Development and Evaluation of the 8-item Caregiver Self-Efficacy Scale (CSES-8)

Lessons from a Pilot Study of a Culturally Tailored Financial Well-Being Intervention Among Latino Family Caregivers

Financial strain disproportionally affects the growing population of Latino family caregivers. This pilot study aimed to test the feasibility of a culturally tailored psychoeducational intervention for Latino caregivers designed to reduce financial strain by improving resourcefulness and self-efficacy. Feasibility was assessed according to participant demands, ability to deliver the intervention, and preliminary efficacy. From May 2022 to September 2023, Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving (CONFIDENCE) was administered to 69 caregivers over 11 cohorts in a community setting. Caregivers attended an average of 3.13 (SD = 0.17) of five sessions. Eligible caregivers were given the option to participate in a single-arm pre- and post-test study. Results from N = 20 caregivers indicated reduced levels of financial strain 2 months post-intervention (p-value = .013). Findings also showed improvements resourcefulness and self-efficacy. Although CONFIDENCE appears feasible to deliver and may affect desired outcomes, future studies should reduce intervention demands to improve attendance.Trial RegistrationThis trial is registered at ClinicalTrials.gov (NCT05292248).

Assessment of the validity of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem): a cross-sectional survey study

OBJECTIVES

The aim of the present study was to examine the reliability and validity (structural and convergent) of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem).

DESIGN

Cross-sectional survey study.

SETTING

Online survey in Germany.

PARTICIPANTS

The ResQ-Care-Dem was completed by 243 informal caregivers of people with dementia (Mage=59.7 years, SD=10.9, 84.8% female).

METHODS

The ResQ-Care-Dem consists of four scales: two resilience scales (psychological aspects and social aspects of resilience) and two burden scales (interpersonal burden and general burden). The reliability of the two resilience and two burden scales was assessed using Cronbach's alpha as a measure of internal consistency. Structural validity was examined using a principal axis factor analysis. Convergent validity was assessed by Pearson's correlations with the Zarit Burden Interview (ZBI-7), the Caregiver Self-Efficacy Scale (CES-8) and the Gain in Alzheimer Care Instrument (GAIN).

RESULTS

The ResQ-Care-Dem scales' internal consistencies ranged between 0.65 and 0.81. The factorial structure could partly be confirmed, with the items of the four scales primarily loading on four factors. The burden scales demonstrated high and positive correlations with the score for caregiver burden (ZBI-7, r=0.51 - 0.55) and small to high, negative correlations with the scores for caregiver self-efficacy (CES-8, r=-0.52 -0.56) and gains from caregiving (GAIN, r=-0.21 -0.22), supporting construct validity of the scales. The resilience scales showed small to high positive correlations with the scores for caregiver self-efficacy (CES-8, r=0.50 - 0.57) and gains from caregiving (GAIN, r=0.27 - 0.50), as well as moderate negative correlations with the caregiver burden score (ZBI-7, r=-0.45 -0.50), providing evidence for the scales' construct validity.

CONCLUSIONS

The reliability and structural validity of the ResQ-Care-Dem were partially confirmed. Evidence supporting its convergent validity suggests that the questionnaire has potential as a tool for assessing caregiver burden and resilience factors among informal caregivers of people with dementia. While these findings indicate potential practical applicability, future studies should investigate its performance in real-world settings and assess changes over time (eg, responsiveness) in longitudinal studies.

Modeling Pathways by Which the Caregiver TLC Psychoeducational Program Affects Psychological Health of Caregivers

BACKGROUND AND OBJECTIVES

The study seeks to elucidate the pathways by which the Caregiver Thrive, Learn & Connect (TLC) psychoeducational program affects the psychological health of caregivers by examining the degree to which changes in self-efficacy, personal gains, and emotional support mediate the changes in perceived depression, anxiety, and burden.

RESEARCH DESIGN AND METHODS

Using pre-post data from the Caregiver TLC randomized controlled trial (n = 81) for each outcome and mediator pair, a series of multiple regression models were executed to test the degree to which the program's total effects on changes in depression, burden, and anxiety from baseline to post-intervention are due to changes in each mediator variable from pre- and post-intervention assessments. Caregivers were primarily female (85%), White (62%), and Black (38%), with a median age of 62 and household income of $75,000+. Caregivers reported caring for a person with dementia (69%) or chronic health conditions (31%).

RESULTS

Mediation path modeling indicated that changes in self-efficacy were affected by participation in the Caregiver TLC program, mediating between 32% and 63% of the total treatment effect on the outcome variables. Change in personal gains and change in emotional support also demonstrated meaningful mediation effects, albeit smaller in magnitude.

DISCUSSION AND IMPLICATIONS

Results confirm that the observed positive impact of the Caregiver TLC program is due to changes in self-efficacy (in particular) and to a lesser degree to changes in personal gains and emotional support. These results confirm that strengthening caregivers' perceived self-efficacy to manage stress plays a significant role in improving psychosocial functioning.

Assessing the effectiveness of horticultural therapy for family caregivers coping with dementia: A quasi-experimental mixed-method study

This study was designed to examine the degree to which horticultural therapy (HT) improves psychological well-being, relationship closeness, burden of care, caregiver self-efficacy and hope, among the family caregivers of people living with dementia. We utilized a quasi-experimental design employing a pre-post test methodology that integrates both quantitative and qualitative data. Forty family caregivers engaged in six weekly HT sessions, each lasting 60 min. Participants completed a self-administered structured questionnaire concerning the research variables prior to the first session and following the final session. Qualitative data were obtained from session diaries maintained by the HT therapists. The results revealed significant improvements in psychological well-being and caregiving self-efficacy. Qualitative analysis revealed three key themes: uncertainty and hope, coping with care responsibilities, and personal conflicts. The observed improvements in psychological well-being and caregiving self-efficacy indicate that HT may provide a valuable resource for caregivers.

Development and psychometric testing of the family caregiver self-efficacy scale for patients in the early post-coronary artery bypass grafting

BACKGROUND AND OBJECTIVES

Family caregiver self-efficacy plays an important role in improving the health and quality of life of patients in the early post-coronary artery bypass grafting (CABG). However, there is a lack of targeted self-efficacy assessment tool for caregivers of patients. Thus, the purpose of this study was to develop a Family Caregiver Self-Efficacy Scale for patients in the early post-CABG (FCSES-EPCABG) and to test its reliability and validity.

METHODS

Based on self-efficacy theory, the initial scale was formed by the literature review, semi-structured interviews, Delphi expert consultation, and pre-survey. Through the convenience sampling method, 133 caregivers who met the selection criteria were chosen for the questionnaire survey at Wuhan Asian Heart Hospital from January 2024 to May 2024. The aim was to test the reliability and validity of the scale.

RESULTS

The final scale contained five dimensions of wound care, medication management, cardiac rehabilitation management, social support, and self-care, with a total of 22 items. The item-level content validity index ranged from 0.889 to 1.000, the scale-level content validity index/average was 0.985, and the content validity ratio ranged from 0.778 to 1.000. The exploratory factor analysis showed that the cumulative variance contribution rate of the five dimensions was 69.433%. In the criterion-related validity analysis, the total score of the FCSES-EPCABG was positively correlated with the total score of the General Self-Efficacy Scale (r = 0.762, P<0.001). The Cronbach's alpha coefficient of the scale was 0.919, the half reliability was 0.779, and the test-retest reliability was 0.936.

CONCLUSION

The FCSES-EPCABG has satisfactory reliability and validity, which is suitable for evaluating the self-efficacy of family caregivers of patients in the early post-CABG.

Boosting REsources And caregiver empowerment for Tracheostomy care at HomE (BREATHE) Study: study protocol for a stratified randomization trial

BACKGROUND

Annually, about 4000 US children undergo a tracheostomy procedure to provide a functional, safe airway. In the hospital, qualified staff monitor and address problems, but post-discharge this responsibility shifts entirely to caregivers. The stress and constant demands of caregiving for a child with a tracheostomy with or without ventilator negatively affect caregivers. The aims of the study are to relieve the burden and stress experienced by caregivers at home, improve safety and outcomes for children post-discharge, and identify facilitators and barriers to implementation of comprehensive pediatric discharge programs.

METHODS

The Boosting REsources and cAregiver empowerment for Tracheostomy care at HomE (BREATHE Study) is a pragmatic two-arm, randomized trial with six sites across the US. Caregivers of a child with a tracheostomy are randomized to comparator ("Trach Me Home") or intervention ("Trach Plus"). The Comparator arm is the current gold standard focusing on caregiver education, technical skill building, and case management. The Intervention arm contains all elements of the Comparator plus educational resources, social support and communication with the outpatient pediatrician. Caregivers will complete three surveys: baseline (pre-discharge), 4-week and 6-month post-discharge. Outpatient pediatricians will complete a survey to assess self-confidence in caring for a child with tracheostomy and satisfaction with discharge communication. Interviews with clinicians and staff will identify facilitators and barriers to implementation. The study will examine whether the Intervention arm leads to lower caregiver burden, lower readmission rates and higher pediatrician satisfaction than Comparator arm.

DISCUSSION

The BREATHE Study will advance our understanding of how hospitals can support caregivers with a child with a tracheostomy as they resume life, work, and family activities after discharge.

TRIAL REGISTRATION

Registered on clinicaltrials.gov (NCT06283953). February 28, 2024.

The Connected We St@nd programme: A feasibility pilot study of an online self-management intervention for adults on in-centre haemodialysis and family caregivers

OBJECTIVE

The 'Connected We St@nd' is an online self-management intervention programme for people receiving in-centre haemodialysis and family caregivers that combines an educational and psychosocial support component. This study aimed to evaluate its feasibility and acceptability before proceeding to a large-scale trial.

DESIGN

This was a pre-post single-arm feasibility pilot study conducted with adults undergoing in-centre haemodialysis and family caregivers.

METHODS

Feasibility was based on eligibility, consent, retention, completion and intervention adherence rates, while acceptability was assessed in post-intervention focus group interviews.

RESULTS

Twenty-six people (16 adults on haemodialysis and 10 family caregivers) recruited through social networks completed the intervention. Consent, retention and completion rates were excellent (>90%) and eligibility (77.5%) and intervention adherence were satisfactory (69% for the psychosocial support sessions). Qualitative findings revealed that participants shared positive feelings regarding their participation in the programme. The valuable interactions with group peers and health psychologists during the support sessions, the perception of the adequacy and coherence of the programme's contents and materials and the participants' confidence in using the platform developed to deliver the intervention were some of the aspects highlighted as facilitators of intervention acceptability. Additionally, people on haemodialysis and caregivers reported that participation in the programme brought several educational and emotional benefits (e.g., additional disease-related knowledge, improved communication and coping skills, greater confidence in managing dialysis complications or caregiving demands) that helped increase their self-management skills and psychosocial adjustment to the demands of kidney failure and renal therapies.

CONCLUSIONS

The results suggested that the 'Connected We St@nd' programme is likely to be feasible and acceptable for adults on haemodialysis and family caregivers, thus representing a promising resource for the future of interdisciplinary renal rehabilitation. Suggestions were made to fine-tune the intervention design to proceed with a large-scale trial.

Protocol for a telephonic mixed methods study to understand needs and find solutions for bereaved dementia caregivers

INTRODUCTION

Most caregivers of people living with dementia will experience bereavement within 10 years, but study of and support for their needs rarely persists following the death of their care recipients. A single model that leverages theoretical insights as well as observation from lived experience might help identify who will have greater difficulty following dementia-related bereavement and suggest core mechanisms to target to relieve clinical and subclinical consequences. The millions of existing bereaved dementia caregivers likely have considerable insight into ways to improve experience. Rather than creating interventions from scratch, researchers might leverage those insights to more rapidly improve the lives of bereaved dementia caregivers.

METHODS AND ANALYSIS

This study uses a transformative mixed methods approach to explore the needs of caregivers for individuals with Alzheimer's disease (AD) and AD-related dementias, incorporating both quantitative surveys (n=400) and qualitative semistructured interviews (n=45) across diverse subgroups. The study described in this protocol aims to quantitatively test a new model based on self-determination theory to help understand when and why bereaved dementia caregivers experience better and worse outcomes following bereavement. The study also aims to qualitatively explore the ways that bereaved dementia caregivers might meet their needs to inform future interventions.

ETHICS AND DISSEMINATION

The study adheres to institutional guidelines, ensuring participant consent and minimising risks through verbal consent procedures and the removal of personal identifiers from survey responses. The study team will share findings widely through academic publications, conferences and targeted outreach to advocacy groups and healthcare professionals, while also providing concise summaries of results to participants and making them accessible through the lab's website.

A randomised controlled trial of the Learning Skills Together (LST) intervention to improve dementia family caregivers' self-efficacy with complex care

BACKGROUND

Nearly two-thirds of family caregivers of persons living with Alzheimer's disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a 6-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD.

METHODS

To test the efficacy of LST, we will conduct a two-arm single-site randomized controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomization, a post-intervention survey, and a 3- and 6-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention's mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention.

DISCUSSION

LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care.

TRIAL REGISTRATION

Clinical Trials.gov NCT05846984 . This study was registered on May 6, 2023.

EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU

CONTEXT

Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress.

OBJECTIVES

The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates.

METHODS

Surrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals. Participants completed evaluations of EMPOWER's acceptability and measures of psychological distress pre-intervention, immediately post-intervention, and at 1- and 3-month follow-up assessments.

RESULTS

Delivery of EMPOWER appeared feasible, with 89% of participants completing all 6 modules, and acceptable, with high ratings of satisfaction (mean=4.5/5, SD = .90). Compared to EUC, intent-to-treat analyses showed EMPOWER was superior at reducing peritraumatic distress (Cohen's d = -0.21, small effect) immediately post-intervention and grief intensity (d = -0.70, medium-large effect), posttraumatic stress (d = -0.74, medium-large effect), experiential avoidance (d = -0.46, medium effect), and depression (d = -0.34, small effect) 3 months post-intervention. Surrogate satisfaction with overall critical care (d = 0.27, small effect) was higher among surrogates randomized to EMPOWER.

CONCLUSIONS

EMPOWER appeared feasible and acceptable, increased surrogates' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.

A randomised controlled trial of the Learning Skills Together (LST) intervention to improve dementia family caregivers' self-efficacy with complex care

Background

Nearly two-thirds of family caregivers of persons living with Alzheimer's disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a six-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD.

Methods

To test the efficacy of LST, we will conduct a two-arm single-site randomised controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomisation, a post-intervention survey, and a three- and six-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention's mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention.

Discussion

LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care.

Caregiver Thrive, Learn, & Connect: Testing the Efficacy of an Online Psychoeducational Program for Family Caregivers

OBJECTIVES

Research reports that providing care to a relative or friend with a chronic health condition or significant neurocognitive disorders, such as dementia is a demanding job. Caregiving often leads to higher risk for adverse mental health outcomes. In this study, we examine the short-term efficacy of the CaregiverTLC online psychoeducational program to caregivers of adults with chronic health or significant memory troubles.

METHOD

Using pre-post data from the CaregiverTLC randomized controlled trial (n = 81) we examined differences between the intervention and control conditions on caregivers' psychosocial outcomes for depressive symptoms, self-efficacy, burden, anxiety, and caregiver gains.

RESULTS

Data analyses indicated significant decrease in self-reported depressive symptoms, burden, anxiety, and significant increases in self-efficacy and caregiver gains for caregivers in the active intervention compared to those in the control condition.

CONCLUSIONS

These results suggest that regardless of whether caregivers care for a person with a chronic illness or significant neurocognitive disorder, they can benefit from participation in this online psychoeducational program.

CLINICAL IMPLICATIONS

The CaregiverTLC program may be an effective method to teach skills to reduce depression, burden, and anxiety, and improve self-efficacy and personal gains among caregivers of older adults with chronic illnesses.