Designing and Validation of Health-Related Quality of Life Inventory for Family Caregivers of Hemodialysis Patients

Phased therapeutic intervention improves long-term prognosis of new hemodialysis patients

Objective

To explore the effect of phased therapeutic intervention in improving the long-term prognosis of new hemodialysis(HD) patients.

Method

This was a retrospective study. A total of 90 new HD patients in Qinhuangdao Haigang Hospital from June 2021 to June 2022 were included and stratified according to their compliance. They were grouped using a random number generator. The control group was given routine nursing intervention, while the intervention group was intervened with phased change nursing intervention. The effects of different intervention modes on patient compliance, biochemical indicators, cardiac function indicators and inflammatory cytokines were compared.

Results

At T0, the compliance of the two groups was improved compared with that before the intervention. The compliance of the intervention group at T1 and T2 (71.11%, 91.11%) was higher than that of the control group(48.89%, 75.56%), with statistically significant differences(p< 0.05). At T0, the levels of hemoglobin(Hb), hematocrit(Hct), serum iron(SI), transferrin saturation (TS) and left ventricular ejection fraction(LVEF) all increased compared with those before intervention(p< 0.05), At T1 and T2, Hb, Hct, SI, TS and LVEF in the intervention group were higher than those in the control group(p< 0.05). At T1 and T2, LVEDD, LVESD and LVWT in the intervention group were smaller than those in the control group(p< 0.05).

Conclusion

Phased therapeutic intervention can significantly enhance the compliance of new HD patients, as well as further improve their anemia and cardiac function, and reduce inflammatory responses. Therefore, it is worthy of clinical application.

The Hemodialysis Distress Thermometer for Caregivers (HD-DT-C): development and testing of the psychometric properties of a new tool for screening psychological distress among family caregivers of adults on hemodialysis

PURPOSE

To develop and test the measurement properties of the HD-DT-C, a new tool designed to facilitate the screening of psychological distress and its sources in family caregivers of adults on hemodialysis.

METHODS

The present investigation was carried out in three phases: Phase 1 focused on the process of developing and exploring the content validity and clinical utility of the HD-DT-C using a mixed-methods approach and feedback panels; Phase 2, where the psychometric properties of this new tool were tested in a cross-sectional study (n = 106 caregivers); and Phase 3, where the European Portuguese version of the HD-DT-C was translated and culturally adapted into American English using a forward-backward translation procedure, followed by an expert panel review.

RESULTS

Findings suggested that the HD-DT-C was perceived by feedback panels as practical, appropriate, and useful for increasing dialysis provider/family caregiver communication in nephrology centers. The European Portuguese version of the HD-DT-C showed good test-retest reliability (ICC = 0.991 for the barometer and κ ≥ 0.80 in 77% of the checklist items), high diagnostic accuracy (AUC = 0.956), and strong convergent validity (all r ≥ 0.50) with reference measures that assess quality of life, caregiver burden, and symptoms of anxiety and depression. Cutoff scores with good clinical utility (CUI +  ≥ 0.70) were recommended for screening distress in research (≥ 6) and clinical practice (≥ 5).

CONCLUSION

The HD-DT-C is a brief, reliable, valid, and acceptable measure for identifying self-reported psychological distress and its sources among people caring for a family member or friend on hemodialysis. Future research is needed to explore the measurement properties of the American English version of this new tool.

Perceived stress, social support, and insomnia in hemodialysis patients and their family caregivers: an actor-partner interdependence mediation model analysis

Objectives

Patients' and caregivers' physical and mental health may interact. The theory of dyadic illness management holds that patients and caregivers should be regarded as a whole in health management. Previous studies have found that hemodialysis patients and their family caregivers experience poor sleep quality. Perceived stress and social support have effects on insomnia. However, the dyadic interaction between perceived stress, social support, and insomnia among hemodialysis patients and caregivers is unclear. This study aimed to explore the mediating role of social support in the association between perceived stress and insomnia in hemodialysis patient-caregiver dyads.

Methods

A total of 259 hemodialysis patient-caregiver dyads completed the Chinese Perceived Stress Scales (CPSS), the Perceived Social Support Scale (PSSS), and the Athens Insomnia Scale (AIS) in Lanzhou, China, from May 2022 to July 2022. The actor-partner interdependence mediation model analysis was used for data analysis.

Results

In the actor effect, there was a significant positive correlation between perceived stress and insomnia in hemodialysis patients (β = 0.091, p = 0.001) and their family caregivers (β = 0.588, p < 0.001). Patient's and caregiver's social support played partial mediating roles in the relationship between caregiver's perceived stress and insomnia (β = 0.135, p < 0.001 and β = 0.111, p < 0.001). In the partner effect, caregiver's perceived stress was positively connected with patient's insomnia (β = 0.915, p < 0.001), and the mediating effect of patient's social support on the relationship between caregiver's perceived stress and patient's insomnia was statistically significant (β = -0.040, p = 0.046).

Conclusion

The perceived stress, social support and insomnia of hemodialysis patients and their family caregivers had interactive effects. Effective dyadic-based interventions should be developed to improve hemodialysis patients' and caregivers' sleep quality.

Relationship between fatigue and quality of life and related factors in family caregivers of patients on hemodialysis

BACKGROUND

The incessant and stressful nature of providing care to patients with chronic diseases can cause fatigue in caregivers. Caregivers' fatigue and reduced quality of life can reduce the patient's quality of care. Since it is important to pay attention to the mental health of family caregivers, this study investigated the relationship between fatigue and quality of life and their related factors in family caregivers of patients on hemodialysis.

METHODS

This cross-sectional descriptive-analytical study was performed in 2020-2021. One hundred seventy family caregivers were recruited by convenience sampling from two hemodialysis referral centers in the east of Mazandaran province, Iran. The data collection tools were the Family Caregiver Quality of Life questionnaire and Krupp's fatigue severity scale.

RESULTS

The majority (88%) of caregivers had moderate to severe fatigue. Caregivers' fatigue was a major factor influencing their quality of life. There was a significant fatigue difference between some categories of kinship and the caregiver's income level (P < 0.05). Caregivers with lower income and education levels, those who were the patient's spouse, and those who could not leave the patient alone had significantly worse quality of life than other caregivers (P < 0.05). Also, caregivers living with the patient in the same house had a worse quality of life than those living separately (P = 0.05).

CONCLUSION

Considering the high prevalence of fatigue among family caregivers of patients on hemodialysis and its adverse effect on their quality of life, it is recommended to perform routine screenings and implement fatigue alleviation interventions for these caregivers.

Development and psychometric properties evaluation of caregiver burden questionnaire in family caregivers of hemodialysis patients

Backgorund

This study aimed to design and psychometrically evaluate the caregiver burden questionnaire for family caregivers of hemodialysis patients.

Methods

This study was conducted using an exploratory sequential mixed method on family caregivers of hemodialysis patients in Iran. In the first phase, the generation of the items was done based on results of directed qualitative content analysis according to the Structural model of the caregiver burden and review of the literature. After developing the item pool, face and content validity, item analysis, structural, convergent and discriminant validity, internal consistency, reliability, interpretability, and feasibility were evaluated.

Results

The primary tool entered the psychometric evaluation phase with 64 items. After performing face and content validity and item analysis, the number of items was reduced to 28. Exploratory factor analysis was performed with 28 items and 300 caregivers, and finally, four subscales with 21 items were developed. The results of confirmatory factor analysis indicated a good fit of the model. Cronbach's alpha and the Intraclass Correlation Coefficient of all subscales were higher than 0.7 and 0.9, respectively. The standard error of measurement was 1.39. All subscales had acceptable values in convergent validity criteria and the HTMT index less than the threshold value. The total score of the questionnaire had no ceiling and floor effect; the percentage of unanswered items was within the acceptable range.

Conclusion

The results show that the caregiver burden questionnaire for caregivers of patients undergoing hemodialysis has good psychometric properties and can measure the caregiver burden in these caregivers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01025-7.

Development and psychometric evaluation of Sexual and Reproductive Health Assessment Scale for women with educable intellectual disability (SRH-WIDS): a sequential exploratory mixed-method study

BACKGROUND

Women with Intellectual disability have many problems in their sexual and reproductive health due to their special mental and physical conditions caused by disability. This study aimed to develop and evaluate the psychometric properties of Sexual and Reproductive Health Scale for Women with Educable Intellectual disability.

METHODS

This sequential exploratory mixed-method study was conducted at two qualitative and quantitative stages in Tehran, from 2018 to 2020. At the qualitative stage, in-depth and semi-structured interviews were conducted with 21 parents and caregivers of women with intellectual disability to explain the concepts and to generate items. Thereafter, the item pool was formed based on the concepts and themes extracted from the qualitative phase as well as the review of literature. At the second stage, psychometric properties of the scale were assessed. Finally, responsiveness, interpretability, and feasibility of the scale were determined.

RESULTS

An item pool containing 95 items was produced at the first stage. At the second stage, the final version of scale was developed. The psychometric properties of this final version were then assessed and the results showed that the instrument has good validity and reliability. The results of exploratory factory analysis showed that the instrument contains seven factors. Accordingly, these factors explained 53% of the total variance of the instrument variables.

CONCLUSIONS

The results show that the SRH-WIDS with 25 items has sufficient validity and reliability, so it could be easily used by caregivers to assess the sexual and reproductive health of Women with Educable Intellectual disability. Ethical code: IRI.TUMS.VCR.REC 1397.340.

Comparison of Iran's nursing education with developed and developing countries: a review on descriptive-comparative studies

Background

Iran’s nursing education has undergone significant modifications in the last decades, especially following the Islamic revolution and the Iran-Iraq war. This review outlined changing trends in Iran’s nursing education and evaluate its status compared to other developing and developed countries.

Methods

Six international and two national electronic data sources were searched up to May 2021, using relevant keywords and terms. The studies were included if they addressed history, development, or evolutionary aspects of Iran’s nursing education or evaluated its status by comparing it with developing or developed countries, using Bereday's model. To obtain more relevant information, the organizational documents of the Iranian Ministry of Health and Medical Education and the Iranian Ministry of Culture and Higher Education were searched. Of 753 evidence found in the initial search, 73 were considered eligible for this review. A systematic and unbiased data synthesis was performed and a narrative and tabulated summary was presented.

Results

The evolution in Iran’s nursing education has resulted in the establishment of Bachelor, Master, and Ph.D. programs. Iran’s nursing education system plays an important role in fulfilling the healthcare system’s mission, and it does not hold a dissatisfactory position in comparison with other developed and developing countries. However, this system is expected to be more versatile for the upcoming changes and advancements.

Conclusion

Iran’s nursing education has a moderate rating despite recent changes. Hence, this system has to be modified in some aspects by adopting experiences of other countries, with an appropriate and successful education system, to prepare future highly competent nurses.

Psychometric Properties of the Persian Version of Palliative Care Outcome Scale (POS) in Adult Patients With Cancer

Background

Measuring the outcomes of palliative care plays an important role to improve the quality, efficiency, and availability of these services in patients with cancer. Using valid, reliable, and culturally appropriate tools has a considerable role to measure these outcomes. This study aimed to assess the psychometric properties of the translated version of the Palliative care Outcome Scale (POS).

Methods

This methodological study was conducted in two outpatient clinics related to Shohada Tajrish and Baqiyatallah hospitals in Tehran in 2019-2020. The translation was done using the Forward-Backward approach after gaining permission from the developer. Face validity was tested with 10 patients with cancer through cognitive interviewing, as well as content validity with four experts. Construct validity was performed by (n = 203) exploratory factor analysis and confirmation (N = 150). To assess the reliability, internal consistency was assessed by using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). Furthermore, interpretability and ceiling and floor effects were assessed.

Results

A total of 353 patients with cancer under palliative care were included in the study. Then, three psychological (30%), physical (12.25%), and social factors (12.08%) with a cumulative variance of 54.34% were extracted in exploratory factor analysis. Confirmatory factor analysis showed that the model has a good fit of information. Cronbach's alpha coefficient for scale was 0.719. Furthermore, the ICC was 0.812. The scale was interpretable, and ceiling and floor effects were 0%.

Conclusion

Persian version of the POS was evaluated as a valid and reliable tool. Therefore, it can be used by the clinician to monitor the consequences of palliative care in Iranian cancer patients.

Investigating the relationship between quality of life and hope in family caregivers of hemodialysis patients and related factors

Background

Family caregivers of hemodialysis patients are the first and most crucial source of care at home. They experience many problems in the care of hemodialysis patients, which can affect their quality of life and hope, affecting the quality of care provided to patients. This study aimed to determine the relationship between quality of life and hope in family caregivers of hemodialysis patients.

Methods

A cross-sectional (descriptive-analytical) study performed on 300 family caregivers in the east of Mazandaran province in Iran. Data were collected using the Family Caregiver Quality of Life (FQOL), SF8 and adult hope scale. Data analysis was performed in SPSS version 16, and a P-value of below 0.05 was considered statistically significant.

Results

The results showed that, there was a direct and significant relationship between hope and quality of life. However, the quality of life was significantly lower in suburban residents, the unemployed, spouses, people with lower education and income levels, caregivers who cannot leave their patients alone, those living with their patients in the same house, and those taking care of male patients, compared to other participants (P < 0.05). Suburban residents, the unemployed, people with an insufficient level of income, and those living with their patients in the same house had significantly lower hope, compared to other subjects.

Conclusion

Since an increase of hope and quality of life of caregivers can cause improved quality of patient care, it is recommended that hope-based educational programs and interventions be implemented for caregivers.

Psychological consequences for family caregivers of patients receiving hemodialysis: threat or opportunity?

BACKGROUND

Family caregivers of patients receiving hemodialysis experience physical and psychological disorders. They are unfortunately neglected. The aim of this study was to explain the psychological consequences for family caregivers of patients receiving hemodialysis.

METHODS

This qualitative inductive conventional content analysis research approach was conducted in Tehran, Iran. Nineteen hemodialysis patient caregivers were enrolled via purposive sampling. Data collection was conducted through in-depth and semi-structured interviews until reaching data saturation. All interviews were recorded, transcribed, imported into the Open Code Software, and analyzed using the Graneheim and Lundman methods.

RESULTS

The results included two main categories: (1) threats to the psychological integrity; (2) development of capabilities. The first main category comprised the sub-categories of "care-related negative feelings and emotions," care-related stress and its behavioral impacts on care, "psychological disorders arising from care provision," and "impaired quality and quantity of sleep." The second main category comprised of the sub-categories of "care-related positive feelings and emotions" and "coping strategies."

CONCLUSIONS

The present study showed that though caring for hemodialysis patients threatens the caregiver's psychological integrity, it provides the opportunity of development capabilities.