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Wang W, Zhang Z, Mei Y, Zhou B, Zhang D, Liu L. The caregiver contribution to self-care of stroke inventory (CC-SCSI): evaluation of psychometric characteristics. BMC Nurs 2024; 23:284. [PMID: 38671426 PMCID: PMC11055333 DOI: 10.1186/s12912-024-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The caregiver contribution to self-care plays an important role in improving the health outcomes of chronic patients, which needs urgent attention. However, it has been hindered by the lack of a tailored instrument that assesses the caregiver contribution to self-care of stroke. OBJECTIVES To test the psychometric characteristics of the caregiver contribution to self-care of stroke Inventory (CC-SCSI) in health care practice. METHODS Participants were recruited in Henan Province from March 2021 to October 2022, utilizing a multicenter stratified sampling approach. A 23-item self-report CC-SCSI with 3 separate scales measuring caregiver contribution to self-care maintenance of stroke, caregiver contribution to self-care monitoring of stroke and caregiver contribution to self-care management of stroke was tested for validity through discriminant validity, confirmatory factor analysis, concurrent validity and convergent validity. The reliability was tested by Cronbach's α coefficient and test-retest reliability. Qualitative data were analysed using thematic analysis. A STROBE checklist was used. RESULTS The three scales of the CC-SCSI exhibited good discriminant validity. Confirmatory factor analysis supported the three-factor structure of the Caregiver Contribution to Stroke Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Stroke Self-Care Monitoring scale. The moderate correlation between the CC-SCSI and the Self-Care of Stroke Inventory indicated acceptable concurrent validity. The moderate correlation between the CC-SCSI and the Caregiver Contribution to Self-Care of Chronic Illness Inventory indicated acceptable convergent validity. Cronbach's αs for the Caregiver Contribution to Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management scales ranged from 0.876 to 0.974. Test-retest reliability showed average ICC values ranging from 0.828 to 0.903 (P < 0.001). CONCLUSIONS The 23-item CC-SCSI presents good psychometric properties and could be used to explore the caregiver contribution to stroke self-care in health care practice and research.
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Affiliation(s)
- Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Bing Zhou
- School of Information Engineering, Zhengzhou University, Zhengzhou, Henan, China
| | - Dudu Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lamei Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Wang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect 2023; 26:2325-2339. [PMID: 37497863 PMCID: PMC10632628 DOI: 10.1111/hex.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/11/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Promoting self-care is the core response strategy of the global health system to the burden of stroke. Although self-care in stroke represents a dyadic phenomenon, the dyadic self-care experience of stroke survivors and their caregivers is often overlooked in clinical practice. OBJECTIVES The aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. DESIGN A descriptive qualitative design was used to conduct the study. RESULTS The Consolidated Criteria for Reporting Qualitative Research was used for study reporting. A total of 21 stroke survivor-caregiver dyads were recruited for this study between May 2022 and September 2022. Data were collected through semistructured interviews and analyzed using thematic analysis. In this study, four themes were identified: (1) poor relationship quality of the dyads, (2) dyadic incongruence in managing stroke, (3) a slow and tiring dyadic self-care process and (4) happy cooperation in coping with dyadic self-care. DISCUSSION AND CONCLUSION Healthcare professionals should give greater consideration to the contradictions and disparities that may arise between stroke survivors and caregivers during the self-care process. It is crucial for them to provide personalized and tailored support and interventions that can assist these individuals in achieving a more optimal balance in their dyadic self-care. PATIENT/PUBLIC CONTRIBUTION Patients were involved in the formulation of interview questions for this study. No members of the public were involved in this study.
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Affiliation(s)
- Wenna Wang
- Academy of Medical SciencesZhengzhou UniversityZhengzhouHenanChina
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Gianluca Pucciarelli
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
| | - Yongxia Mei
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Zhenxiang Zhang
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Ercole Vellone
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
- Department of Nursing and ObstetricsWroclaw Medical UniversityWrocławPoland
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Kreitzer N, Adeoye O, Wade SL, Kurowki BG, Thomas S, Gillespie L, Bakas T. Iterative Development of the Caregiver Wellness After Traumatic Brain Injury Program (CG-Well). J Head Trauma Rehabil 2023; 38:E424-E436. [PMID: 36951450 PMCID: PMC10517076 DOI: 10.1097/htr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES (1) To iteratively design a web/phone-based intervention to support caregivers of adults acutely following traumatic brain injury (TBI), Caregiver Wellness (CG-Well), and (2) to obtain qualitative and quantitative feedback on CG-Well from experts and caregivers to refine the intervention. SETTING A level I trauma and tertiary medical center. PARTICIPANTS Convenience sample of a total of 19 caregivers and 25 experts. DESIGN Multistep prospective study with iterative changes to CG-Well: (1) developed intervention content based on qualitative feedback from a prior study and literature review; (2) obtained qualitative feedback from 10 experts; (3) refined content using a modified Delphi approach involving 4 caregivers and 6 experts followed by qualitative interviews with 9 caregivers; (4) designed CG-Well website and videos; and (5) obtained feedback on program acceptability, appropriateness, and feasibility from 6 caregivers and 9 experts. INTERVENTIONS CG-Well included content on TBI, self-care and support, and skill-building strategies delivered through a website and telephone calls. MAIN OUTCOME MEASURES Qualitative data were analyzed using content analysis. Caregivers and experts completed Likert-type scales to rate module relevance, clarity, accuracy, utility and website acceptability, appropriateness, and feasibility (1 = strongly disagree to 5 = strongly agree). Means and standard deviations (SD) characterized ratings. RESULTS Qualitative findings were instrumental in designing and refining CG-Well. Ratings were positive for modules (means and SD for relevant [4.9, 0.33], clear [4.6, 0.53], accurate [4.9, 0.33], and useful [5, 0]) and the website (means and SD for acceptable [4.8, 0.36], appropriate [4.8, 0.35], and feasible [4.8, 0.36]). CONCLUSIONS The iterative design process for CG-Well resulted in a highly acceptable program. An early-stage randomized controlled trial is underway to estimate treatment effects for a future well-powered clinical trial.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine (Drs Kreitzer and Gillespie and Ms Thomas) and College of Nursing (Dr Bakas), University of Cincinnati, Cincinnati, Ohio; Department of Emergency Medicine, Washington University, St Louis, Missouri (Dr Adeoye); Departments of Pediatrics (Dr Wade) and Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowki), Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowki)
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Meyer K, Gonzalez A, Benton D. Qualitative Evaluation of Family Caregivers' Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality. JMIR Form Res 2023; 7:e42561. [PMID: 37606980 PMCID: PMC10481209 DOI: 10.2196/42561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/29/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships. OBJECTIVE The purpose of this study is to describe caregivers' experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing. METHODS Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis. RESULTS Our findings indicate that caregivers were overall satisfied with KINDER's focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program's multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion. CONCLUSIONS Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers' comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities.
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Affiliation(s)
- Kylie Meyer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Alexander Gonzalez
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Donna Benton
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
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Hines EA, Farr EM, Rhudy LM, Chesak SS, Kinzelman Vesely EA, Esterov D. Efficacy of resilience interventions for dyads of individuals with brain injury and their caregivers: A systematic review of prospective studies. NeuroRehabilitation 2023; 52:29-46. [PMID: 36617756 DOI: 10.3233/nre-220125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acquired brain injury (BI) is associated with negative mental health outcomes for both people with BI, their caregivers (CG), and patient-CG dyads, which may be mitigated through increased resilience. However, little is known regarding the efficacy of resilience interventions focused on CGs of individuals with BI, as well as dyads, which may be instrumental for positive outcomes. OBJECTIVE To systematically review the evidence of the efficacy of resilience interventions focused on CGs and/or dyads of individuals with BI. METHODS A search of MEDLINE, Embase, APA PsycINFO, CINAHL with Full Text, Scopus, SCIE, and ESCI was conducted. Each title and abstract were screened by two authors independently. Each full text review, study data extraction, and study quality assessment was performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS Out of 11,959 articles retrieved, 347 full text articles were assessed for review and 18 met inclusion criteria for data extraction and quality assessment. Resilience interventions were stratified into 5 different categories based on the type of intervention. CONCLUSION This systematic review suggests that dyadic/CG resilience interventions may improve mental health related outcomes, but conclusions were limited secondary to heterogenous outcomes and lack of a standardized resiliency construct. Future efforts are compulsory to create a standardized resiliency construct and associated outcomes focused on persons with BI, their CGs, and dyads.
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Affiliation(s)
- Emily A Hines
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ellen M Farr
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Lori M Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, MN, USA
| | - Sherry S Chesak
- Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, MN, USA
| | | | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Rhudy LM, Hines EA, Farr EM, Esterov D, Chesak SS. Feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor and their family caregivers. NeuroRehabilitation 2023; 52:123-135. [PMID: 36617758 DOI: 10.3233/nre-220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes. OBJECTIVE The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload. METHODS The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention. RESULTS Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging. CONCLUSION The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions.
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Affiliation(s)
- Lori M Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, Minnesota, USA
| | - Emily A Hines
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ellen M Farr
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherry S Chesak
- Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, USA
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Tu J, Xue X, Bai X, Liu Y, Jia M, Zhou H. Development of a self-help cognitive behavioral therapy programme for reducing the stigma of stroke survivors: a modified delphi study. Top Stroke Rehabil 2022; 30:468-482. [PMID: 35686678 DOI: 10.1080/10749357.2022.2083296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stigma is a common psychological consequence for stroke survivors that aggravates their physical and psychological burden and hinders their rehabilitation. Currently, there are few interventions targeted at the stigma of stroke survivors. OBJECTIVES This study reports on the development of a self-help cognitive behavioral therapy (CBT) programme driven by a logical model of stigma in stroke survivors, CBT and the advice of multidomain experts. METHODS A logical model of stigma in stroke survivors was derived from a systematic search of the literature and semistructured interviews with 21 patients to identify factors influencing stigma. The item content of the programme was generated based on this logical model in combination with CBT. A modified Delphi process with an expert panel of multidomain experts was used to evaluate and refine the content of the programme. SPSS 20.0 was used for data analysis. RESULTS Seventeen experts accepted the invitation to participate, and all completed two rounds of the Delphi survey. Six sections and 26 items were identified. Consensus was reached among experts that the self-help CBT programme included the following six sections: health education, understanding stigma, cognition change, skills training and self-care, self-acceptance and relapse prevention. CONCLUSIONS The self-help CBT programme includes health education and psychological education. This study extends the limited body of research on stroke-related stigma interventions, and the next step is to evaluate its efficacy in trials.
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Affiliation(s)
- Jinyi Tu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiang Xue
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuejie Bai
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yue Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Miao Jia
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongzhen Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Lyons KS, Lee CS. Understanding the family care dyad: A comparison of two multilevel models. Eur J Cardiovasc Nurs 2020; 19:178-184. [DOI: 10.1177/1474515120902368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although there has been increasing attention on a dyadic perspective of illness, contemporary dyadic research methods are still rarely utilized in cardiovascular disease. The focus of this paper is to describe the advantages of two types of multilevel dyadic models (the matched pairs model and the lesser known incongruence model). Data exemplars in a sample of heart failure family dyads are used to illustrate the distinct advantages of these two related multilevel dyadic models with particular emphasis on alignment with research questions. The more commonly known matched pairs model examines separate outcomes for each member of the dyad, controlling for the interdependent nature of the data. By re-parameterizing this model into a univariate dyadic outcomes model, researchers can address distinct, and sometimes more appropriate, research questions (e.g. incongruent appraisals of the illness experience). This paper promotes greater application of these methods in cardiovascular research to further understanding of the dyadic experience and more appropriately target interventions.
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Affiliation(s)
- Karen S Lyons
- William F. Connell School of Nursing, Boston College, USA
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