The Impact of an Intervention to Improve Caregiver Contribution to Heart Failure Self-care on Caregiver Anxiety, Depression, Quality of Life, and Sleep

Heterogeneity of Fatigue in Patients with Chronic Heart Failure: Latent Categories and Influencing Factors

Objective

The objective of this study was to analyze the latent categories of fatigue in patients with chronic heart failure (CHF), explore their characteristic differences, and identify the associated influencing factors.

Methods

This cross-sectional study included 289 patients with CHF who were enrolled at 2 tertiary-level hospitals in Shandong, China, from August to December 2023. The convenience sampling method was used to collect data. Furthermore, the level of fatigue, insomnia, anxiety, depression, and social support were evaluated using the Chinese version of the Multidimensional Fatigue Inventory-20, Insomnia Severity Index, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Multidimensional Scale of Perceived Social Support. Latent profile analysis was performed to elucidate the latent categories of fatigue in the patients. In addition, the risk factors associated with the different categories were assessed using multiple logistic regression analyses.

Results

The average fatigue score was 62.45 ± 13.55. The potential fatigue profile of CHF was divided into three categories: low fatigue group C1 (18.6%), moderate fatigue group C2 (47.4%), and high fatigue group C3 (34.0%). Multiple logistic regression analysis showed that C3 patients with CHF were mainly characterized by lower ejection fraction (OR = 0.01, p = 0.008), insomnia (OR = 1.19, p = 0.005), and anxiety (OR = 1.20, p = 0.034). C2 patients indicated lower ejection fraction (OR = 0.04, p = 0.040), and C1 patients had higher social support (OR = 0.91, p < 0.001; OR = 0.93, p < 0.001).

Conclusion

This study indicated that CHF patients had significantly heterogeneous levels of fatigue. Therefore, it is recommended that medical staff could adopt more precise interventions according to different category characteristics to improve the outcomes of patients with CHF.

Coping With Chronic Obstructive Pulmonary Disease Together: A Dyadic Study of Self-Care and Quality of Life in Patients and Their Caregivers

AIM

To investigate the relationship between self-care and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) and their caregivers.

DESIGN

A multicentre, cross-sectional study.

METHODS

COPD patients and their caregivers were recruited from four tertiary hospitals in Jinan, Shandong Province, China from March to November 2022. Data collection included demographic and clinical characteristics, patients' self-care, caregivers' contribution to patient self-care, and QOL. Statistical analysis included descriptive statistics, paired t-tests, Pearson correlations and Actor-Partner Interdependence Model (APIM) analyses.

RESULTS

A total of 275 valid questionnaires were collected (patients: 67.6% male, mean age 70.5; caregivers: 58.5% female, mean age 54.2). APIM analyses revealed actor effects of self-care on QOL for both patients and caregivers, as well as partner effects indicating the influence of one's self-care on the partner's QOL.

CONCLUSION

This study elucidates the dyadic relationship between self-care and QOL in COPD patients and caregivers. Higher levels of self-care maintenance by both patients and caregivers were associated with improved physical and mental QOL. Conversely, increased self-care monitoring was correlated with reduced QOL for both patients and caregivers. No significant relationship was found between self-care management and QOL.

IMPLICATIONS FOR THE PROFESSION

For healthcare professionals specialising in geriatric care, our research provides more valuable guidance for the nursing of COPD patients. While maintaining vigilance is essential for both COPD patients and caregivers, our study suggests that excessive monitoring may have adverse effects on QOL, though this impact may vary depending on the underlying need for monitoring. This underscores the importance of tailored interventions that balance necessary vigilance with the potential risks of over-monitoring. By carefully considering the motivations behind monitoring, professionals can better support both patients and caregivers, ultimately enhancing self-care, improving QOL and contributing to healthy ageing.

REPORTING METHOD

The STROBE checklist was used to report the present study.

PATIENT OR PUBLIC CONTRIBUTION

During the research design phase, we conducted interviews with patients and caregivers to capture pertinent issues related to their daily self-care routines. This initial step allowed us to gain an understanding of the potential differences between patients' self-care levels and caregivers' contributions to patients' self-care, while also exploring the potential impact on their health. Prior to data collection, we conducted a pilot study to identify any shortcomings in the research design and made corresponding adjustments. The phrasing of questions in the questionnaire was refined based on the feedback from patients and caregivers. During the interpretation phase, we solicited feedback from a subset of patients and caregivers to further validate our findings, thereby enhancing the clarity and relevance of our results for the target audience.

Psychometric Testing of the Cross-Culturally Adapted Thai Version of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale in Caregivers of Patients With Chronic Illnesses

AIM

To evaluate the psychometric properties of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC).

BACKGROUND

The CSE-CSC scale was developed congruently with the Caregiver Contribution to Self-Care of Patient with Chronic Illness Inventory (CC-SC-CII) to assess caregiver self-efficacy (CSE), the motivation factor of caregiving. Its applicability in Asian populations, including Thailand, was limited.

METHODS

Psychometric tests were guided by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) principles. This included translating the English version into Thai, following the principles of good practice for the translation and cultural adaptation process for patient-reported outcome (PRO) measures. Nine nursing experts evaluated the content validity. The analysis included caregivers of patients with chronic conditions from 16 primary care centres in Thailand. We tested the structural validity using exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and concurrent validity for CC-SC-CII-v2. We tested the scale's reliability with methods for multidimensional and unidimensional constructs, the intraclass correlation coefficients (ICCs) and measurement error variance.

RESULTS

Kappa coefficient (k = 1.00) indicated the scale's excellent content validity. The final analysis included a total of 407 samples. The EFA with the first split-half subsample (n = 194) extracted a two-dimensional structure. One reflected CSE in Maintenance and Monitoring behaviour and another captured CSE in Management behaviour. CFA with the second split-half subsample (n = 213) and the overall sample (n = 407) supported the scale's bidimensional model with high factor loadings. Each dimension and the overall CSE-CSC scale positively correlated with each scale and the overall CC-SC-CII-v2. McDonald's ω and Cronbach's α (both ranged from 0.91-0.94) indicated excellent internal reliability. Test-retest reliability showed ICCs between 0.95 and 0.96. Measurement error yielded satisfactory results.

CONCLUSION

Testing of the Thai CSE-CSC scale supported validity and reliability, indicating that the scale can apply to Thai caregivers. This scale can be used in clinical practice and research to evaluate CSE in contribution to patient self-care.

Language Validation and Cultural Adaptation of the Italian Version of the Family Caregiver Quality of Life Scale

BACKGROUND

Heart failure significantly impacts healthcare systems and society, affecting quality of life (QoL) due to its symptoms and continuous care needs. Nurses are crucial in managing heart failure, supporting both patients and caregivers who face physical, emotional, social, and spiritual challenges. The Family Caregiver Quality of Life (FAMQOL) scale evaluates caregivers' QoL across all dimensions. This study aims to translate and culturally adapt the FAMQOL from English to Italian, enhancing its utility in nursing research and practice to better identify and support caregiver well-being.

METHODS

Following EORTC guidelines (2017), the FAMQOL underwent linguistic validation and cultural adaptation. This included independent forward translations from English to Italian, back translations, and reconciliation discussions to produce a testable translation. A pilot test with 15 caregivers assessed the questionnaire's acceptability and comprehensibility.

RESULTS

Linguistic adjustments ensured the questionnaire's understandability in Italian. Interviews confirmed its acceptability and comprehensibility, with minor modifications enhancing clarity.

CONCLUSIONS

The translation process successfully adapted the FAMQOL for Italian caregivers. This tool is essential for nursing research and practice, providing a culturally relevant assessment of the burden of care. It allows targeted interventions to support health workers, intercepting the QoL of caregivers early and, consequently, the well-being of patients with heart failure.

Quality of Life and Incidence of Clinical Signs and Symptoms among Caregivers of Persons with Mental Disorders: A Cross-Sectional Study

BACKGROUND

Caring for individuals with mental disorders poses significant challenges for caregivers, often leading to compromised quality of life and mental health issues such as stress, anxiety, and depression. This study aims to assess the extent of these challenges among caregivers in Greece, identifying which demographic factors influence their well-being.

METHOD

A total of 157 caregivers were surveyed using the SF-12 Health Survey for quality-of-life assessment and the DASS-21 questionnaire for evaluating stress, anxiety, and depression symptoms. t-tests, Kruskal-Wallis tests, Pearson's correlation coefficients, and regression analyses were applied to understand the associations between demographics, quality of life, and mental health outcomes.

RESULTS

The study found that caregivers, especially women and younger individuals, faced high levels of mental health challenges. Marital status, educational level, and employment status also significantly influenced caregivers' well-being. Depression was the most significant factor negatively correlating with the mental component of quality of life. The magnitude of the burden experienced by caregivers highlighted the urgency for targeted social and financial support, as well as strategic treatment programs that consider caregiver well-being.

CONCLUSIONS

Caregivers of individuals with mental disorders endure significant stress, anxiety, and depression, influencing their quality of life. Demographic factors such as age, gender, marital status, education, and employment status have notable impacts. Findings emphasize the need for society-wide recognition of caregivers' roles and the creation of comprehensive support and intervention programs to alleviate their burden, particularly in the context of the COVID-19 pandemic.