Resourcefulness training for grandmothers raising grandchildren: establishing fidelity

Acquiring Resourcefulness Skills: Formal Versus Informal Training

BACKGROUND

Although resourcefulness has been successfully taught during formal training programs, it can also be acquired informally through life experiences. Family caregivers have many opportunities for learning to be resourceful on their own and those who participate in research may acquire knowledge or skills that increase their resourcefulness. The effects of such differential experiences on the resourcefulness of family caregivers have not been examined over time.

OBJECTIVE

This study compared changes in resourcefulness over time in caregivers who received no intervention, an educational program, biofeedback, or Resourcefulness Training©.

METHODS

This longitudinal analysis of data from a randomized controlled trial involved 219 caregivers of persons with bipolar disorder who completed the Resourcefulness Scale© before no intervention, an educational program, biofeedback, or Resourcefulness Training, and at 6 and 12 months afterward. Differences across the groups were examined using RMANOVA. Patterns of mean scores including differences and linear trends in resourcefulness for the four groups were examined.

RESULTS

Overall, caregivers increased linearly in resourcefulness over time [F(1,215) = 4.836, P = .015]. Although each group showed improvement in resourcefulness, caregivers who received Resourcefulness Training showed the greatest improvement from baseline (estimated mean = 88.244, SE = 2.734) at both 6 months (estimated mean = 92.610, SE = 2.813, P = .026) and 12 months post-intervention (estimated mean = 95.049, SE = 2.752, P = .003).

CONCLUSIONS

Consistent with resourcefulness theory, the findings showed caregivers of persons with bipolar disorder became more resourceful over time with or without formal training. However, those who received Resourcefulness Training demonstrated resourcefulness skills sooner and to a greater extent, thereby providing the rationale for formal Resourcefulness Training programs.

Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review

This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.

Resourcefulness as a mediator in the relationship between self-perceived burden and depression among the young and middle-aged stroke patients: A cross-sectional study

Objective

To explore the relationships among self-perceived burden, resourcefulness and depression, and to study further whether resourcefulness mediates the effects of self-perceived burden on depression in young and middle-aged stroke patients.

Methods

A cross-sectional survey was conducted with 1050 young and middle-aged stroke patients. We used a general demographic questionnaire, Self-Perceived Burden Scale (SPBS), Resourcefulness Scale© (RS) and Hamilton Depression Scale (HAMD) to assess self-perceived burden, resourcefulness, and depression. Statistical methods included correlation analysis, multiple linear regression, and structural equation model.

Results

1018 valid questionnaires were collected with a response rate of 96.95%. Resourcefulness was inversely correlated with self-perceived burden (r = -0.367, p < 0.01) and depression (r = -0.625, p < 0.01); Self-perceived burden was positively associated with depression (r = 0.698, p < 0.01). Multiple linear regression analyses showed that resourcefulness mediated the effects of self-perceived burden on depression; The structural equation model demonstrated that the resourcefulness mediated the relationship between self-perceived burden and depression.

Conclusion

Resourcefulness is a mediator between self-perceived burden and depression. Medical staff adjust the psychological state of stroke patients based on the theory of resourcefulness, thereby improving their problem-solving ability, actively encouraging patients to establish problem-solving strategies, providing disease rehabilitation knowledge and skills, and promoting the improvement of resourcefulness level.

Caregiving Stress and Self-Rated Health during the COVID-19 Pandemic: The Mediating Role of Resourcefulness

Family caregivers faced unprecedented circumstances and experienced increased levels of stress during the COVID-19 pandemic. Resourcefulness can minimize the effect of stress on health outcomes. The purpose of this study was to examine the associations between caregiving stress during the pandemic, resourcefulness, and self-rated health and assess the mediating effect of resourcefulness. A convenience sample of 70 family caregivers of adults with chronic and/or disabling conditions was recruited using social media groups and professional networking platforms. Data were collected using an online survey and analyzed using linear regression. Mediation analysis was conducted using the PROCESS macro. Higher levels of caregiving stress during the pandemic and lower levels of resourcefulness were associated with worse self-rated health, while controlling for age, employment status, and weekly caregiving hours. Resourcefulness mediated the relationship between caregiving stress and self-rated health. Our findings highlight the importance of assessing the psychological impact of the pandemic on family caregivers' outcomes. Resourcefulness skills can be targeted to improve the health and well-being of family caregivers during and beyond the pandemic.

Effects of Teaching Resourcefulness in Patients with Coronary Heart Disease

This cluster randomized controlled trial aimed to investigate the effects of an intervention to teach resourcefulness on depression and coping style of patients with coronary heart disease (CHD). A convenience sample of 72 patients in community settings took part. Participants in the intervention group (n = 36) received an 8-week intervention based on the concept of resourcefulness, plus routine health education. Participants in the control group (n = 36) received routine health education only. After the intervention, participants in the intervention group had significantly higher scores on resourcefulness and coping styles, and lower scores on depression than those in the control group (both ps < .001). The findings suggest that a well-developed intervention to teach resourcefulness could help patients with CHD to be more resourceful, improve their level of depression, and choose more effective strategies to cope with stress.

Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade?

BACKGROUND AND OBJECTIVES

In this manuscript, we update the literature over the last decade in addressing several new content areas that have emerged in the grandfamilies literature, along with issues that are still important to understanding grandparents raising their grandchildren today.

RESEARCH DESIGN AND METHODS

The social science and gerontological literature since 2004 was accessed, reviewed, organized topically, and integrated, based upon an exhaustive PsychINFO literature search.

RESULTS

Our review indicates an ongoing and/or growing emphasis on (a) the strengths of grandparent raising grandchildren, (b) diversity among grandfamilies along a number of parameters, (c) the social-interpersonal, cultural, and policy-related contexts of grandfamilies, (d) process-focused research, (e) parenting, parenting skills, and family relationships, (f) grandparent psychological distress, (g) targets for and the efficacy of interventions with grandfamilies, and (h) methodological issues relevant to the study of grandfamilies.

IMPLICATIONS

We discuss the implications of our findings in terms of more completely understanding grandfamilies along a number of parameters, as well as presenting specific recommendations for future research and practice.

Is There More to Resourcefulness Than Personal and Social Skills?

This study examined relationships among personal and social resourcefulness and spiritual practices and their associations with perceived stress, depressive symptoms, and self-assessed health in 138 women caregivers of elders with dementia. Caregivers who rated high on personal and social resourcefulness and spiritual practices (by median splits) had the lowest perceived stress, fewest depressive symptoms, and best self-assessed health, followed in sequence by women rating high on two of the three, high on one of the three, and low on all three. Hierarchical regression analyses that introduced spiritual practices after resourcefulness showed significant increases in the R-square change by 3% and 5% for perceived stress and depressive symptoms, respectively, but no significant change for self-assessed health. Strong associations among personal and social resourcefulness and spiritual practices, and similar relationships with two health outcomes, suggest that spiritual practices may be a third dimension of resourcefulness.

Positive Thinking Training Intervention for Caregivers of Persons with Autism: Establishing Fidelity

More than 3.5 million in the US are diagnosed with autism spectrum disorder (ASD) and caregivers experience stress that adversely affects their well-being. Positive thinking training (PTT) intervention can minimize that stress. However, before testing the effectiveness of PTT, its fidelity must be established. This pilot intervention trial examined fidelity of an online PTT intervention for ASD caregivers with a random assignment of 73 caregivers to either the online PTT intervention or to the control group. Quantitative data [Positive Thinking Skills Scale (PTSS)] and qualitative data (online weekly homework) were collected. The mean scores for the PTSS improved for the intervention group and decreased for the control group post intervention. Evidence for use of PTT was found in caregivers' online weekly homework. The findings provide evidence of the implementation fidelity of PTT intervention and support moving forward to test PTT effectiveness in promoting caregivers' well-being.

Interventions to Improve Grandparent Caregivers’ Mental and Physical Health: An Integrative Review

The aim of this integrative review is to appraise grandparent caregiver interventions that are designed to improve their physical and mental health. A database search was performed to identify relevant studies published between January 1, 1980, and December 31, 2014. Thirteen publications, including 11 studies, met all inclusion and exclusion criteria. All studies included grandparent mental health outcomes with fewer focusing on physical health and social relations. Improvements were found in all three areas with fewer improvements seen in physical health. However, small effect sizes were seen with most measures of these outcomes. Although the interventions led to positive grandparent caregiver outcomes, the studies were limited by their design, only one of which was a randomized controlled trial. Also, interventions did not consider variations in the grandchild’s or parent’s ages or if the grandparent provided primary or shared care. These gaps should be addressed in future research.

Journaling as reinforcement for the resourcefulness training intervention in mothers of technology-dependent children

Resourcefulness, a set of cognitive and behavioral skills used to attain, maintain, or regain health, is a factor related to depressive symptoms in mothers of children with chronic conditions and complex care needs who are dependent on medical technology such as mechanical ventilation or feeding tubes. The purpose of this secondary analysis of a randomized, controlled pilot intervention study was to determine the feasibility, acceptability and fidelity of daily journal writing as a method of reinforcement of resourcefulness training (RT) that teaches the use of social and personal resourcefulness skills. Participants returned their journals to the study office at the end of the four-week journaling exercise. Content analysis from exit interviews and journals supported the feasibility, acceptability and fidelity of daily journaling for reinforcement of RT in this population. Journal writing can be used by pediatric nurses to reinforce and promote resourcefulness skill use in parents of technology-dependent children.

Resourcefulness Training for Dementia Caregivers: Establishing Fidelity

Providing care for an elder with dementia can produce extreme stress that adversely affects caregiver health. Learning to be resourceful, which involves practicing resourcefulness skills using a journal or voice recorder, may reduce caregiver stress. However, before testing the effectiveness of journaling and voice recording as resourcefulness training (RT) practice methods, intervention fidelity should first be established. This pilot trial with 63 women dementia caregivers examined the fidelity of journaling and voice recording and whether allowing a choice between the methods affected RT intervention fidelity. Following RT, Resourcefulness Scale scores were similar for journal and recorder methods but higher for caregivers in the choice versus random condition. Patterns of RT skill use documented in journals or recordings were similar for choice and random conditions and for journal and recorder methods. The results support the implementation fidelity of RT that allows caregivers to choose a method to reinforce their resourcefulness skills.

Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review

BACKGROUND

The American Behaviour Change Consortium (BCC) framework acknowledges patients as active participants and supports the need to investigate the fidelity with which they receive interventions, i.e. receipt. According to this framework, addressing receipt consists in using strategies to assess or enhance participants' understanding and/or performance of intervention skills. This systematic review aims to establish the frequency with which receipt is addressed as defined in the BCC framework in health research, and to describe the methods used in papers informed by the BCC framework and in the wider literature.

METHODS

A forward citation search on papers presenting the BCC framework was performed to determine the frequency with which receipt as defined in this framework was addressed. A second electronic database search, including search terms pertaining to fidelity, receipt, health and process evaluations was performed to identify papers reporting on receipt in the wider literature and irrespective of the framework used. These results were combined with forward citation search results to review methods to assess receipt. Eligibility criteria and data extraction forms were developed and applied to papers. Results are described in a narrative synthesis.

RESULTS

19.6% of 33 studies identified from the forward citation search to report on fidelity were found to address receipt. In 60.6% of these, receipt was assessed in relation to understanding and in 42.4% in relation to performance of skill. Strategies to enhance these were present in 12.1% and 21.1% of studies, respectively. Fifty-five studies were included in the review of the wider literature. Several frameworks and operationalisations of receipt were reported, but the latter were not always consistent with the guiding framework. Receipt was most frequently operationalised in relation to intervention content (16.4%), satisfaction (14.5%), engagement (14.5%), and attendance (14.5%). The majority of studies (90.0%) included subjective assessments of receipt. These relied on quantitative (76.0%) rather than qualitative (42.0%) methods and studies collected data on intervention recipients (50.0%), intervention deliverers (28.0%), or both (22.0%). Few studies (26.0%) reported on the reliability or validity of methods used.

CONCLUSIONS

Receipt is infrequently addressed in health research and improvements to methods of assessment and reporting are required.

Preliminary Evidence for Effectiveness of Resourcefulness Training in Women Dementia Caregivers

Nearly 10 million women in the U.S. are caregivers for an elder with dementia, which often produces overwhelming stress and adversely affects their health. Resourcefulness training (RT) may promote the caregiver's optimal health and continue in their caregiving role. This pilot trial of 138 women dementia caregivers examined the effectiveness of RT on perceived stress, depressive cognitions, and negative emotions over time. Caregivers were first randomized to RT or no RT and then further randomized into random versus choice conditions followed by assignment to the journal or recorder methods, thus creating eight groups. We examined differences on perceived stress, depressive cognitions, and negative emotions between groups: 1) RT versus no-RT, 2) choice versus random condition; and 3) journaling versus recording. Significant time by group interactions were found on stress (F=4.36, p<.05), depressive cognitions (F=10.93, p<.001), and negative emotions (F=20.48, p<.001) in the RT versus no RT group. No differences were found between the random versus choice conditions or the journaling versus recording methods for practicing the RT skills. The results provide evidence for the effectiveness of RT for decreasing stress, depressive cognitions, and negative emotions in women caregivers of elders with dementia. The findings also suggest the need for further examination of the effects of allowing caregivers to choose a method for practicing RT in larger samples if caregivers of elders with dementia.

Evaluating an Online Resourcefulness Training Intervention Pilot Test Using Six Critical Parameters

Few resources are available to help grandmother caregivers to grandchildren manage their complex family situations that may have immediate and long-term consequences for themselves and their families. Resourcefulness training is an intervention designed to help grandmothers improve their ability to deal with these problems. The purpose of this pilot study was to evaluate the necessity, feasibility, acceptability, fidelity, safety, and effectiveness (i.e., effect sizes) of an online, computer-based resourcefulness training intervention that was adapted from a face-to-face intervention. Twelve grandmothers raising or living with grandchildren participated in the pilot intervention that included (a) watching an instructional video on resourcefulness, (b) completing two online questionnaires over a 6-week time period, and (c) writing in an online journal every day for 4 weeks. Data are evaluated within the context of the six parameters important to intervention development. Qualitative and quantitative results provide initial support for all six parameters. Recommendations to improve aspects of the intervention are discussed.

The Effect of a Resourcefulness Training Intervention on Relocation Adjustment and Adaptive Functioning among Older Adults in Retirement Communities

The population of older adults is increasing rapidly and is expected to reach 83.7 million by the year 2050. Previous research demonstrates that greater resourcefulness is associated with better quality of life and life satisfaction. The purpose of this pilot study was to evaluate the effects of a resourcefulness training intervention on positive cognitions, resourcefulness, relocation adjustment, and adaptive functioning among older adults who have relocated to retirement communities. Resourcefulness theory provided the theoretical framework for this study. Forty older adults who relocated to three retirement communities in Milwaukee, WI were randomly assigned to either a diversional activity group or to a resourcefulness training (RT) intervention group. Two older adults dropped out of the study (one from the diversional activity group and one from the RT group), leaving 38 elders. The results of the study indicated that there were slight increases (a trend) in the mean of positive cognitions, relocation adjustment, adaptive functioning, and personal resourcefulness in the expected direction for the RT intervention group as compared to the diversional group. Recommendations for future research include the use of larger and more diverse samples over a longer periods of time (6 weeks and 12 weeks post-intervention) as well as the use of cut scores on the resourcefulness scale so that the RT training intervention is taught to those who need it.

Interventions for Grandmothers: Comparative Effectiveness of Resourcefulness Training, HRV Biofeedback, and Journaling

In the United States, more than one million grandmothers are raising their grandchildren, and this can be stressful, produce depressive symptoms, and adversely affect their quality of life. The pilot trial of 60 grandmothers reported here examined the effects of a cognitive behavioral intervention (resourcefulness training), biofeedback control training (focused on heart rate variability), and journaling on measures of perceived stress, depressive symptoms, and quality of life. Comparative analysis revealed a decrease in stress with all three conditions; a decrease in depressive symptoms in the resourcefulness training group; and improved quality of life in the resourcefulness training and biofeedback groups.

Resourcefulness training for grandmothers: preliminary evidence of effectiveness

In this pilot study of 102 grandmothers raising grandchildren, we used a quasi-experimental, repeated measures design to examine effects of resourcefulness training reinforced by expressive writing (journaling) or verbal disclosure (digital voice recording) in reducing stress and depressive symptoms and enhancing quality of life. Resourcefulness training was compared with expressive writing, verbal disclosure, and attention control conditions. Both the expressive writing and verbal disclosure methods for reinforcing resourcefulness training were more effective than the other three conditions in reducing stress and depressive symptoms and improving quality of life. No difference was found between the two reinforcement methods. Grandmothers may benefit from learning resourcefulness skills and from practicing them in ways that best fit their needs and lifestyles.