title: Influence of individual and contextual characteristics on the provision of individualized care in long-term care facilities.
abstract: OBJECTIVE
  Previous research examining improved provision of individualized care (I-Care) in long-term care (LTC) facilities has primarily considered contextual influences. Using Kanter's theory of structural empowerment, this study explored the relationship among contextual-level characteristics, individual-level characteristics, and access to empowerment structures on LTC staffs' perceived ability to provide I-Care.
  
  
  METHODS
  Multilevel models were used to examine 567 staffs' (registered nurse [RN], licensed practical nurses [LPN], care aides) reported ability to provide I-Care, nested within 41 LTC facilities. I-Care was first modeled as a function of within-person (e.g., age, job classification, experience) and between-context (e.g., facility ownership status, culture change models) variables. Independent of these predictors, we then assessed the influence of staffs' access to empowerment structures (information, support, opportunities, resources, informal power, and formal power) on reported ability to provide I-Care.
  
  
  RESULTS
  The intraclass correlation coefficient indicated that 91.7% of the total variance in perceived ability to provide I-Care reflected within- versus between-person differences, with the 6 empowerment variables accounting for 31% of this within-person variance independent of the other context- and person-level covariates. In the final model, only informal power (i.e., quality of interprofessional relationships) and resources (i.e., adequate time and supplies) uniquely predicted I-Care. Notably, access to resources also attenuated the significant effect of support, suggesting a possible mediating effect.
  
  
  CONCLUSIONS
  These findings suggest that both contextual- and individual-level factors exert considerably less influence on I-Care than factors associated to staffs' perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs' access to structural empowerment.
authors.affiliation: Address correspondence to Sienna Caspar, Interdisciplinary Studies Graduate Program, University of British Columbia, Green College, Green Commons, Room 153A, 6201 Cecil Green Park Rd. Vancouver, BC V6T 1Z1. E-mail: Siennac@shaw.ca.
authors.forename: Sienna
authors.initials: S
authors.lastname: Caspar
authors.forename: Heather A
authors.initials: HA
authors.lastname: Cooke
authors.forename: Norm
authors.initials: N
authors.lastname: O'Rourke
authors.forename: Stuart W S
authors.initials: SW
authors.lastname: MacDonald
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D006801:Humans; D007857:Leadership; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009726:Nurses; D009728:Nursing Assistants; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D015279:Organizational Culture; D010358:Patient Participation; D010559:Personnel Management; D011209:Power, Psychological; D011787:Quality of Health Care; D055815:Young Adult
keywords: nursing home; organizational and institutional issues; quality of care