1
|
Bolgeo T, Di Matteo R, Simonelli N, Dal Molin A, Bassola B, Lusignani M, Maconi A, Rasero L, Iovino P, Vellone E. Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory. PLoS One 2024; 19:e0302891. [PMID: 38728276 PMCID: PMC11086860 DOI: 10.1371/journal.pone.0302891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Tatiana Bolgeo
- Research Training Innovation Infrastructure, Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure, Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Niccolò Simonelli
- SC Cardiology, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Health Professions’ Direction, Maggiore della Carità Hospital, Novara, Italy
| | - Barbara Bassola
- School of Nursing, University of Milan, Niguarda Hospital, Milan, Italy
| | - Maura Lusignani
- School of Nursing, University of Milan, Niguarda Hospital, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Maconi
- Director of Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Iovino
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
2
|
Yang W, Sun L, Hao L, Zhang X, Lv Q, Xu X, Wang Y, Li Y, Zhou L, Zhao Y, Zang X, Wang Y. Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial. EClinicalMedicine 2024; 69:102481. [PMID: 38370538 PMCID: PMC10874718 DOI: 10.1016/j.eclinm.2024.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme. Methods This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168. Findings Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (β: 8.5, 95% CI: 0.7, 16.4) and management (β: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (β: 9.7, 95% CI: 1.5, 17.9) and T2 (β: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints. Interpretation Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions. Funding The National Natural Science Foundation of China.
Collapse
Affiliation(s)
- Weiling Yang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lili Hao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
3
|
Kleman C, Turrise S, Winslow H, Alzaghari O, Lutz BJ. Individual and systems-related factors associated with heart failure self-care: a systematic review. BMC Nurs 2024; 23:110. [PMID: 38336711 PMCID: PMC10854154 DOI: 10.1186/s12912-023-01689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/25/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 - Dec 2021) using the Socioecological Model as a review framework. METHODS An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review. RESULTS A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level. CONCLUSION Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.
Collapse
Affiliation(s)
- Carolyn Kleman
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA.
| | - Stephanie Turrise
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| | - Heidi Winslow
- Manager of Nurse Residencies, Novant New Hanover Regional Medical Center, 2131 S. 17th Street, Wilmington, NC, 28401, USA
| | - Omar Alzaghari
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| | - Barbara J Lutz
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| |
Collapse
|
4
|
Xu M, Ruan T, Luo Z, Sun L, Zhu L, Hu S. Empowered But Isolated: A Qualitative Research on Experiences of Family Caregivers of Patients With Acute Heart Failure in China. J Cardiovasc Nurs 2023; 38:546-554. [PMID: 37816082 DOI: 10.1097/jcn.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Family caregivers play crucial roles in the self-management of patients with heart failure (HF). However, little is known about caregiving experiences of Chinese family caregivers during acute HF. OBJECTIVE The aim of this study was to describe Chinese family caregivers' experiences in symptom management and care-seeking during acute HF. METHODS This is an exploratory, qualitative study using the Consolidated Criteria for Reporting Qualitative Research guidelines. Data were collected through semistructured interviews and analyzed with thematic analysis. FINDINGS A total of 21 family caregivers of patients with acute HF were enrolled in this study. "Empowered but isolated" was identified as the overarching theme during data analysis, including 3 themes and 6 subthemes: (1) "Responsible symptom managers: leading the home-based symptom management," including 2 subthemes, "Proxy in symptom management" and "Only knowing the surface, instead of the truth"; (2) "Powerless anchors: care-seeking is a torturous journey," including 2 subthemes, "Facing discrepancies in care-seeking" and "Seeing a doctor is the last choice"; (3) "Carrying the weight forward: responsibility combing with emotional burnout," including 2 subthemes, "Living on tenterhooks" and "Submitting to fate." CONCLUSIONS In this study, we described Chinese family caregivers' experiences in symptom management and care-seeking during acute HF. Although empowered as proxy, they were also isolated bearing a great burden, receiving insufficient support from patients, family, and the medical system.
Collapse
|
5
|
Mokhnatkin JV, Bae M, Dale W, Tiwari A, Patanapirom J, Sedrak MS. Facilitators and Barriers to Older Adult Participation in Cancer Trials: A Qualitative Study Exploring Patient-Caregiver Dyad Congruence. JCO Oncol Pract 2023:OP2200843. [PMID: 37079865 DOI: 10.1200/op.22.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
PURPOSE Family caregivers play an integral role in caring for older adults with cancer. Few studies have examined older adults with cancer and their family caregivers as a unit in a relationship or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with cancer, including the decision to enroll in a cancer clinical trial. METHODS Semistructured interviews of 32 older women (age ≥ 70 years) with breast cancer and their family caregivers (16 dyads) were conducted at both academic and community settings from December 2019 to March 2021 to explore perceived facilitators and barriers to cancer trials. Dyad congruence was defined as aligned (matching) perspectives, and incongruence was defined as misaligned (nonmatching) perspectives. RESULTS Five (31%) of 16 patients were age ≥80 years, 11 (69%) had nonmetastatic breast cancer, and 14 (88%) were treated in an academic setting. Six (38%) of 16 caregivers were in the 50-59 age group, 10 (63%) were female, and seven (44%) were daughters. Dyad congruence centered on the clinical benefit of trials and physician recommendation. However, compared with caregivers, patients were more motivated to contribute to science. Patients and caregivers also differed on the perceived extent to which the caregiver influenced enrollment. CONCLUSION Older patients with cancer and their caregivers generally agree about the facilitators and barriers to cancer trial enrollment, but some perceptions are misaligned. Further research is needed to understand whether misaligned perspectives between patients and caregivers influence clinical trial participation of older adults with cancer.
Collapse
|
6
|
Abshire Saylor M, DeGroot L, Pavlovic N, McIlvennan CK, Taylor J, Gilotra NA, Gallo JJ, Davidson PM, Wolff JL, Szanton SL. The Context of Caregiving in Heart Failure: A Dyadic, Mixed Methods Analysis. J Cardiovasc Nurs 2023; 38:00005082-990000000-00079. [PMID: 37068019 PMCID: PMC10567991 DOI: 10.1097/jcn.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Caregiving for persons with heart failure (HF) varies based on the individual, family, and home contexts of the dyad, yet the dyadic context of HF caregiving is poorly understood. OBJECTIVE The aim of this study was to explore dyadic perspectives on the context of caregiving for persons with HF. METHODS Family caregivers and persons with HF completed surveys and semistructured interviews. Investigators also photographed caregiving areas to complement home environment data. Descriptive qualitative analysis resulted in 7 contextual domains, and each domain was rated as strength, need, or neutral. We grouped dyads by number of challenging domains of context, categorizing dyads as high (≥3 domains), moderate (1-2 domains), or minimal (0 domains) needs. Quantitative instruments included the 36-item Short Form Health Survey, ENRICHD Social Support, HF Symptom Severity, and Zarit Burden Interview. We applied the average score of each quantitative measure to the groups derived from the qualitative analysis to integrate data in a joint display. RESULTS The most common strength was the dyadic relationship, and the most challenging domain was caregiving intensity. Every dyad had at least 2 domains of strengths. Of 12 dyads, high-needs dyads (n = 3) had the worst average score for 7 of 10 instruments including caregiver and patient factors. The moderate-needs dyads (n = 6) experienced the lowest caregiver social support and mental health, and the highest burden. CONCLUSION Strengths and needs were evident in all patient-caregiver dyads with important distinctions in levels of need based on assessment of multiple contextual domains. Comprehensive dyadic and home assessments may improve understanding of unmet needs and improve intervention tailoring.
Collapse
|
7
|
Irani E, Buck HG, Lyons KS, Margevicius S, Vellone E, Bugajski A, De Maria M. Examining how congruence in and satisfaction with dyadic care type appraisal contribute to quality of life in heart failure care dyads. Eur J Cardiovasc Nurs 2023; 22:158-165. [PMID: 35709307 DOI: 10.1093/eurjcn/zvac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022]
Abstract
AIMS Given the complexity of heart failure (HF) management, persons with HF and their informal caregivers often engage in dyadic illness management. It is unknown how congruent appraisal of dyadic HF care type is associated with dyadic health. Our aim was to examine how congruence in and satisfaction with appraisal of dyadic HF care type contribute to quality of life (QOL) for dyads. METHODS AND RESULTS This is a secondary analysis of cross-sectional data on 275 HF care dyads (patients 45.1% female, caregivers 70.5% female). Congruent appraisal and satisfaction were assessed using the Dyadic Symptom Management Type instrument. Quality of life was measured using the Short Form-12. Multilevel dyadic models were estimated to examine the contribution of congruence and satisfaction with dyadic care type to physical and mental QOL. Congruent appraisal of dyadic care type was positively associated with caregivers' mental QOL (B = 2.69, P = 0.026). Satisfaction with dyadic care type was positively associated with physical and mental QOL for persons with HF (B = 1.58, P = 0.011 and B = 2.09, P = 0.002, respectively) and informal caregivers (B = 1.70, P = 0.004 and B = 2.90, P < 0.001, respectively), while controlling for age, New York Heart Association class, daily hours spent together, relationship type, and congruence with dyadic care type. CONCLUSION Satisfaction with dyadic care type appraisal was a stronger contributor to QOL for HF care dyads, compared with congruent appraisals. It is important to understand reasons for dissatisfaction within the dyad to assist dyad members in reaching shared appraisals while managing HF.
Collapse
Affiliation(s)
- Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA
| | - Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy
| | | | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy
| |
Collapse
|
8
|
Factors Related to Patients' Self-care and Self-care Confidence in Korean Patients With Heart Failure and Their Caregivers: A Cross-sectional, Correlational Study. J Cardiovasc Nurs 2023; 38:140-149. [PMID: 35507026 DOI: 10.1097/jcn.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure. OBJECTIVE The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure. METHODS In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression. RESULTS Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence. CONCLUSION Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care.
Collapse
|
9
|
Simonelli N, Bolgeo T, Iovino P, Di Matteo R, Maconi A, Vellone E. Self-care in coronary heart disease patient and caregiver dyads (HEARTS-IN-DYADS)-Protocol of a multicenter longitudinal study. Res Nurs Health 2023; 46:37-47. [PMID: 36538334 DOI: 10.1002/nur.22286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.
Collapse
Affiliation(s)
- Niccolò Simonelli
- SC Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tatiana Bolgeo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing Midwifery and Paramedicin Australian Catholic University, Melbourne, Victoria, Australia
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
10
|
Mitra R, Pujam SNK, Jayachandra A, Sharma P. Dyadic congruence, dyadic coping, and psychopathology: Implications in dyads for patients with acute coronary syndrome. JOURNAL OF MARINE MEDICAL SOCIETY 2023. [DOI: 10.4103/jmms.jmms_124_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
|
11
|
Nelson KE, Saylor MA, Anderson A, Buck H, Davidson PM, DeGroot L, Fisher M, Gilotra NA, Pavlovic N, Szanton SL. "We're all we got is each other": Mixed-methods analysis of patient-caregiver dyads' management of heart failure. Heart Lung 2022; 55:24-28. [PMID: 35436655 DOI: 10.1016/j.hrtlng.2022.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals living with heart failure often require informal caregiving assistance for optimal self-care maintenance. The influence of caregiver burden and resilience on dyadic congruence is not well understood. OBJECTIVE To compare how dyadic congruence is influenced by level of burden and resilience expressed by caregivers of patients with heart failure. METHODS Mixed-methods analysis of individuals with heart failure and their caregivers, focusing on measures of caregiver burden (Zarit Burden Interview) and resilience (Brief Resilience Scale). Data were integrated using the Heart Failure Care Dyadic Typology. RESULTS Twelve dyads (n=24 participants) were classified as Type II (n=7) and Type III (n=5) dyads. Among Type II dyads, average caregiver burden was 19.43 (± 13.89) and resilience was 3.16 (± 1.04). For Type III dyads, average caregiver burden was 3.80 (± 4.27) and resilience 4.07 (± 1.36), respectively. Two key themes were derived: 1) caregivers' tendency to take the lead, and 2) the usefulness of cognitive reframing. Data integration elucidated that theme 1 was more common among Type II dyads and those with higher burden, and theme 2 was more prevalent among Type III dyads and those with higher resilience. CONCLUSION Findings highlight important variances in how dyads collectively manage heart failure. Future inquiry should involve tailored intervention development to bolster informal caregivers' quality of life and ability to better support patients throughout their heart failure trajectory.
Collapse
Affiliation(s)
- Katie E Nelson
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | | | - Annabel Anderson
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Harleah Buck
- University of Iowa College of Nursing, Iowa City, IA, USA
| | | | - Lyndsay DeGroot
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Marlena Fisher
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Nisha A Gilotra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
12
|
Informal Caregivers’ Experiences with Performing Telemonitoring in Heart Failure Care at Home—A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10071237. [PMID: 35885765 PMCID: PMC9324585 DOI: 10.3390/healthcare10071237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.
Collapse
|
13
|
El-Dassouki N, Pfisterer K, Benmessaoud C, Young K, Ge K, Lohani R, Saragadam A, Pham Q. The value of technology to support dyadic caregiving for individuals living with heart failure: A qualitative descriptive study (Preprint). J Med Internet Res 2022; 24:e40108. [PMID: 36069782 PMCID: PMC9494221 DOI: 10.2196/40108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background The demand for health services to meet the chronic health needs of the aging population is significant and remains unmet because of the limited supply of clinical resources. Specifically, in managing heart failure (HF), digital health sought to address this gap during the COVID-19 pandemic but highlighted an access issue for those who could not use technology-mediated health care services without the support of their informal caregivers (ICs). The complexity of managing HF symptoms and recurrent exacerbations requires many patients to comanage their illness with their ICs in a care dyad, working together to optimize patient outcomes and health-related quality of life. However, most HF programs have missed the opportunity to consider the dyadic perspective despite interdependencies on HF outcomes. Objective This study aims to characterize the value of technology in supporting caregiving for individuals living with HF. Methods Motivated by an observed unique pattern of engagement in patients enrolled in our Medly HF management program at the Peter Munk Cardiac Centre in Toronto, Canada, we conducted 20 semistructured interviews with a convenience sample of ICs. All interviews were analyzed using the iterative refinement of a codeveloped codebook. The team maintained reflexivity journals to reflect the impact of their positionality on their coding. Themes were first derived deductively using HF typologies (patient-oriented dyads, caregiver-oriented dyads, and collaboratively oriented dyads) and then inductively refined and recategorized based on concepts from the van Houtven et al framework. Results We believe that there is a need to formally and intentionally expand HF technologies to include dyadic needs and goals. We suggest defining 3 opportunities in which value can be added to technological design. First, identify how technology may be leveraged to increase psychological bandwidth by reducing uncertainty and providing peace of mind. We found that actionable feedback was highly desired by both partners. Second, develop technology that can serve as a member of the dyad’s support system. In our experience, automated prompts for patients to take measurements can mimic the support typically provided by ICs and ease their workload. Third, consider how technology can mitigate the dyad’s clinical knowledge requirements and learning curve. Our approach includes real-time actionable feedback paired with a human-in-the-loop, nurse-led model of care. Conclusions Our findings identified a need to focus on improving the dyadic experience as a whole by building IC functionality into digital health self-management interventions. Through a shared model of care that supports the role of the patient in their own HF management, includes ICs to expand and enhance the patient’s capacity to care, and acknowledges the need of ICs to care for themselves, we anticipate improved outcomes for both partners.
Collapse
Affiliation(s)
- Noor El-Dassouki
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Kaylen Pfisterer
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Camila Benmessaoud
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Karen Young
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kelly Ge
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ashish Saragadam
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
14
|
Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041919. [PMID: 35206131 PMCID: PMC8871794 DOI: 10.3390/ijerph19041919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
Self-care behaviors are essential for the effective treatment of heart failure (HF), and poor self-care may lead to adverse clinical events in patients with HF. A growing body of literature addresses the need to analyze the characteristics of both patient and caregiver since they are in mutual, long-term interaction, and their reactions to events are dependent on each other. One of the most common approaches for analyzing data on HF self-care dyads is the Actor–Partner Interdependence Model (APIM). The purpose of this study was to conduct a scoping review to answer the following question: what did we learn from HF dyadic studies based on the APIM approach? Medline, Academic Search Ultimate, and CINAHL Complete databases were searched, using the terms “dyad,” “dyadic,” and “heart failure,” for studies published between 2009 and April 2021. Fifteen studies were reviewed from a pool of 106 papers. Studies using the APIM approach revealed interrelated patient and caregiver characteristics that influence self-care and explain many complex dyadic behaviors. Our analysis provided evidence that (1) APIM is a useful analytical approach; (2) a family-oriented approach can improve the functioning of a patient with HF; and (3) social support from caregivers significantly enhances patients’ adaptation to illness.
Collapse
|
15
|
Bugajski A, Szalacha L, Rechenberg K, Johnson A, Beckie T, Morgan H. Psychometric Evaluation of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory in the United States. Heart Lung 2021; 51:1-8. [PMID: 34731690 DOI: 10.1016/j.hrtlng.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND High quality self-care among individuals with chronic obstructive pulmonary disease (COPD) promotes better outcomes, however, there are few validated self-care measures that are psychometrically sound to be used in research. OBJECTIVES The purpose of this study is to examine the psychometric properties of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) in an English-speaking population in the United States. METHODS Factorial validity, construct validity and reliability of the SCCOPDI were examined using components analysis via principal components analysis, hypothesis testing via multivariate linear regression, Cronbach's alpha, and split-half reliability. RESULTS The SCCOPDI demonstrated strong evidence of validity and reliability on par with the SCCOPDI's original construction. Component analysis produced item loadings consistent with the theoretical underpinnings of the instrument. Reliability metrics yielded good internal consistency across all subscales of the SCCOPDI. CONCLUSIONS The SCCOPDI is a valid and reliable instrument to measure self-care in people with COPD.
Collapse
Affiliation(s)
- Andrew Bugajski
- Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805.
| | - Laura Szalacha
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Kaitlyn Rechenberg
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Ayesha Johnson
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Theresa Beckie
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| | - Hailey Morgan
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL 33612, United States.
| |
Collapse
|
16
|
De Maria M, Ferro F, Ausili D, Buck HG, Vellone E, Matarese M. Characteristics of dyadic care types among patients living with multiple chronic conditions and their informal caregivers. J Adv Nurs 2021; 77:4768-4781. [PMID: 34487558 DOI: 10.1111/jan.15033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS To examine the distribution of dyadic care types in multiple chronic conditions, compare self-care and caregiver contributions to patients' self-care in each care type and identify the patient and caregiver characteristics associated with each care type. DESIGN Secondary analysis of a multicentre, cross-sectional study. METHODS Patient-caregiver dyads were enrolled from outpatient clinics and community settings. The Dyadic Symptom Management Type Scale was used to categorize dyads by type. Self-care, self-efficacy, comorbidities and cognitive impairment were measured in patients, whereas caregiver contributions to patient self-care, self-efficacy, caregiver burden and hours of caregiving were measured in caregivers. Sociodemographic characteristics perceived social support and mutuality were measured in both patients and caregivers. Univariate and multivariate analyses were performed. RESULTS A sample of 541 patient-caregiver dyads was examined. The most frequent dyadic care type was the collaborative-oriented (63%). In the patient-oriented type, patients scored higher on self-care compared with caregivers; in the caregiver-oriented and collaborative types, caregivers scored higher than patients supporting the typology. The patient-oriented type was associated with younger, healthier male patients with better cognitive status, who scored higher for mutuality and whose caregivers scored lower for burden. The caregiver-oriented type was associated with older, less educated patients, with caregivers experiencing higher burden and unemployment. The collaborative type was associated with sicker patients, with the caregiver more probably to be female and employed, with higher perceived social support, mutuality and burden. The incongruent dyadic care type was associated with lower caregiver mutuality. IMPACT In the context of multiple chronic conditions, clinicians should consider targeting any educational interventions aimed at improving patient self-care and caregiver contributions to self-care by dyadic care types.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
17
|
A pilot randomized clinical trial of a teamwork intervention for heart failure care dyads. Heart Lung 2021; 50:877-884. [PMID: 34407481 DOI: 10.1016/j.hrtlng.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dyadic heart failure (HF) management can improve outcomes for patients and caregivers and can be enhanced through eHealth interventions. OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of an eHealth dyadic teamwork intervention, compared to an attention control condition. METHODS We recruited 29 HF patient-caregiver dyads from inpatient units and randomized dyads to an intervention or a control group. We calculated enrollment and retention rates, described acceptability using interview and questionnaire data, and computed intervention effect sizes. RESULTS 37% of eligible dyads agreed to participate and 93% of randomized participants completed follow-up questionnaires. Participants found both study conditions to be acceptable. Between-group effect sizes suggested that the intervention led to improvements in relationship quality, self-efficacy, and quality of life for patients and caregivers. CONCLUSIONS Dyadic recruitment from acute care settings is challenging. Findings provide initial evidence that our intervention can contribute to better health outcomes for HF dyads.
Collapse
|