A Multilevel Modeling Approach to Examine Incongruent Illness Appraisals in Family Care Dyads Over Time

Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory

BACKGROUND

Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD).

AIMS

The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI).

METHODS

The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores.

RESULTS

We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales.

CONCLUSION

The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads

CONTEXT

To effectively manage cancer pain, there is a need to understand how caregiving dyads appraise symptoms. Dyadic appraisal of symptoms influences whether the dyad perceives the patient's pain is managed well and whether they are on the same page with their appraisal. Beliefs can act as barriers to the dyadic appraisal.

OBJECTIVES

This secondary data analysis examined incongruence within Black cancer caregiving dyads regarding beliefs about pain management and potential medication side effects using the Barriers Questionnaire-13. Associated factors were also examined.

METHODS

Guided by the Theory of Dyadic Illness Management, dyadic multilevel modeling was conducted with data from 60 Black cancer caregiving dyads to determine the dyadic appraisal of beliefs about pain management and potential medication side effects, which includes the average perception of barriers within the dyad (i.e., dyadic average) and the dyadic incongruence (i.e., gap between patient and caregiver).

RESULTS

On average, Black cancer caregiving dyads reported moderate barriers regarding pain management (2.262 (SE=0.102, P<0.001) and medication side effects (2.223 (SE=0.144, P<0.001). There was significant variability across dyads regarding barriers to pain management and medication side effects. Lower patient education and higher patient-reported pain interference were significantly associated with more perceived barriers to pain management and potential medication side effects. Incongruence within dyads regarding barriers to pain management and medication side effects were significantly associated with the caregiver's report of patient's pain interference.

CONCLUSION

Findings suggest the importance of appraisal that includes both members of Black cancer caregiving dyads regarding pain management.

Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases

BACKGROUND

Neurodegenerative diseases (NDDs) are increasingly prevalent and radically alter the lives of individuals and their informal care partners (together called a dyad). As symptoms progress, dyads are at risk for elevated emotional distress and declines in relationship functioning and quality of life. Psychosocial interventions delivered to dyads early after diagnosis have successfully prevented chronic emotional distress across several chronic illnesses including cancer and acute brain injury. Dyads with NDD could benefit from such interventions, however, they are limited. Because NDDs have symptom profiles that are distinct from other chronic illnesses, they require a unique framework and interventions. Given the limited dyadic interventions and unified symptoms across NDDs, a transdiagnostic framework may help to enhance scalability and efficiency. To address this problem, we developed a transdiagnostic framework that cuts across NDD physical and emotional diagnoses to inform cost-effective and sustainable NDD dyadic interventions.

METHODS

To develop this framework, we conducted: (1) a narrative review on dyadic adjustment and existent dyadic interventions for those with NDDs, and (2) integrated findings to develop our NDD transdiagnostic framework for dyadic interventions early after diagnosis.

RESULTS

Findings revealed no existent dyadic interventions for NDDs delivered shortly after diagnosis. Among available interventions, all were delivered later in disease progression, thereby focusing on dyadic challenges at more advanced stages. In addition, although research emphasized the influence of individual, dyadic, and contextual factors on dyads' early adjustment to NDDs, no conceptual model has been developed. Informed by theory and current research, we introduce an NDD transdiagnostic framework for couples' early biopsychosocial adjustment. This framework includes NDD specific: contextual factors, illness-related factors, individual and dyadic stressors, adaptive coping strategies, and dyads' resources.

CONCLUSIONS

Our NDD transdiagnostic framework can be used to inform early dyadic psychosocial interventions that cut across all NDDs. This approach has important implications for implementation and scalability.