Health-promoting behavior and quality of life among caregivers and non-caregivers in Taiwan: a comparative study

Title.  Health-promoting behavior and quality of life among caregivers and noncaregiversin Taiwan: a comparative study.
Aim.  This paper is a report of a study conducted to compare middle-aged female family caregivers and non-caregivers in terms of: (a) differences in quality of life and health-promoting lifestyle behaviors; and (b) the relationship between health-promoting lifestyle behaviors and quality of life.
Background.  Caregiving for older relatives is a stressful responsibility that detracts from the quality of life of female caregivers and imposes barriers to practising healthy behaviors. Recent studies on caregiving responsibilities have been primarily conducted in Western cultural contexts, with few studies of Chinese groups.
Method.  This cross-sectional, comparative study included a convenience sample of 39 female caregivers and 98 non-caregivers recruited in southern Taiwan in 2007. Data were collected using the World Health Organization Quality of Life Instrument-BREF Taiwanese version and Health Promotion Lifestyle Profile II.
Results.  The majority of caregivers reported a low level of caregiving input with family support. They also reported a statistically significantly higher proportion of health-promoting behaviors than non-caregivers, although quality of life did not differ between the two groups. Practising healthy behaviors may more strongly influence quality of life in caregivers than in non-caregivers.
Conclusion.  Policymakers should consider direct family support and uphold the value of family cohesion in order to maintain healthy behaviors and a high quality of life in family caregivers. Further studies with larger and more comparably-sized participant groups are recommended to investigate the interactions between levels of care, family support, caregiving consequences, health-promoting behaviors and the caregivers' quality of life.     

Caregiver burden and health promotion

Few of the studies describing caregiver stress and burden have focused on the effects of caregiving on the ability of the caregiver to attend to his or her own health needs. Therefore, the major purpose of this study was to investigate whether the perception of burden is related to the health-promoting behaviors of caregivers of the elderly. One hundred twenty-one predominantly female caregivers, mean age 61.1 years, S.D. = 13.4, completed questionnaires measuring demographic and health-related factors, the Objective and Subjective Burden Scales, and the Health-Promoting Lifestyle Profile. Findings suggest that those perceiving lower subjective burden practice more health-promoting behaviors than those with higher subjective burden scores, confirming Pender's contention that situational factors, such as caregiver burden, may affect health promotion.     

Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers

In Western cultures, adverse health effects resulting from providing care for impaired elders is well documented for family caregivers, but little is known about the health of Korean caregivers. This study examined the level of depression and physical health of 120 daughter and daughter-in-law caregivers who cared for cognitively or functionally impaired elderly in Korea. It was hypothesized that cultural factors would have a greater effect on caregivers' health outcomes than noncultural factors, but, contrary to this expectation, the effects of noncultural factors were found to outweigh those of cultural factors. Moreover, the caregivers in this study reported a relatively high level of depression, and more caregivers rated their own health as "poor" than did Western caregivers in previous studies. Family caregiving for the impaired elderly is stressful and negatively affects Korean caregivers' health outcomes regardless of societal values such as filial piety and familism regarding parent care in Korea. Culturally acceptable and sensible support programs may be useful in sustaining long-term care at home by Korean daughter and daughter-in-law caregivers. Further family caregiving studies in the Korean sociocultural context are recommended.     

Health-promoting self-care in family caregivers

Caregiving for family members with cognitive impairment is stressful and time consuming. Because of the attention needed to manage the memory and behavior problems of the care receiver, family caregivers have little time to attend to their own health needs. Most research related to the health of family caregivers has been conducted within a stress-illness framework. Fewer researchers have studied caregiver health from a health-promotion paradigm. The purpose of this study was to compare health-promoting self-care behavior infamily caregivers with demographically matched noncaregivers and to investigate the mediational effect of health-promoting self-care behavior on the relationship between stress and well-being. Findings revealed that family caregivers scored significantly lower on all measures of health promotion, with the exception of Nutrition and Number of Medications, and significantly higher on Barriers to Health-Promoting Actions. Health-promoting self-care behavior acted as a mediator to reduce the effect of caregiver stress on general well-being.     

Predictors of initiation of early sex in black and white adolescent females

This study examined the extent to which problem solving, self-image, and other health-related factors predict age at first intercourse among Black and White adolescent females. The volunteer sample was 16 to 19 years old; 52% were Black (n=105), and 48% (n=97) were White. Adolescents were recruited from family planning clinics throughout South Carolina. Stratified analyses identified race as a modifier of the relationship between problem solving and time of first intercourse (early or delayed). Logistic regression revealed three predictors of early age at first intercourse in Black girls, but only one predictor in White girls. There were no race differentials in either age or the proportion of girls initiating early intercourse. However, Black girls who had less problem solving skill than their peers were five times more likely to have early intercourse, three times more likely to practice fewer health-promoting behaviors, and seven times more likely to have 10 or fewer years of education. Early intercourse was significantly associated with unprotected first intercourse. Our findings suggest that interventions may need to be tailored for different risk groups within Black populations of adolescent girls.     

Predictors of family caregivers' burden and quality of life when providing care for a family member with schizophrenia in the People's Republic of China

Limited research has been undertaken regarding family caregivers' burden and quality of life (QOL) when providing care for a family member with schizophrenia in the People's Republic of China. This study examined the following in Chinese families caring for a member with schizophrenia: (i) the level of family caregivers' burden and QOL; (ii) the relationships among the demographic characteristics of family caregivers, the demographic characteristics of family members with schizophrenia, and family caregivers' burden and QOL; and (iii) the best predictors of family caregivers' burden and QOL. The findings suggest that family caregivers suffer a high level of burden when caring for a family member with schizophrenia. Numerous significant correlations were found among the variables. The best predictor of family caregivers' burden was found to be their level of education, while the best predictors of family caregivers' QOL were physical health and household income.     

Health-promoting behaviors of elderly korean immigrants in the United States

The purpose of this study was to explore health-promoting behaviors among elderly Korean immigrants, and to examine the relationships of their health-promoting behaviors with self-efficacy and perceived health status. One hundred ten elderly Korean immigrants residing in the United States were interviewed using a structured questionnaire. The mean score of health promoting behaviors of elderly Korean immigrants was 2.54 on the 5-point Likert scale. Nutrition was the subdomain with the highest mean score (M=3.01) and exercise was the subdomain with the lowest mean score (M=1.92). Both self-efficacy (r=0.49, p=0.01) and perceived health status (r=0.19, p=0.043) were significantly related to health-promoting behaviors. Education (F=3.61, p=0.016) and economic status (F=3.01, p=0.034) were significantly associated with health-promoting behaviors. This study showed poor practices of healthy lifestyles of elderly Korean immigrants. Low exercise scores indicated the need for community based exercise and health promotion programs for the elderly Korean immigrants population.     

Caregivers' difficulties in activating long-term mental illness patients with low self-esteem

The aim of the study was to describe psychiatric caregivers' perceptions of self-esteem and activities for patients with long-term mental illness. The study design used a qualitative approach, based on an open lifeworld perspective. A total of 13 caregivers at four psychiatric hospital units in a large Swedish city were interviewed about their views on patients' physical activity and/or other pastimes, as well as their self-esteem and its bearing on the patients' well-being. According to the caregivers, it is up to the patients themselves to decide what they wish to occupy themselves with. In the same time the caregivers' opinions are that patients have difficulties to occupy themselves. The caregivers believe that patients' disability is based in a lack of self-esteem, commitment and capacity to realize their wishes. The caregivers in this study argue that activities are valuable for self-esteem and physical health of people with long-term mental illness. The caregivers consider that it is the patient's responsibility to initiate their needs of activities. This means that the caregivers do not use their knowledge about the importance of activities for the patient's health. Search terms: activity, caregivers, mental illness.     

The attitude of Japanese family caregivers toward the elderly with dementia

This research examined family caregivers' attitudes toward their elderly relatives living with dementia. A convenience sample of fifty-nine Japanese caregivers was used. Caregiver attitudes were investigated multi-dimensionally (negative attitude, attitude of acceptance, and attitude of active interaction) using a questionnaire developed specifically for this study. The dimensions did not correlate with one another but were associated with different caregiver/elderly characteristics: i.e., negative attitude with short stay use, length of time caregivers and elderly relatives were living together and problem behaviors; attitude of acceptance with sleeping pill use and the type of relationship; and attitude of active interaction with dementia diagnosis. The results have implications for nurses in facilitating constructive caregiver attitudes.     

Healthy lifestyles and health-related quality of life among men living with HIV infection.

Although healthy lifestyles are related to improved quality of life in the general population, little is known about the role of healthy lifestyles during HIV infection. The authors examined the relationships between health-promoting behaviors, risk behaviors, stress, and health-related quality of life (HRQOL) among 226 men with HIV infection who were attending three infectious disease clinics. As hypothesized, health-promoting behaviors were positively related and stress was negatively related with most of the HRQOL dimensions. Contrary to the hypothesis, tobacco use, recreational drug use, and unsafe sexual behaviors were not related to the HRQOL dimensions. Hazardous alcohol use was negatively associated with one HRQOL dimension--social functioning. The association of modifiable factors, such as health-promoting behaviors and stress, with HQROL offers opportunities for improving HIV-related health care. Relatively simple, straightforward changes in lifestyles such as eating well, remaining active, and avoiding stressful life events may result in improvements in HRQOL.     

Caring for a family member with Alzheimer's disease: coping with caregiver burden post-nursing home placement

Most nursing home research has focused on predictors for placement, the placement decision-making process, or the effects of placement on the nursing home resident. Little research is available on family caregivers' experiences after placing their loved ones in a nursing home. The purpose of this qualitative study was to identify how family caregivers coped with the burden of post-nursing home placement of a family member with Alzheimer's disease (AD). Several factors that positively or negatively affected coping among family caregivers were identified. Family caregivers' interactions with their loved one, other nursing home residents, family and friends, nursing staff, and the nursing home-sponsored support group all contributed positively to their coping with the burden of post-nursing home placement. Factors that decreased family caregivers' coping were role disruption, guilt over placement, and uncertainty about the future.     

Seeking support: caregiver strategies for interacting with health personnel.

Support from health professionals can assist family caregivers and have a positive impact on their health. The purpose of this study was to explore women's perceptions of support from community resources while caring for a family member with dementia. The research questions were: What factors influence female caregivers' interactions with health personnel when seeking support? What strategies do women employ in interactions with health personnel to secure support? Symbolic interaction was the theoretical foundation for the study, which included secondary analysis of 62 interviews with 20 women concerning their caregiving experience. In addition, new data were collected from 2 focus groups with 8 volunteers recruited from among the original 20 participants. The data indicated that the women's expectations of their caregiving role and their appraisal of the care recipient influenced their interactions with health personnel when seeking support. They employed 4 broad strategies: collaborating, getting along, twigging, and fighting/struggling. A woman's use of strategies varied according to the degree of mutuality in decision-making with staff and was accompanied by both positive and negative experiences. These findings confirm the importance of mutuality in relationships with health personnel and support the use of partnership and empowerment models of professional practice.     

Chronic pain-associated behaviors in the nursing home: resident versus caregiver perceptions

Pain assessment in nursing home residents poses challenges since many of these individuals are too cognitively impaired to respond to traditional self-report instruments. Assessment of pain behavior in this population offers a logical alternative. The purpose of this study was to compare perceptions of behaviors identified as being pain-related in 42 nursing home residents with chronic pain, as reported by residents themselves, their nursing home caregivers and their family caregivers. Our specific research agenda was to identify the most salient behaviors that signal pain in nursing home residents; to determine the test-retest agreement of residents' self-perceived pain behaviors; to learn of the confidence that caregivers feel regarding assessment of residents' pain behavior; and to examine the agreement between caregivers and residents about pain behaviors in particular residents. We also wanted to compare residents' and caregivers' ratings of the residents' pain intensity. Finally, we explored the beliefs of nursing home staff about the influence of dementia on pain and pain assessment. Twenty-two of 26 pain-related behaviors identified by residents showed fair to perfect test-retest agreement (kappas 0.40–1). For the vast majority of pain-related behavior items, kappas for resident–caregiver agreement were <0.30. Agreement with regard to pain intensity was similarly poor (r=−0.19–0.34). Confidence in pain rating was high for both nurse (on average, 7.2 on a scale of 0–10) and family (on average, 6.7) caregivers. Seventy-one percent of nurses felt that pain assessment is more difficult in demented individuals, but that cognitive function does not influence pain prevalence. While nursing home residents with chronic pain and their caregivers have different perceptions regarding which behaviors are pain-related, additional studies are required to determine the underpinnings of these differing perceptions and to determine the extent to which formal pain behavior observation protocols will be useful for evaluating nursing home residents with chronic pain.     

An explanatory model of health promotion and quality of life in chronic disabling conditions

BACKGROUND: Although previous studies have examined selected factors influencing health-promoting behaviors or quality of life, the complex interplay of these variables in persons with chronic disabling conditions has not been investigated. OBJECTIVE: To test an explanatory model of variables influencing health promotion and quality of life (Stuifbergen & Rogers, 1997) in persons living with the chronic disabling condition of multiple sclerosis (MS). METHODS: A sample of 786 persons with MS (630 women and 156 men) completed a battery of instruments measuring severity of illness-related impairment, barriers to health-promoting behaviors, resources, self-efficacy, acceptance, health-promoting behaviors, and perceived quality of life. The proposed model was assessed and modified using the weighted least squares procedure (WLS), which is implemented by LISREL8 (Joreskog & Sorbom, 1993). RESULTS: The initial model was modified to obtain a recursive model with adequate fit, chi2 (8, N = 786) = 77, p < 0.05; GFI = 0.96; IFI = 0.98; CFI = 0.98. The antecedent variables accounted for 58% of the variance in the frequency of health-promoting behaviors and 66% of the variance in perceived quality of life. The effects of severity of illness on quality of life were mediated partially by health-promoting behaviors, resources, barriers, self-efficacy and acceptance. CONCLUSIONS: The final model supports the hypothesis that quality of life is the outcome of a complex interplay among contextual factors (severity of illness), antecedent variables (Stuifbergen & Rogers, 1997), and health-promoting behaviors. The strength of direct and indirect paths suggests that interventions to enhance social support, decrease barriers, and increase specific self-efficacy for health behaviors would result in improved health-promoting behaviors and quality of life. Further research using a longitudinal design is needed to clarify the effects of the interaction between health-promoting behaviors and trajectory of illness on quality of life for persons with chronic disabling conditions.     

Female caregivers' experiences of exposure to violence in nursing homes

Although earlier studies have examined caregivers' experiences of exposure to violence, few have investigated female caregivers working in nursing homes with a specific focus on experiences throughout the entire scenario of a violent situation. This study illuminates female caregivers' experiences of being exposed to violence in nursing homes. Twenty caregivers working in three nursing homes located in northern Sweden were asked to narrate about a situation in which they had been exposed to violence. Their narratives were analysed by using qualitative content analysis. We found that the caregivers had preconceived ideas about violent behaviour, that they experienced a loss of control over the situation, and that they then strove to regain control. Experiences such as these may influence caregivers' interactions with residents who display violent behaviour. As a result of violent interactions, caregivers may distance themselves from the residents, an attitude that may decrease the quality of care. There is a risk that violence in nursing homes is accepted and normalized as a part of the job and hence persists.     

An exploratory study of primary family caregivers' needs and factors in their interaction with home care nurses

The purpose of this study was to explore the interaction needs of primary caregivers and related factors in patient home healthcare. The study used a cross-sectional design. All caregivers of patients receiving home nursing services for over one month from eight home care agencies in Kaohsiung city were eligible to participate. The sample consisted of 120 caregivers. A structured questionnaire of interaction needs was used in interviews with each of the participants in their homes. Based on the Interactional Model of Client Health Behavior (IMCHB) and related literature, a questionnaire was used that primary caregivers might require home care nurses to complete. The instrument had a satisfactory validity and reliability. Our findings were as follows: 1. According to caregivers' answers, the most important of the four criteria for measuring caregivers' service needs in their interaction with home care nurses was "professional attitude in caring, " followed by "providing help with decision-making and planning, " "emotional support, " and, finally, "caring abilities and information"; 2. We discovered four factors that were considered important regarding caregivers' home nursing service interaction needs. In order of importance, they were (1) patient's age, (2) the patient's disease must have been diagnosed by a physician, (3) the caregiver's self-perceived health status, and (4) there had to be an alternative home helper. In conclusion, home care nurses' professional attitude in caring was of the greatest concern to caregivers. Our study suggests that emotional support needs to be maintained and improved in home nursing practical services. We provide several recommendations as to how practices, research, and education can be changed or developed in order to enhance home nursing services.