet the puppies. The residents were overjoyed by the puppies and eagerly awaited
future visits.
The focus of Francis’ study, and something that many other AAA studies mention, is the
participants’ emotional response to animals. The joy, comfort, and excitement of interacting with
an animal are responses that can easily be observed, but not easily measured. Animals’ greeting
rituals, naturally affectionate disposition, loyalty, and widely perceived ability to love
unconditionally may all serve to promote feelings of self-worth and self-esteem (Wells, 2007).
Helping to shift resident’s focus from ailments and day-to-day struggles to that of pleasure is an
important goal. As one AAA researcher noted, “smiles could not be counted separately, as the
participants smiled throughout the entire visit” (Colby & Sherman, 2002). It is the sheer joy and
smiles that residents, staff, and volunteers experience that during AAA visits that are perhaps the
most important benefits. After all, the main objective these activities are to promote well-being
and quality of life.
The literature review thus far has introduced AAA and its relationship to various physical
and mental health outcomes. A recently published article (Collins et al., 2006) reviewing the
relationship between psychosocial well-being and community participation of service dog
partners called for the need for future research to investigate factors influencing participation.
Addressing this call, and the potential practical, physical, and psychological benefits of AAA, this
7
study was designed to assess the significance of various predictors of interest in participation in
animal-assisted activity programs at long-term care facilities for the elderly. Gaining information
on factors that influence willingness to participate will be helpful to care providers to address the
needs and interests of the residents. If residents indicate that they are interested in AAA, then
perhaps this study could serve as a catalyst for connecting animal visitation groups with interested
parties.
There has been a growing interest in the benefits of activities involving human-animal
interactions; however, no studies have investigated voluntary participation in an animal-assisted
activity program. Researchers have been interested in the possible benefits that these humananimal interactions provide, as well as what mechanisms may be driving these interactions. This
study will add to the current literature by exploring the driving forces behind individual’s
willingness to interact with animals through an animal-assisted activity program. This is
important for the field of AAA because practitioners need to be able to identify characteristics of
potential participants and/or aspects of their background that would lead them to want to
participate.
The current study will contribute to the literature by examining demographic variables
such as ethnicity, gender, pet ownership, education, and age, in addition to the main variables of
CES-D scores, PAS scores and their relationship to scores on the AAA participation scale. In the
following section, each of the variables will be considered in drawing predictions about their
relationship to participation.
Attitude Toward Pets
Templer et al. (1981) developed the Pet Attitude Scale (PAS), which is an 18-item Likerttype scale that measures three factors regarding pets: love and interaction, pets in the home, and
joy of pet ownership. Some research has explored the relationship between the PAS and various
8
outcomes, although none have explored its relationship to participation in an AAA program.
Jenkins (1986) used the PAS to determine positive regard toward dogs that participants
petted to lower their blood pressure. Hama, Yogo, and Matsuyama (1996) found that people who
scored higher on the PAS had greater reduction in the mean arterial pressure and systolic pressure
when petting dogs. The PAS was found to correlate positively with childhood animal bonding
(Brown, 2000). Finally, kennel workers were found to have significantly higher scores on the
PAS than social work students (Templer, et al., 1981).
One of the key theoretical approaches to understanding the impact of pets on people is
Bowlby’s Attachment Theory, which is based on the emotional bond formed between a human
infant and its caregiver. The primary infant behavior associated with attachment theory is the
seeking of proximity to an attachment figure, usually the primary care giver, in stressful
situations. This attachment serves the biological function of protection and security and the
capacity to form bonds can be generalized to others. Ainsworth (1989) proposes that dogs and
cats can also provide an emotional bond of attachment that promotes a sense of well-being and
security. The idea that mere exposure can facilitate attachment can explain why people who are
exposed to pets earlier in life are more interested in them as they get older (Sable, 1995).
Animals have also been recognized as having motivating effects on humans. For
example, they often motivate humans to go on a walk (Serpell, 1991) and they have been
recorded as motivating individuals with mobility difficulties to walk (Francis, 1991). Animals
may act as a catalyst in human participation for individuals with positive attitudes toward pets by
making the activity enjoyable and worthwhile, more so than if that activity did not involve an
animal.
Although there have been no other studies that have directly examined pet attitude and
participation, attachment theory would suggest that people who hold more positive attitudes
9
towards pets would be more interested in participating in an animal-assisted activity program.
Hypothesis 1.It is hypothesized that there will be a positive relationship between scores
on the Pet Attitude Scale (PAS) and interest in participation in an AAA program.
Gender
Some research has assessed gender differences in pet ownership and attitude toward pets.
Risley, Holley, and Wolf (2006) investigated the human-animal bond and ethnic diversity. They
found that the majority of their female participants (60%) owned companion animals. In a study
by Prato-Previde, Fallini, and Valescchi (2006) there was shown to be a difference in the way that
males and females interacted with their pets, such that females tended to respond to the presence
of a pet more readily than males. In addition, Marks, Koepke, and Bradley (1994) found that
females had slightly more positive scores on the Pet Attitude Scale than males.
Al-Fayez, Awadalla, Templer, and Arikawa (2003), found Kuwaiti PAS scores for both
male and females correlated more highly with the score of their fathers than with the scores of
their mothers. This finding was different from those found with Americans where the PAS score
of adolescents correlated more highly with their mothers. This contrast appears to be consistent
with the father’s dominant role in Arab families.
In one study, researchers tested oxytocin levels before and after owners interacted with
their pet dog(s) after arriving home from work (Miller et al., 2009). Oxytocin (OT) is a hormone
that promotes feelings of relaxation and facilitates bonding, attachment and socialization. In the
study, there were 10 men and 10 women and each gender group was assigned to either a reading
condition or a dog interaction condition. The results showed that women’s oxytocin levels rose
significantly after interacting with their dog. The oxytocin levels decreased in all other groups
and conditions. Oxytocin is believed to be responsible for eliciting the calm, relaxed feeling that
the female participants felt after they had interacted with their pet dog as well as maternal and
10
pro-social behaviors.
Due to findings that females are more likely to own a pet, have a chemical response to
their pets that elicits feelings of bonding and attachment, and have slightly higher scores on the
PAS, the researcher formulated the following hypothesis.
Hypothesis 2. It is hypothesized that there will be a main effect of gender on
participation, with females being more interested in participating in an AAA program than males.
Depression
The companionship and nurturing instinct that animals bring out in humans may have a
positive effect on depression and loneliness (Miller et. al., 2009). Depression is one of the most
common emotional and psychological disorders, affecting approximately 20% of elderly people
living in long-term care facilities (Zullo, n.d.). Depression can intensify the effects of co-existing
physical illnesses such as heart disease, cancer, stroke, and diabetes (National Instititue of Mental
Health, n.d.). Sounter and Miller (2007) conducted a meta-analysis to see if AAA could
effectively treat depression. In order for a study to be included in the meta-analysis it had to
include random assignment, a comparison or control group, use of AAA or AAT, a self-report
measure of depression, and report sufficient information to calculate effect sizes. Five studies met
all of the requirements for the meta-analysis (four dissertations and one conference paper). Four
of the five studies used in the analysis showed a significant reduction in depression from pre-test
to post-test for participants in the AAA group. The review supported the hypothesis that AAA
effectively alleviates depression. The release of endorphins in the brain elicited by human-animal
interactions is one explanation for the reduction in depression following the participation in AAA
(Allen, 2001).
Thus, research has demonstrated that depression is lower among residents after
participation in AAA; however, an important question is whether depressed participants would be
11
less likely to choose to participate in a voluntary program. Depression is common among nursing
home residents, as they often face difficult life transitions such as losing a loved one,
experiencing diminished physical and mental abilities, and displacement from their home.
Cummings (2002), interviewed residents at assisted-living centers on variables including
depression, life satisfaction, functional status, perceived health, perceived social support, and
participation in activities. She found that the variables that were linked to higher rates of
depression were increased functional impairment, poor health, female gender, and perceived lack
of social support. However, when residents reported high levels of social support, gender,
functional impairment, and other health measures were no longer significantly linked to
depression. Therefore, providing activities for residents, and encouraging relationship building
among residents and between staff members were suggested ways to improve social support and
decrease depression.
Voekel et al. (1995) studied factors predicting nursing home residents’ participation in
activities provided by their living facility. They hypothesized that personal competence variables
including activities of daily living, health, cognition, and competence would influence elderly
activity involvement. Depression was a personal competence variable that was shown to be
associated with reduced participation. It seems that people who are depressed frequently lack the
energy to participate and have difficulty experiencing pleasure, which drives participation.
Residents who were not depressed spent more time in activities than residents that were
depressed. Due to research findings and logic that depression is generally linked to lower levels
of participation:
Hypothesis 3.It is hypothesized that there will be a negative relationship between
depression scores on the Center for Epidemiological Studies Depression Scale (CES-D) and
interest in participation in an AAA program.
12
Chapter 2
METHOD
Participants
The participants in this study were residents at senior living centers in Sacramento and
Ventura, CA. Fifty-seven participants (41 female, 16 male) completed a packet of surveys. The
participants ranged in age from 64 to 96 years of age and had a mean age of 82. There were 52
Caucasian (91%), 3 Latino/Latina (5%), 1 African American (2%), and 1 Native American (2%)
participants. The majority of participants had a college education, with 44% having an
Associate’s degree or higher. Twenty-four participants owned a pet (42%) and 33 did not (58%).
The majority of participants (90%) reported that they were not allergic to animals.
Materials
Demographic information. Demographic data was collected using a demographic sheet
that contained questions on gender, age, education, ethnicity, pet ownership, and animal allergies.
The living facility of the participant was also documented.
Depression scale. The Center for Epidemiologic Studies Depression Scale (CES-D)
(Radloff, 1977) is used to measure how frequently depressive symptoms are experienced in a
week time span. The CES-D contains 20 questions rating negative and positive affect such as “I
felt depressed,” and “I was happy.” The items are measured on a 4 point scale ranging from 0 =
not at all to 3 = almost all the time. Positive items are reverse coded. A score of 16 or higher
typically indicates that an individual is at high risk for depression. Please refer to Appendix A for
a copy of the full scale.
The CES-D has well-established normative reliability and validity data with inter-item
reliability ranging from .80 to .90 and test-retest reliability ranging from .40 to .70, as well as
13
correlations with the Beck Depression Inventory >.80. The CES-D has strong psychometric
sensitivity for identifying symptomatic individuals, has been tested on people of a wide range of
ethnicities, and has been translated into several different languages. For this study, the
Cronbach’s alpha score of internal consistency reliability was .78.
Pet attitude scale. The Pet Attitude Scale (PAS) (Templer et al., 1981) measures three
factors regarding pets: love and interaction, pets in the home, and joy of pet ownership. The PAS
is an 18-item, paper and pencil, Likert-type scale. The items are measured on a 7-point scale
ranging from 1= strongly disagree to 7 = strongly agree. Some examples from the PAS are, “I
love pets”, “I hate pets”, and “Pets are fun, but it’s not worth the effort of owning one.” The PAS
has a reported Cronbach’s alpha of .91 and a reliability of .92 (Al-Fayez et al., 2003). The value
of Cronbach’s alpha for the current study was .87. Please refer to Appendix B for a copy of the
PAS scale.
Participation in AAA. There are no existing measures in the literature for interest in
participating in an animal-assisted activity program. A measure was developed by the author of
the thesis in which the participants were asked to rate on a scale from one to seven (strongly
disagree to strongly agree) interest in various aspects of participating in an animal-assisted
activity program if one were made available at their care facility. These items demonstrated
strong internal consistency reliability with a Cronbach’s alpha of .88. The items on this measure
can be found in Appendix C.
Procedure
The researcher first obtained ethical approval from the psychology department’s Human
Subjects Committee. Next, the survey packets were distributed with the consent form on the front
of the packet and the participants were asked to read and sign the consent form. After the
participant signed and returned the survey packet, the researcher removed the consent forms from
14
the survey packet to ensure confidentiality. Following that, the researcher returned the packet of
materials to the participants. The survey packet contained a demographic sheet, and three
surveys: the CES-D Depression Scale, the Pet Attitude Scale, and the AAA Participation Scale.
If the consenting participant was unable to read or write on his or her own, the researcher
asked the questions on the survey and wrote down the participant’s responses. After participants
completed filling out the inventories, the researcher collected the packets and placed them in an
envelope separate from the consent forms to ensure participant confidentiality. The researcher
then orally debriefed the participants, answered any questions, and handed out the debriefing
page for participants to keep. The researcher thanked each participant for his or her participation.
Agency Settings
The researcher collected data at six assisted-living centers in Sacramento, CA and
Ventura, CA: Carlton Plaza Senior Living Center (n = 15), Sunrise Assisted Living, Munroe
Center (n = 4), Sunrise Assisted Living, Carmichael Center (n = 3), Aegis Living (n = 4), and The
Palms at Bonaventure (n= 35).
Carlton Plaza Senior Living is family owned and has been supporting seniors for more
than 20 years. Their mission is to empower residents through their continuum of care services. As
the residents’ health needs change, so does the level of support. Carlton Plaza offers a wide array
of services to support residents’ every day needs and to nurture all aspects of the residents’
lifestyles. Carlton Plaza is located in Northern California and offers six living facilities
throughout the Bay Area and Sacramento (www.carltonseniorliving.com).
Sunrise Assisted Living was founded in 1981 with a mission to champion quality of life
for all seniors. Sunrise provides personalized independent and assisted living, care for individuals
with memory loss, as well as nursing and rehabilitative services. Sunrise Senior Living currently
offers 415 locations in the U.S, Canada, Germany, and the U.K. (www.sunriseseniorliving.com).
15
The Palms at Bonaventure in Ventura, CA offers health and personal care provided by
licensed nurses. Some of the amenities that are offered include beautifully designed common
areas, chef-prepared meals, a library, a whirlpool, and a movie room with complimentary
refreshments. The Palms makes activity involvement an integral part of life by providing a
variety of activities to choose from daily.
A memory care unit is available with a caring staff, and a safe living environment that
combines the comfort of home with a physical design that was created to enhance the quality of
life for residents with memory impairments (www.seniorlivinginstyle.com).
Aegis of Carmichael is located in a residential neighborhood and is characterized by its
‘small town’ feel. The staff members at Aegis are committed to providing a friendly environment
and specialize in caring for residents with Alzheimer’s disease. On top of friendly, individualized
care the residents are offered weekly happy hour and entertainment as well as frequent trips to
places like the Crocker Art Museum and River Cats baseball games (www.seniorsforliving.com).
All of the facilities currently keep at least one resident pet dog the common area with
which the residents are free to interact. Some of the larger homes allow residents to keep their
own pets in their rooms.
16
Chapter 3
RESULTS
Data Screening
All variables were first screened for the presence of outliers, defined as being three
standard deviations outside the mean. In addition, the shape of the distribution was examined to
check that all variables were approximately normally distributed by examining the Q-Q plots and
Shapiro-Wilk’s test for normality. Most variables were approximately normally distributed, with
two exceptions in terms of outliers. The CES-D had an interesting distribution, with a low score
of 0 (no depressive symptoms) and a high score of 44 (out of a possible 60, indicating maximum
depression symptoms). The average variation around the mean of 12.2 was 10.39, meaning that
scores above 43 fell outside the 3-standard deviation cut-off. There was one score of 44, and two
additional scores next to this measure. It was decided not to include these scores in the analysis
due to their extreme values (suggesting high levels of depression) because these three participants
might drive results that would be un-representative of the other participants. In the interest of
confidentiality, these participants were not individually identified, but a plan was made to
communicate to their agency settings that we had identified significant depression among some of
the residents at their location.
There was one outlier for age. As mentioned above, the average age was 81.7 (SD =
7.44), with the youngest participant being aged 57 and the oldest being 96 years old. Although
we had no reason to suspect that this lower outlier would affect the results, in the interest of
consistency in decision-making, we did not include this participant in subsequent analysis.
The removal of outliers from the data set resulted in losing four respondents’ data, for a
total new sample size of 57 participants. It should be noted that the analyses were re-run
including all participants and none of the findings from the second analyses were different. For
17
clarity of presentation, results will be presented using the attenuated data set.
To ensure that the dependent variable did not vary as a function of the facility from which
participants were studied, an analysis was conducted to compare these facilities. The results of a
one-way ANOVA indicated that the participation scores did not significantly differ between
participants based on living facility, F (4, 56) = .26, p > .05. Thus, this variable does not need to
be used as a control in subsequent analyses.
Descriptive Statistics and Correlations Among Study Variables
Means and standard deviations for all continuous variables are presented in Table 1. The
average level of education represented in the sample was “some college” (M = 6.67, SD = 1.75).
The mean score for PAS was 5.40 (SD = 1.06) indicating an overall moderately positive attitude
toward pets. The average score on the CES-D was 10.07 (SD = 7.20). The average participation
score revealed an overall neutral attitude toward participating in an AAA program if one were
available, with the mean score being almost exactly the midpoint of the scale (M = 3.89, SD =
1.86).
Pearson product moment correlations are also presented in Table 1. Only two of the
continuous variables were significantly related. Scores on the Pet Attitude Scale were negatively
related to age r(57) = -.27, p < .05. Scores on the Pet Attitude Scale were significantly positively
related to interest in participation in an AAA program r(57) = .47, p < .01. This correlation
addresses one of the hypotheses and will be re-visited below.
18
Table 1
Means, Standard Deviations, and Correlations for Study Variables
Variable
M
SD
1.
2.
3.
4.
5.
81.7
6.62
12.2
5.39
3.99
7.44
1.72
10.4
1.06
1.84
Age
Education
Depression
Pet Attitude
Participation
1
--.07
.06
-.27*
-.05
_____
2
3
4
5
--.02
-.04
-.07
(.78)
.03
.17
(.87)
.47**
(.88)
Note. Coefficient alphas are presented in parenthetical boldface along the diagonal. N= 57 for all
analyses. *p < .05. **p < .01
Tests of Hypotheses
The following section presents the tests of each of the demographic comparisons as well
as the relationship between the PAS, CES-D, and AAA participation. The original analytic plan
was to build a regression model that would maximize prediction of participation scores by
entering significant demographic variables first, and then observing the contributions of the
psychological variables of depression and pet attitudes. Because these variables have never been
studied empirically, it was decided to build the model by first assessing the bivariate relationships
among study variables. The final analysis will include a regression equation including all the
significant variables to show the overall R squared.
Gender and Participation. To assess the relationship between gender and participation, a
one-way ANOVA was conducted. Results showed that the differences between the two groups
were statistically significant F (1, 56) = 4.47, p < .05). A comparison of mean scores shows that
men reported more interest in AAA programs (M = 4.66, SD = 1.67) than did women (M = 3.56,
SD = 1.86). It should be noted that the direction of the gender effect is opposite from that
19
predicted by the literature, and this will be addressed in the discussion section. The results of the
Levene’s Test were not significant (p = .15) therefore equal variances between male and female
participation are assumed.
Depression and Participation. The relationship between CES-D scores and participation
were assessed via a Pearson Product Moment Correlation: This analysis showed no significant
relationship, (r = .17, p > .05).
Pet Attitude Scores and Participation. As mentioned above, the results of a Pearson
Product Moment Correlation revealed a significant correlation between PAS scores and
participation (r = .47, p < .01). Thus, this analysis revealed that PAS scores accounted for 21.6%
of the variation in participation scores, leaving 78% of the variation in participation scores
unexplained by pet attitude.
Overall Regression in Predicting Participation Scores. The results thus far suggest that
only gender and Pet Attitude Scores emerged as significant predictors of willingness to
participate in an AAA program. A regression model was then run using both of these variables to
assess the overall prediction of participation. Variables were included in the equation using the
Stepwise method, entering gender first and then observing the independent prediction of the PAS.
Results can be observed in Table 2. Considering both variables in the equation, 27% of the
variance of participation scores can be predicted with gender and Pet Attitude Scales.
20
Table 2
Regression Analysis for Predictors of Participation
______________________________________________________________________________
Step and Predictor variable
B
SEB
β
R2
Δ R2
______________________________________________________________________________
1. Gender
-.97
.47
-.24
.08
.08*
2. Pet Attitude Scores
.78
.20
.45
.27
.19*
______________________________________________________________________________
*p < .05
21
Chapter 4
DISCUSSION
In the current study, self-report measures of demographic variables, depression, and
attitude toward pets were examined as possible predictors of willingness to participate in an AAA
program. PAS scores and gender were found to be significant predictors of willingness to
participate in an AAA program. These findings will be discussed as they relate to the relevant
literature base.
The hypothesis that individuals with higher scores on the Pet Attitude Scale (PAS) will
be more likely to participate in an AAA program than those with lower scores on the PAS, was
supported. This finding is consistent with the results of earlier studies explaining that people who
are exposed to pets earlier in life are more interested in them as they get older (Sable, 1995) and
that preferences and previous experiences determine participation.
In the second hypothesis, it was predicted that females would be more interested in
participating in an AAA program than males. This hypothesis was not supported; in fact, men
were more interested in participation than women were. The findings of the current study are
contrary to that of Voelkl (1995), where male residents were found to spend less time in activity
programs than female residents. An F-test was run to determine whether the gender outcome was
actually due to age. The F-test was not significant F(1,59) = .72, p > .05), therefore the gender
outcome was not actually due to differences in age between males and females. In Herzog’s
(2007) review of gender differences in human-animal interaction, it was noted that gender
differences result from the interaction of many factors on many different levels, and can change
over time.
The third hypothesis that those who scored higher on the Center for Epidemiological
22
Studies Depression Scale (CES-D) (more depressed) will be less likely to participate in an AAA
program than those with lower scores (less depressed),was not supported. In a study by
Matschinger et al., (2006), 986 individuals over 75 years of age were given the CES-D scale.
Results of the study showed that care should be taken when administering the CES-D to an
elderly population. Questions on the CES-D are worded both positively and negatively in an
effort to avoid the respondent’s tendency to answer positively to each question regardless of its
content. The results of the study showed that oppositely worded items do not necessarily solve the
problem of respondent’s answering favorably to all items, and that they instead may distort the
dimensional structure and reliability of the scale. On the contrary, an analysis of the CES-D,
conducted by Lewinsohn et al., 1997, revealed that neither age, gender, cognitive impairment,
functional impairment, physical disease, nor social desirability had a significant negative effect
on the psychometric properties or screening efficacy of the instrument.
Strengths and Limitations
There were several limitations of this study, including the sample size, the self-report
nature of the scales, the ordering of the scales, the convenience sample of the participants, the
self-report of the data, and the length of survey given the age range of the participants. The small
sample size limits both the statistical power as well as the generalizeability of the study. A
convenience sample was used, not random sampling, and as a result the participants tended to be
more active mentally, physically, and socially.
All of the scales in the survey packet were arranged in the same order. This
methodological error may have introduced practice effects, ordering effects, and/or hypothesis
guessing. If this study were to be replicated, the ordering of the scales should be randomized.
In addition, there was a considerable amount of resistance to the surveys from both the
directors and residents, which is the reason for the small sample size. The directors were
23
concerned about maintaining resident privacy even after reassurance from the researcher that
participant confidentiality was a top priority. The residents commonly felt either that the survey
packet was too difficult to complete or were generally uncomfortable with the personal nature of
the depression questions.
One of the strengths of this study is that the specific topic of participation in an AAA
program has not been studied before and it has important implications for the growing elderly
population. Understanding the factors that drive participation is important because it is a way to
help ensure that residents’ interests are being met. When residents participate in desirable
activities, it is a way to promote life satisfaction and well-being.
A second strength of this study was the development of a participation scale specific to
AAA with high internal consistency reliability. This scale can be used by long-term care facilities
and by other researchers to assess the level of interest in an AAA program. OBRA mandates all
long-term care facilities to provide activities of interest to residents and the AAA participation
scale may be useful to care providers in assessments of resident activity interests.
Due to the findings that gender and PAS scores significantly predicted participation in an
AAA program, this information could also potentially be used as to screen new residents or to
periodically screen all current residents to determine if an AAA program would be a good fit at
that location.
Directions for Future Research
Souter and Miller (2007) discussed the need for additional exploration of the relationship
between AAA and depression. Future research should be conducted to identify the specific subfactors of depression that can be alleviated by a visit by an animal within an AAA context.
Researchers might investigate whether it is factors such as the tactile stimulation, the social
facilitation, or the non-judgmental nature of the visiting animals, which leads to decreased
24
feelings of depression following participation in an AAA program. With this information, the
factors found to alleviate depression could be emphasized during AAA visits.
Few studies have examined factors that influence people’s attitudes toward pets. The
results of this study indicated that pet ownership positively influenced pet attitude. Future studies
should explore the relationship between other factors such as gender, ethnicity, and loneliness on
attitudes toward pets. Herzog (2007) reviewed gender differences in human-animal interactions
and called for future studies that investigate the sources of gender differences in human-animal
interactions and specifically mentioned that reports should include the effect sizes for these
differences. Barker, et al. (2010) investigated the stress buffering response patterns from
interacting with a therapy dog. He suggested that larger-scale studies are needed to replicate and
test the differences in levels of stress reduction between dog owners and those interacting with an
unfamiliar dog. Additionally, according to Barker et al. (2010), the strong inverse relationship
found between pet attitude and perceived stress suggests that dog owners with positive attitudes
toward pets may experience stress reduction from interacting with an unfamiliar dog, such as
occurs in AAA. These findings emphasize the need to control for pet attitudes in human-animal
interaction research.
Le Roux and Kemp (2009) suggested that factors such as social interaction and loneliness
should be explored in relation to an AAA program. Several studies have found pet ownership to
be effective in reducing feelings of loneliness. To address loneliness as it relates to AAA
programs, future studies should explore the factors that influence the ability of dogs to facilitate
social interactions, such as type of animal, gender, and attitude toward pets, particularly in an
AAA setting (Wells, 2004).
Finally, future research should be conducted at assisted- living facilities where active
AAA programs are already in place and assess the demographic factors, depression, loneliness,
25
and PAS scores in relation to actual, documented participation in the AAA program, instead of
stated desire to participate. Additionally data on attitudes toward unfamiliar dogs or animals
should be collected instead of pet attitude since unfamiliar animals are used in AAA programs. If
this study were to be replicated in the future, I would recommend using shortened versions of the
PAS and CES-D because of the fatigue factor and resistance to filling out the survey packet
related to the length of the original scales.
26
APPENDICES
27
APPENDIX A
Center for Epidemiologic Studies Depression Scale (CES-D)
Instructions: Circle the number for each statement that best describes how often you felt or behaved this way
DURING THE PAST WEEK.
0
1
2
3
Rarely or none of the
time
(less than 1 day)
Some or a little of the time
(1-2 days)
Occasionally or a moderate
amount of the time
(3-4 days)
Most or all of the time
(5-7 days)
1. I was bothered by things that usually don’t bother me.
2. I did not feel like eating; my appetite was poor.
3. I felt that I could not shake off the blues.
4. I felt I was just as good as other people.
5. I had trouble keeping my mind on what I was doing.
6. I felt depressed.
7. I felt that everything I did was an effort.
8. I felt hopeful about the future.
9. I thought my life had been a failure.
10. I felt fearful.
11. My sleep was restless.
12. I was happy.
13. I talked less than usual.
14. I felt lonely.
15. People were unfriendly.
16. I enjoyed life.
17. I had crying spells.
18. I felt sad
19. I felt like people dislike me.
20. I could not get “going.”
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
28
APPENDIX B
Pet Attitude Scale
Read each statement and then circle the number, using the response choices listed below, that corresponds
with how you generally feel towards pets.
1=
2=
3=
4=
5=
6=
7=
Strongly
disagree
Disagree
Somewhat
disagree
Neutral
Somewhat
agree
Agree
Strongly
Agree
1. I really like seeing pets enjoy their food.
1
2
3
4
5
6
7
2. My pet means more to me than any of my friends.
1
2
3
4
5
6
7
3. I would like a pet in my home.
1
2
3
4
5
6
7
4. Having pets is a waste of money.
1
2
3
4
5
6
7
5. Housepets add happiness to my life (or would if I
had one).
1
2
3
4
5
6
7
6. I feel that pets should always be kept outside.
1
2
3
4
5
6
7
7. I spend time every day playing with my pet (or
would if I had one).
1
2
3
4
5
6
7
8. I have occasionally communicated with a pet and
understood what it was trying to express.
1
2
3
4
5
6
7
9. The world would be a better place if people would
stop spending so much time caring for their pets and
started caring more for other human beings instead.
1
2
3
4
5
6
7
10. I like to feed animals out of my hand.
1
2
3
4
5
6
7
11. I love pets.
1
2
3
4
5
6
7
12. Animals belong in the wild or zoos, but not in
the home.
1
2
3
4
5
6
7
13. If you keep pets in the house you can expect a lot
of damage to furniture.
1
2
3
4
5
6
7
14. I like housepets.
1
2
3
4
5
6
7
15. Pets are fun but it’s not worth the trouble of
owning one.
1
2
3
4
5
6
7
16. I frequently talk to my pet.
1
2
3
4
5
6
7
17. I hate animals.
18. You should treat your housepets with as much
respect as you would a human member of your
family.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
29
APPENDIX C
Participation Scale
In this study, the animal-assisted activity involves volunteers brining in a trained dog for either a one-on-one
visit or a group visit. Please address the following questions in terms of your participation in an animalassisted activity program.
1=
Strongly
disagree
2=
Disagree
3=
Somewhat
disagree
4=
Neutral
1. I am interested in participating in an animal-assisted
activity program.
2. I am interested in receiving more information about
animal-assisted activities.
3. I would enroll in an animal-assisted activity program.
4. I would like to visit with animals through an animalassisted activity program.
6=
Agree
5=
Somewhat
agree
7=
Strongly
Agree
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
30
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