A Social Exergame Intervention to Promote Physical Activity, Social Support, and Well-Being in Family Caregivers

Care Tasks and Caregiver Burden Among Family Caregivers of Patients With Mental Disorders in China: Illness Perception as a Mediator and Social Support as a Moderator

INTRODUCTION

Caring for a family member with mental disorders is burdensome, which may not only damage the caregivers' well-being and health, but also hinder patients' recovery. It is critical to investigate the underlying mechanisms for caregiver burden.

AIM

To examine the mediating effect of illness perception and the moderating function of social support on the association between care tasks and caregiver burden.

METHOD

A total of 1169 family caregivers of patients with mental disorders were recruited via convenience sampling across China. Data were collected using acceptable reliability scales (Cronbach's α > 0.6). The relationships among care tasks, illness perception, social support and caregiver burden were examined in the SPSS PROCESS macro.

RESULTS

Illness perception partially mediates the relationship between care tasks and overall caregiver burden, personal strain and role strain, while social support only alleviates the impact of care tasks on personal strain but not on role strain.

DISCUSSION

Care tasks could positively predict caregiver burden. As a mediating moderating mechanism, illness perception and social support could further explain how care tasks affect caregiver burden.

IMPLICATIONS FOR PRACTICE

Psychiatric nurses should provide psychoeducation for family caregivers of patients with mental illness to improve their negative illness perception, as well as increase their social support.

Irrelevant Interests? A Qualitative Study Into How German Family Surrogates of Persons Living With Dementia Fulfill Their Legal Role as Advocates of an Advance Directive

BACKGROUND AND OBJECTIVES

German legislation establishes advance directives (ADs) as legally binding instruments that all involved parties need to adhere to. This applies also to family members who have been authorized as official surrogates of the AD's author. As surrogates, they are expected to make sure that the AD is being implemented. Our study aims at uncovering how family members experience their legally assigned role as an advocate of an AD.

RESEARCH DESIGN AND METHODS

We conducted 25 episodic interviews with family surrogates of persons living with dementia and used thematic analysis to make sense of our interview data.

RESULTS

Family surrogates expressed scepticism toward ADs as instruments for planning end-of-life care. They did not necessarily follow the decisions expressed in the AD. We found cases in which family surrogates intentionally refrained from bringing the ADs to the attention of health care providers as well as cases in which the ADs conflicted with self-related interests of family surrogates.

DISCUSSION AND IMPLICATIONS

Our findings lead us to critique the legal construction of family surrogates as advocates of the AD. Family members are directly and enduringly affected by the end-of-life care decisions that the AD sets out and are thus no neutral agents who have no stake in the matter. Expecting them to simply transmit decisions formulated in the AD means expecting them to render their own interests irrelevant-which, arguably, might be too much to ask.

Feedbacks Using behaviOral econOmic theories on STEP countS in Cardiovascular Disease Patients (FOOTSTEPS) Using Novel Daily Step Counts Retrieving System

The effectiveness of gamification-based feedback systems that utilize non-monetary points to promote exercise among cardiovascular disease (CVD) patients has not been fully evaluated. This study aimed to evaluate the effectiveness of a gamification program using non-monetary points on the daily step counts in CVD patients. We collected 30 patients with a history of heart failure or myocardial infarction at a single tertiary center between January 9, 2023, and April 13, 2023. The primary outcome was the change in daily step counts. The baseline step counts were compared with those during the 4-week gamification and the 1-week follow-up period. A total of 29 participants with a mean age of 64.6 years were finally enrolled, and 8 (27.6%) were female. Among them, 23 (79.3%) had a history of old myocardial infarction, and 9 (31.0%) had a history of chronic heart failure. During the intervention period, the average daily step counts increased significantly from baseline in weeks 1-5 (week 1: 1165 steps; 95% CI, 319-2011; P = 0.009, week 2: 1508; 635-2382; P = 0.001, week 3: 1321; 646-1996; P < 0.001, week 4: 1436; 791-2081; P < 0.001, week 5:1148; 436-1860; P < 0.001). Higher body mass index was statistically associated with the smaller difference in step counts from the baseline, and the lower proportion of achievement of step count goals. Female sex was significantly associated with the higher proportion of achievement of step count goals. In conclusion, this pilot prospective interventional study demonstrated the effectiveness of gamification-based feedback systems that utilize non-monetary points to increase daily step counts in CVD patients.

Caring for Dementia Caregivers: Psychosocial Factors Related to Engagement in Self-Care Activities

Caregivers often prioritize the needs of the care recipient and neglect their own health needs. It is imperative to understand the factors related to their self-care practices and engagement in self-care activities. The present study examined the extent to which dementia caregivers engaged in self-care activities, how this varied depending on caregiver characteristics, and whether self-care engagement mediated the relationship between social support and caregiver outcomes. The study utilized baseline data from a diverse sample of dementia caregivers (N = 243) who participated in a randomized trial evaluating a psychosocial technology-based caregiver intervention. Results showed that the dementia caregivers engaged in low levels of self-care activities and that their engagement varied based on the caregivers' background characteristics (age, gender, race/ethnicity, relationship to the care recipient, and employment status). Less caregiver involvement (e.g., less ADL/IADL help provided and more caregiver preparedness) and more social support predicted higher self-care activity engagement. Self-care activity engagement served as a mediator, such that more social support predicted more self-care activities, which, in turn, were associated with more positive perceptions of caregiving and less caregiver burden and depression. The findings suggest a need for interventions that promote self-care engagement among dementia caregivers and underscore the importance of social support and caregiver preparedness to caregivers' well-being.