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Abedini NC, Shulein OM, Berrú-Villalobos S, Ramírez-Quiñones J, Creutzfeldt CJ, Portocarrero J, Zunt JR, Abanto-Argomedo C. Outcomes and Experiences of Patients and Their Caregivers After Severe Stroke Requiring Tube Feeding in Peru. J Pain Symptom Manage 2024; 67:296-305. [PMID: 38215896 DOI: 10.1016/j.jpainsymman.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Evaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers. METHODS Retrospective chart review to describe the prevalence of FT placement and characteristics of patients admitted with stroke to the Instituto Nacional de Ciencias Neurológicas in Lima, Peru between January 2019 and 2021. Follow-up calls to stroke survivors discharged home with FTs or their caregivers included quantitative and qualitative questions to assess long-term outcome and explore perspectives around poststroke care and FT management. We analyzed quantitative data descriptively and applied thematic analysis to qualitative data using a consensus-driven codebook. RESULTS Of 812 hospitalized patients with stroke, 146 (18%) were discharged home with FT, all with nasogastric tubes (NGTs). Follow-up calls were performed a median of 18 months after stroke with 96 caregivers and three patients. Twenty-five patients (25%) had died, and 82% of survivors (n = 61) remained dependent for some care. Four themes emerged from interviews: (1) perceived suffering (physical, emotional, existential) associated with the NGT and stroke-related disability, often exacerbated by lack of preparedness or prognostic awareness; (2) concerns around compromised personhood and value-discordant care; (3) coping with their loved-one's illness and the caregiving role; and (4) barriers to NGT care and skill acquisition. CONCLUSION We identified a high burden of palliative and supportive needs among severe stroke survivors with NGTs and their caregivers suggesting opportunities to improve poststroke care through education, communication, and support.
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Affiliation(s)
- Nauzley C Abedini
- Department of Medicine (N.C.A.), University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine (N.C.A., C.J.C.), Seattle, Washington, USA
| | - Orli M Shulein
- Department of Rehabilitation (O.M.S.), University of Washington, Seattle, Washington, USA
| | | | | | - Claire J Creutzfeldt
- Cambia Palliative Care Center of Excellence at UW Medicine (N.C.A., C.J.C.), Seattle, Washington, USA; Department of Neurology (C.J.C.), University of Washington, Seattle, Washington, USA.
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases (J.P.), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph R Zunt
- Departments of Neurology and Global Health (J.R.Z.), University of Washington, Seattle, Washington, USA
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Scheffler E, Mash R. Evaluation of a stroke rehabilitation training programme for community-based primary healthcare. Afr J Disabil 2023; 12:1137. [PMID: 37794954 PMCID: PMC10546249 DOI: 10.4102/ajod.v12i0.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/06/2023] [Indexed: 10/06/2023] Open
Abstract
Background Family caregiver training is an integral part of stroke rehabilitation programmes and is associated with improved caregiver and stroke survivor outcomes. In the Cape Winelands District, a low-resourced rural community-based setting in South Africa, stroke survivors and family caregivers mostly rely on assistance from community health workers (CHWs), despite their lack of stroke-specific rehabilitation training. Objectives To evaluate the implementation and immediate effects of a bespoke, 16 session, 21 h stroke rehabilitation training programme for CHWs to better support family caregivers. Methods Two cooperative inquiry groups participated in participatory action research to design and develop the programme. This article reports on the implementation of this programme. Inquiry group members directly observed the training, obtained written and verbal feedback, interviewed CHWs and observed them in the community. Consensus on their learning was achieved after reflection on their experience and observations. Results Learning of the cooperative inquiry groups was categorised into the effect on community-based care, the training programme's design and development, how training was delivered and implications for service delivery. Community health workers empowered caregivers and stroke survivors and enabled access to care, continuity, coordination and person-centredness. The need for experiential learning and a spiral curriculum was confirmed. Therapists needed a different set of skills to deliver training. A systems approach and effective leadership were needed to enable community health workers to use their new skills. Conclusion The stroke rehabilitation training programme demonstrated potential for integration into service delivery and equipping CHWs to support family caregivers and stroke survivors. Further evaluation of the programme's effectiveness and scale-up is needed. Contribution Evidence of an intervention to train CHWs to support stroke survivors and family caregivers.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Almubaslat F, Sanchez-Boluarte SS, Diaz MM. A review of neurological health disparities in Peru. Front Public Health 2023; 11:1210238. [PMID: 37744515 PMCID: PMC10513391 DOI: 10.3389/fpubh.2023.1210238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Peru is a historically unique and culturally diverse Latin American country. As a low-to-middle-income country (LMIC), Peru faces health implications from the spread of communicable diseases as well as a growing rate of noncommunicable diseases, both of which have been worsened by the recent COVID-19 pandemic's impact on the national health system. Over the past two decades, the country has aimed to improve health access for its population through various efforts described in this review. Despite this, there are notable neurological health disparities that exist today. This narrative review investigates such disparities through the leading neurological contributors to the national burden of disease in the country, including migraine headaches, cerebrovascular disease, and dementia. Public health disparities that contribute to other major neurological diseases in the country, including epilepsy, neurocysticercosis, Chagas disease, multiple sclerosis, traumatic brain injury, traumatic and non-traumatic spinal cord injuries are also investigated. We also explore potential solutions for overcoming the various neurological health disparities covered in this review that may be applied through public policies, as well as in similar LMICs in Latin America. By overcoming such disparities, the country may be able to successfully address the major contributors of neurological disease burden and create a healthcare environment that can sustainably and equitably improve health outcomes for Peruvian people.
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Affiliation(s)
- Faris Almubaslat
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Sajwani-Merchant Z, Behan D, Swank C, Daniel K. Caregiver experiences of social support following stroke. J Stroke Cerebrovasc Dis 2023; 32:107253. [PMID: 37544057 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Informal caregivers need to support their loved ones while performing caregiving responsibilities. A phenomenological qualitative study was done to understand the role of social support accessible for stroke caregivers. MATERIALS AND METHODS The respondents were enrolled from different organizations or support groups who were conducting activities specifically for stroke victims and/or their caregivers. Data collection was concluded after 10 participants were interviewed as no new major themes were discovered. Hence, saturation of data was obtained with a sample of 10 respondents. RESULTS Two themes were identified from the interviews: "Response to Stroke" and "Stress and Coping". Categories in theme one "Response to Stroke" were "Work Life Balance", "Reaction of Other People or Family to Stroke", and "Expectations and Responsibility from Caregivers". Categories in theme two "Stress and Coping" were "Impact of Stroke on Abilities of Victim", "Stressors and Concerns for the Caregivers", "Strategies used by Caregivers to Cope with Stress", and "Role of Support Group and Social Support to Stroke Caregiver and Care Recipient". CONCLUSIONS Stroke can lead to stress that can alter the responsibilities of caregivers of stroke victims. The role of social support and support groups was found to be critical for family caregivers to cope with caregiving issues.
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Affiliation(s)
- Zara Sajwani-Merchant
- Alumnus of College of Nursing and Health Innovation, University of Texas at Arlington. 411 S. Nedderman, Box 19407, Arlington, TX 76019, USA.
| | - Deborah Behan
- College of Nursing and Health Innovation, University of Texas at Arlington. 411 S. Nedderman, Box 19407, Arlington, TX 76019, USA.
| | - Chad Swank
- 909 N Washington Ave, Dallas, TX 75246, USA.
| | - Kathryn Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington. 411 S. Nedderman, Box 19407, Arlington, TX 76019, USA.
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Huang N, Tang Y, Zeng P, Guo X, Liu Z. Psychological status on informal carers for stroke survivors at various phases: a cohort study in China. Front Psychiatry 2023; 14:1173062. [PMID: 37324810 PMCID: PMC10267735 DOI: 10.3389/fpsyt.2023.1173062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
Background In China, the risk of stroke is higher than that in developed countries such as Europe and North America. Informal caregivers play a major role in providing support to stroke survivors. Currently, only limited studies on changes in psychological state of the caregivers at different stages of stroke have been published. Purpose To investigate the stress and psychological state of informal caregivers of stroke patients in different periods and to explore the factors that affect their states. Methods 202 informal caregivers of stroke patients were selected in a 3a-grade hospital in Chengdu, Sichuan. Follow-up was conducted by face-to-face interviews, telephone calls, or home visits on days 3, 2 months, and 1 year after onset. We investigated the basic information about the caregivers, including their anxiety, depression and social support conditions. We analyzed the pressure and psychological conditions of informal caregivers at different stages of stroke and analyzed its influencing factors. The data were displayed by the number and percentage of the cases; the continuous variables were described by means and standard deviation. In addition, the data were compared by Pearson correlation analysis and logistic regression analysis. Results (1) Within 3 days after the onset of stroke, the informal caregivers had the highest stress, the most severe anxiety and depression, the heaviest burden, and the lowest score of medical-social support. Over time, the pressure and burden of the caregivers are gradually decreasing, anxiety and depression are increasing, and social support is also increasing. (2) The stress and psychological status of informal stroke caregivers are affected by multiple factors, including the caregiver's age, relationship with the patient, patient's age, and patient's physical conditions. Conclusion The stress and psychological status of informal caregivers varied in the different stages of stroke, and they were affected by several factors. Medical staff should pay attention to informal caregivers while providing care for patients. Relevant interventions may be developed based on the results to improve the health of informal caregivers and thus to promote the health of patients.
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Affiliation(s)
- Neng Huang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Yidan Tang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Peng Zeng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Xingtong Guo
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zuoyan Liu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
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Prevalence of Stroke in the Elderly: A Systematic Review and Meta-Analysis. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Yuliana S, Yu E, Rias YA, Atikah N, Chang HJ, Tsai HT. Associations among disability, depression, anxiety, stress, and quality of life between stroke survivors and their family caregivers: An Actor-Partner Interdependence Model. J Adv Nurs 2023; 79:135-148. [PMID: 36257927 DOI: 10.1111/jan.15465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Abstract
AIM To explore the effects of disability, depressive, anxiety and stress symptoms on patients' and their partners' quality of life (QoL) using the actor-partner interdependence model (APIM). DESIGN A cross-sectional study using actor-partner interdependence model. METHODS We recruited 183 dyads of stroke survivors and their family caregivers in Indonesia. The World Health Organization Disability Assessment (WHODAS 2.0), Depression, Anxiety and Stress (DASS-42) and Rand Short Form Health Survey (SF-36) were used to measure disability, depressive, anxiety and stress symptoms and QoL of stroke survivors and family caregivers. The actor-partner interdependence model was tested using multilevel modelling. The actor-partner interdependence mediation model (APIMeM) was applied to estimate the direct and indirect effect. RESULTS Disability had actor effects on stroke survivor's overall QoL and partner effect on family caregiver's overall QoL. More severe disability of stroke survivors was associated with a lower overall QoL of their own and that of family caregiver's overall QoL. Depressive symptoms of stroke survivors had actor effects on stroke survivors' overall QoL and partner effects on family caregivers' overall QoL. Actor and partner effects also exist on family caregiver's depression symptoms to their own overall QoL and stroke survivor's overall QoL. Moreover, higher anxiety symptoms were associated with lower levels of their own and partner's overall QoL in both stroke survivors and family caregivers. Stroke survivor's stress symptoms also negatively associated with their own and family caregiver's overall QoL. However, a family caregiver's stress without a partner effects on stroke survivor's overall QoL. The APIMeM analysis showed that disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, disability mediated by stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). CONCLUSION The findings suggest that stroke survivors and family caregivers may influence each other during the caregiving process and social life. The disability of stroke survivors, and the depression, anxiety and stress symptoms of stroke survivors and family caregivers affect their own QoL and their partners' QoL. Disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, it indirectly via stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). IMPACT Dyadic actor-partner interdependence models have shown promising potential to predict the QoL among patients and family caregivers. The dyadic effects of disability, depression, anxiety and stress symptoms on the QoL of stroke survivors and family caregivers can be applied to guide the future development of nursing intervention addressed decreasing depression, anxiety and stress symptoms to optimize health outcomes among stroke survivors and their family caregivers.
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Affiliation(s)
- Sri Yuliana
- Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Yahya Bima, West Nusa Tenggara, Indonesia.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Erica Yu
- Cizik School of Nursing, The University of Texas Health Science Center, Houston, Texas, USA
| | - Yohanes Andy Rias
- College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, Indonesia
| | - Nur Atikah
- Department of Pharmacy, Poltekkes Kemenkes Surakarta, Middle of Java, Indonesia
| | - Hsiu Ju Chang
- School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
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Lobo EH, Frølich A, Abdelrazek M, Rasmussen LJ, Grundy J, Livingston PM, Islam SMS, Kensing F. Information, involvement, self-care and support-The needs of caregivers of people with stroke: A grounded theory approach. PLoS One 2023; 18:e0281198. [PMID: 36719929 PMCID: PMC9888718 DOI: 10.1371/journal.pone.0281198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Globally, stroke is a leading cause of death and disability, with most care undertaken by caregivers who are generally family and friends without prior experience of care. The lack of experience or unpreparedness results in feelings of uncertainty, burnout, anxiety, burden, etc. Hence, it is necessary to identify the needs of caregivers to better support them in their caregiving journey and improve the quality of care delivered. METHODS The study employed a grounded theory methodology that utilizes information gathered from literature reviews and social media to represent the needs and create a storyline visually. The storyline is further refined and evaluated using an online survey of 72 participants recruited through online stroke caregiving communities. RESULTS The study identified four core categories of needs: (i) Information: sufficient information delivered in layman's terms based on the individual situation of the caregiver and survivor through oral and hands-on demonstrations, (ii) Involvement: inclusion in the decision-making processes at different stages of recovery through face-to-face communication at the hospital, (iii) Self-care: ability to engage in work and leisure activities, (iv) Support: receive support in the form of resources, services and finances from different other stakeholders. CONCLUSIONS There is a need to create a caregiver-centered approach in stroke recovery to ensure limited obstruction to care and reduced uncertainty in stroke recovery. Moreover, through the inclusion of caregivers in stroke recovery, it may be possible to reduce the burden of care to the caregiver and ensure the satisfaction of the healthcare system throughout stroke recovery.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Bhasin E, Mishra S, Pathak G, Chauhan PS, Kulshreshtha A. Cytokine database of stress and metabolic disorders (CdoSM): a connecting link between stress and cardiovascular disease, hypertension, diabetes and obesity. 3 Biotech 2022; 12:308. [PMID: 36276466 PMCID: PMC9530088 DOI: 10.1007/s13205-022-03375-0] [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: 04/12/2022] [Accepted: 09/17/2022] [Indexed: 11/01/2022] Open
Abstract
The risk of metabolic diseases is greatly increased by both chronic and acute stress. Irrespective of the cause, chronic or acute stress has the capacity to alter an individual's cytokine profile. For instance, it has been observed that stress significantly increased concentrations of IL 1 beta, IL 6 and TNF alpha. Alteration in cytokine profiles increase the likelihood of dysregulated metabolism, which subsequently acts as a driving force in the development of disorders, such as cardiovascular disease (CVD), hypertension, diabetes and obesity. Considering the dynamic and versatile role of cytokines in health and disease, an in-depth computational analysis (qualitative and quantitative) was performed to study the role of cytokines as an immuno-molecular link between rising stress levels and an increase in CVD, hypertension, diabetes and obesity. Upon a qualitative comparative analysis of cytokine profiles, a total of 14 cytokines (IL-6, TNF-alpha, IFN-gamma, IL-10, etc.) were observed to be commonly involved in stress and aforementioned four metabolic disorders. Further analysis of quantitative studies has revealed that the cytokine profile for coronary artery disease (CAD) showed remarkable increase in a couple of cytokines. IL 9 registered an increase of 67 percent to reach a concentration of 75 pg/mL. IL 3, on the other hand, was absent in control candidates but reached 56 ± 14 pg/mL in CAD patients. In case of diabetes, IFN-gamma showed an increase of 290 pg/mL. For obesity it was observed that both MCP-1 and IL-1 beta fell by 12.2 pg/mL to reach 44.4 pg/mL in obese patients. A fall of approximately 50 pg/mL was observed in the concentration of VEGF in obese patients. Similarly, hypertension was marked by reduction in concentration of several cytokines - MCP-1 and VEGF being a couple of them. Apart from performing an analysis of cytokine profiles, an innovative database [Cytokine database of Stress and Metabolic disorders (CdoSM)-https://www.akbi-nsut.co.in/] has also been created comprising cytokines involved in stress and the aforementioned metabolic disorders. Upon accessing the database, a user can find the list cytokines associated with a particular condition along with information on cytokine receptor/s; related research articles; cytokine concentration in control v/s diseased candidates for some specific cytokines and the Uniprot ID for the respective cytokine. Database can be accessed by the link-https://www.akbi-nsut.co.in/. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-022-03375-0.
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Affiliation(s)
- Eshan Bhasin
- Netaji Subhas Institute of Technology (NSIT), New Delhi, 110078 India
| | - Shivam Mishra
- Netaji Subhas Institute of Technology (NSIT), New Delhi, 110078 India
| | - Geetansh Pathak
- Netaji Subhas Institute of Technology (NSIT), New Delhi, 110078 India
| | | | - Akanksha Kulshreshtha
- Netaji Subhas Institute of Technology (NSIT), New Delhi, 110078 India
- Division of Biological Sciences and Engineering, Netaji Subhas University of Technology (NSUT), New Delhi, 110078 India
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 215] [Impact Index Per Article: 107.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Hogan U, Bingley A, Morbey H, Walshe C. The experience of informal caregivers in providing patient care in hospitals in low- and middle-income countries: A qualitative meta-synthesis. J Health Serv Res Policy 2022; 27:321-329. [PMID: 35592881 PMCID: PMC9548935 DOI: 10.1177/13558196221101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In low- and middle-income countries, informal caregivers frequently stay in hospitals and perform patient care tasks typically performed by nurses in other contexts. This article reviews qualitative research on these informal caregivers, to gain insight and understanding of their experiences. METHODS We undertook a qualitative meta-synthesis. Relevant literature was identified through searches of electronic databases in 2021. Thematic analysis was conducted to facilitate the identification of conceptual relationships to formulate synthesised findings. RESULTS Twenty-four studies met the inclusion criteria - 13 from Sub-Saharan Africa, five from Bangladesh, two from India, two from Iran, one from Brazil and one from Peru. Three themes were generated from the meta-synthesis: (1) The unwelcome but tolerated guest, (2) Enduring personal sacrifice and (3) Fulfilling familial obligations. These themes emphasised the significant burden associated with the hospital caregiving experience and highlighted the implicit reliance on informal caregivers in low- and middle-income countries. CONCLUSIONS Informal caregivers perform an essential caregiving role, yet occupy a peripheral and voluntary space in hospitals. There is a clear need to support informal caregivers so that they can safely perform their tasks.
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Affiliation(s)
- Unarose Hogan
- Division of Health Research, Faculty of Health and Medicine, 151268Lancaster University, Bailrigg, UK
| | - Amanda Bingley
- Division of Health Research, Faculty of Health and Medicine, 151268Lancaster University, Bailrigg, UK
| | - Hazel Morbey
- Division of Health Research, Faculty of Health and Medicine, 151268Lancaster University, Bailrigg, UK
| | - Catherine Walshe
- Division of Health Research, Faculty of Health and Medicine, 151268Lancaster University, Bailrigg, UK
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Lu Q, Mårtensson J, Zhao Y, Johansson L. Needs of family members caring for stroke survivors in china: A deductive qualitative content analysis study by using the caregiver task inventory-25. BMC Geriatr 2022; 22:96. [PMID: 35114940 PMCID: PMC8812361 DOI: 10.1186/s12877-022-02774-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background In China, family caregivers are usually the main carers of relatives after stroke due to traditional Chinese culture and the limited development of the primary healthcare system. This responsibility often results in burdens and negative health outcomes. However, family caregivers seldom receive support. To improve informal care, as well as the health and well-being of family caregivers, it is important to identify their needs. Objective This study aimed to deductively explore the needs of family members caring for stroke survivors in China. Methods Twenty-six semi-structured interviews were performed with family caregivers of stroke survivors who were selected from one city and three communities by purposive sampling. A deductive qualitative content analysis method was performed by using the Caregiver Task Inventory-25 (CTI-25), an instrument measuring the needs of family caregivers, as a framework. Results All subscales, as well as all belonging items in the CTI-25, were identified in the present study, meaning that the family caregivers had needs related to learning to cope with new role, providing care according to care-receiver’s needs, managing own emotional needs, appraising supportive resources, and balancing caregiving needs and one’s own needs. Moreover, needs related to financial support, both direct and indirect, were identified but not part of the CTI-25. Conclusion These findings identified that family caregivers of stroke survivors in China had various needs, which is important knowledge when assessing needs and improving health care for family caregivers. Cultural adjustments and modifications should be made if CTI-25 is used in mainland China. This study also indicated a comprehensive and holistic perspective (individual, community, and social level) when identifying, assessing needs or implementing interventions to support family caregivers.
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Affiliation(s)
- Qi Lu
- School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,School of Nursing, Tianjin Medical University, Tianjin, China.
| | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Linda Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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13
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Basto-Abreu A, Barrientos-Gutierrez T, Wade AN, Oliveira de Melo D, Semeão de Souza AS, Nunes BP, Perianayagam A, Tian M, Yan LL, Ghosh A, Miranda JJ. Multimorbidity matters in low and middle-income countries. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221106074. [PMID: 35734547 PMCID: PMC9208045 DOI: 10.1177/26335565221106074] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/23/2022] [Indexed: 12/30/2022]
Abstract
Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.
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Affiliation(s)
- Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ana S Semeão de Souza
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno P Nunes
- Department of Nursing in Public Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, Harbin Medical University, Harbin, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,School of Health Sciences, Wuhan University, Wuhan, China
| | - Arpita Ghosh
- The George Institute for Global Health, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India.,University of New South Wales, Sydney, NSW, Australia
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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14
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Zafra-Tanaka JH, Portocarrero J, Abanto C, Zunt JR, Miranda JJ. Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru. J Stroke Cerebrovasc Dis 2021; 31:106275. [PMID: 35121533 PMCID: PMC8702405 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. METHODS A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients' journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. RESULTS We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. CONCLUSION The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients' experiences and feelings by developing solutions in a participatory manner.
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru.
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Joseph R Zunt
- Departments of Neurology and Global Health, University of Washington, Seattle, United States
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, Australia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Silva JKD, Boery RNSDO. Effectiveness of a support intervention for family caregivers and stroke survivors. Rev Lat Am Enfermagem 2021; 29:e3482. [PMID: 34495192 PMCID: PMC8432573 DOI: 10.1590/1518-8345.4991.3482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/25/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: to analyze the effectiveness of a support intervention on the burden and
stress of family caregivers and on the stroke survivors’ independence level,
compared to the Control Group. Method: a quasi-experimental study conducted with 37 participants (Intervention
Group, n=20; and Control Group, n=17). The intervention lasted 8 months. The
outcomes of the caregivers (burden and stress) and of the survivors
(independence level) were measured by the Zarit, Perceived Stress and Katz
scales, at the following moments: pre-intervention, the fourth month of the
intervention and post-intervention. The differences of these outcomes
between groups and intra-group and the effect size were calculated using the
Mann-Whitney and Friedman tests (Bonferroni adjustment by Wilcoxon) and the
Kendall’s W coefficient. Results: the Intervention Group reduced burden (p=0.039) and stress (p=0.009), mainly,
after 8 months of intervention, which was not observed in the Control Group.
The independence level did not change between the groups or moments
(p>0.05). The intervention presented moderate effect size (p=0.45 and
p=0.54). Conclusion: the intervention was effective to reduce the burden and stress of family
caregivers, but did not alter the stroke survivors’ independence level, when
compared to the Control Group.
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Affiliation(s)
- Jaine Kareny da Silva
- Universidade do Estado da Bahia, Departamento de Educação - Campus XII, Guanambi, BA, Brazil.,Scholarship holder at the Programa de Apoio à Capacitação Docente e de Técnicos Administrativos (Bolsa PAC-DT)/ Universidade do Estado da Bahia, Brazil
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16
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Yaria J, Gil A, Makanjuola A, Oguntoye R, Miranda JJ, Lazo-Porras M, Zhang P, Tao X, Ahlgren JÁ, Bernabe-Ortiz A, Moscoso-Porras M, Malaga G, Svyato I, Osundina M, Gianella C, Bello O, Lawal A, Temitope A, Adebayo O, Lakkhanaloet M, Brainin M, Johnson W, Thrift AG, Phromjai J, Mueller-Stierlin AS, Perone SA, Varghese C, Feigin V, Owolabi MO. Quality of stroke guidelines in low- and middle-income countries: a systematic review. Bull World Health Organ 2021; 99:640-652E. [PMID: 34475601 PMCID: PMC8381090 DOI: 10.2471/blt.21.285845] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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Affiliation(s)
- Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Artyom Gil
- Division of Country Health Programme, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | | | - Richard Oguntoye
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Puhong Zhang
- The George Institute for Global Health, Beijing, China
| | - Xuanchen Tao
- The George Institute for Global Health, Beijing, China
| | | | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - German Malaga
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Irina Svyato
- Moscow School of Management SKOLKOVO, Moscow, Russia
| | - Morenike Osundina
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Camila Gianella
- Department of Psychology, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Olamide Bello
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Abisola Lawal
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ajagbe Temitope
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Michael Brainin
- Department of Neurosciences and Preventive Medicine, Danube University, Krems, Austria
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, California, United States of America
| | - Amanda G Thrift
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | | | - Cherian Varghese
- Noncommunicable Disease Department, World Health Organization, Geneva, Switzerland
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Mayowa O Owolabi
- Department of Medicine, University College Hospital, 200001 Ibadan, Oyo State, Nigeria.Correspondence to Mayowa O Owolabi ()
| | - on behalf of the Stroke Experts Collaboration Group
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Division of Country Health Programme, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russia
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, Beijing, China
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Moscow School of Management SKOLKOVO, Moscow, Russia
- Department of Psychology, Pontificia Universidad Católica del Perú, Lima, Peru
- Thung Chang Hospital, Thung Chang District, Nan, Thailand
- Department of Neurosciences and Preventive Medicine, Danube University, Krems, Austria
- Department of Neurosurgery, Loma Linda University, California, United States of America
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Health System Research Institute, Nonthaburi, Thailand
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Noncommunicable Disease Department, World Health Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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17
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Lobo EH, Frølich A, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M. mHealth applications to support caregiver needs and engagement during stroke recovery: A content review. Res Nurs Health 2020; 44:213-225. [PMID: 33341958 DOI: 10.1002/nur.22096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Caregiving in stroke results in severe physical, psychological, and social impacts on the caregiver. Over the past few years, researchers have explored the use of mHealth technologies to support healthcare-related activities due to their ability to provide real-time care at any given place or time. The purpose of this content review is to investigate mHealth apps in supporting stroke caregiving engagement based on three aspects: motivation, value, and satisfaction. We searched app stores and repositories for apps related to stroke caregiving published up to September 2020. Extracted apps were reviewed and filtered using inclusion criteria, and then downloaded onto compatible devices to determine eligibility. Results were compared with evidence-based frameworks to identify the ability of these apps in engaging and supporting the caregiver. Forty-seven apps were included in this review that enabled caregivers to support their needs, such as adjustment to new roles and relationships, involvement in care and caring for oneself using several different functionalities. These functionalities include information resources, risk assessment, remote monitoring, data sharing, reminders and so on. However, no single app was identified that focuses on all aspects of stroke caregiving. We also identified several challenges faced by users through their reviews and the factors associated with value and satisfaction. Our findings can add to the knowledge of existing mHealth technologies and their functionalities to support stroke caregiving needs, and the importance of considering user engagement in the design. They can be used by developers and researchers looking to design better mHealth apps for stroke caregiving.
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Affiliation(s)
- Elton H Lobo
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Mohamed Abdelrazek
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
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18
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e041637. [PMID: 33323445 PMCID: PMC7745514 DOI: 10.1136/bmjopen-2020-041637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Caring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support. METHODS AND ANALYSIS Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers' perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time. ETHICS AND DISSEMINATION This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Ministry of Health and Population, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Mansoura University Faculty of Medicine, Mansoura, Egypt
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19
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Scheffler E, Mash R. Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e12. [PMID: 33054273 PMCID: PMC7565662 DOI: 10.4102/phcfm.v12i1.2629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In less resourced settings, formal rehabilitation services for stroke survivors were often absent. Stroke survivors were referred to community health workers (CHWs) who were untrained in rehabilitation. AIM To describe the experience and perceived needs of stroke survivors, their caregivers and CHWs in a context with limited access to and support from formal rehabilitation services. SETTING The Breede Valley subdistrict, Western Cape, South Africa, a rural, less resourced setting. METHODS A descriptive exploratory qualitative study. Four focus group interviews were held with purposively selected stroke survivors and caregivers and four with CHWs. A thematic approach and the framework method were used to analyse the transcripts. FINDINGS A total of 41 CHWs, 21 caregivers and 26 stroke survivors participated. Four main themes and 11 sub-themes were identified. Because of the lack of knowledge, training and rehabilitation services, the main theme for all groups was having to 'figure things out' independently, with incontinence management being particularly challenging. Secondly was the need for emotional support for stroke survivors and caregivers. Thirdly, contextual factors such as architectural barriers and lack of assistive products negatively impacted care and function. Lastly, the organisation of health and rehabilitation services negatively impacted home-based services and professional support. CONCLUSIONS With appropriate training, the CHWs can be pivotal in the training and support of family caregivers and stroke survivors. Care pathways and the role and scope of both CHWs and therapists in home-based stroke rehabilitation should be defined and restructured, including the links with formal services.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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20
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Silva JK, Anjos KF, Alves JP, Rosa DDOS, Boery RNSDO. Needs for family caregivers of Cerebrovascular Accident survivors. INVESTIGACION Y EDUCACION EN ENFERMERIA 2020; 38:e06. [PMID: 33306896 PMCID: PMC7885534 DOI: 10.17533/udea.iee.v38n3e06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To know the needs of family caregivers of Cerebrovascular Accident survivors. METHODS This is a qualitative, descriptive, and exploratory study. Data were collected from 37 family caregivers of Cerebrovascular Accident survivors from a city in the interior of Bahia, through an interview using a semi-structured form, between September 2017 and March 2018, and submitted to thematic content analysis. RESULTS Three categories emerged: the early need for health education on the disease and care for family caregivers; the need to restructure care for family caregivers; 3) family caregivers need free time for social activities and (self)care. CONCLUSIONS Caregivers have basic needs for health care and social interaction, which can enable by educational health interventions.
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21
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Brites R, Brandão T, Moniz Pereira F, Hipólito J, Nunes O. Effects of supporting patients with dementia: A study with dyads. Perspect Psychiatr Care 2020; 56:614-620. [PMID: 31970779 DOI: 10.1111/ppc.12476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to examine the factors associated with the development of higher burden in informal caregivers of patients with dementia, using dyadic data. DESIGN AND METHODS Seventy-two dyads of patients with dementia and their informal caregivers were assessed, the former in terms of behavioral-psychological symptoms and autonomy, the latter in terms of burden and individual needs. FINDINGS Caregivers at risk for developing higher burden are those who are female, whose care recipient present psychiatric symptoms and lower autonomy, and those who recognize the need for more information/support. PRACTICE IMPLICATIONS Interventions should offer caregivers the tools to provide care, maintaining their psychological well-being. Interventions should target not only common aspects of caregiver burden but also the specificities of caring for a person with dementia.
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Affiliation(s)
- Rute Brites
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Tânia Brandão
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal.,Centro de Psicologia, Universidade do Porto, Porto, Portugal
| | - Francisco Moniz Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Departamento de Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - João Hipólito
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Odete Nunes
- Departamento de Psicologia, Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
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22
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The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:104875. [PMID: 32689648 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104875] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.
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Denham AMJ, Wynne O, Baker AL, Spratt NJ, Loh M, Turner A, Magin P, Bonevski B. The long-term unmet needs of informal carers of stroke survivors at home: a systematic review of qualitative and quantitative studies. Disabil Rehabil 2020; 44:1-12. [DOI: 10.1080/09638288.2020.1756470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alexandra M. J. Denham
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Olivia Wynne
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Amanda L. Baker
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Neil J. Spratt
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, Australia
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
- Department of Neurology, Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, Australia
| | - Madeleine Loh
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alyna Turner
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Parker Magin
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, Australia
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Costa TFD, Pimenta CJL, Nóbrega MMLD, Fernandes MDGM, Nogueira JDA, Costa KNDFM. Validation of Bakas Caregiving Outcome Scale for brazilian portuguese. Rev Lat Am Enfermagem 2020; 28:e3249. [PMID: 32321040 PMCID: PMC7164928 DOI: 10.1590/1518-8345.3191.3249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the psychometric properties of the adapted version of Bakas
Caregiving Outcome Scale for Brazilian Portuguese. Method: this is a cross-sectional methodological study conducted with 151 informal
caregivers of people with cerebral vascular accident sequelae enrolled in
Family Health Units. To assess reliability, Cronbach’s alpha was used.
Construct validity was verified through exploratory factor analysis,
confirmatory factor analysis and correlation with measures of instruments
that evaluate correlated constructs. Results: Cronbach’s alpha for the total BCOS score was 0.89. Factor and exploratory
analysis generated a one-factor structure, which was confirmed by
confirmatory factor analysis. Construct validity was supported by the high
positive correlations with Negative Affect (r = 0.51) and Negative
Experience (r = 0.47) of the Well-being Scale and the Depression Anxiety and
Stress Scale -21 (r = 0.53) and negative correlations with Positive Affect
(r =-0.47) and Positive Experience (r = -0.17) of the Well-being scale. Conclusion: Bakas Caregiving Outcome Scale shows evidence of satisfactory reliability and
validity in family caregivers of cerebral vascular accident survivors.
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Affiliation(s)
| | - Cláudia Jeane Lopes Pimenta
- Universidade Federal da Paraíba, João Pessoa, PB, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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Kokorelias KM, Lu FKT, Santos JR, Xu Y, Leung R, Cameron JI. "Caregiving is a full-time job" impacting stroke caregivers' health and well-being: A qualitative meta-synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:325-340. [PMID: 31769128 DOI: 10.1111/hsc.12895] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well-being. We conducted a qualitative meta-synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, 'caregiving is a full-time job' was identified, encompassing four sub-themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution-based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well-being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.
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Affiliation(s)
- Kristina M Kokorelias
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Fiana K T Lu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Santos
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yi Xu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Robin Leung
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Fadilah N, Rahariyani LD. The Impact of Independent of Activity Daily Living among Stroke Patients on Caregivers Burden. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Weakness among stroke patients causes obstacles when fulfilling their activities in daily living (ADL). This condition also has an impact on the caregivers who provide daily care at home. The purpose of this study was to analyze the effect of independent ADL among the stroke patients on caregiver burden.Methods: The study used an analytical design through a cross-sectional approach. The variables included independent ADL and caregiver burden. A sample of 120 caregivers was taken from 2 community health centers in Surabaya through simple random sampling. The instruments used were Zarit Burden's Interview Schedule and the Katz Index of Independent for ADL. Regression ordinal was used to analyze the influence of independent ADL among stroke patients on caregiver burden.Results: The results showed that the caregiver who take care of stroke patients with severe functional impairment will feel burdened 3 times more than no burden. Post-stroke care at home through a rehabilitation program plays an important role in improving the condition of patients and their families at home, especially the caregivers.Conclusion: Nurses in a community health center through the family health care pathway provide comprehensive bio-psycho-socio-spiritual care in the rehabilitation period as expected. They are expected to improve and maintain the fulfillment of human needs comprehensively for stroke patients and their caregivers, so the quality of life of stroke patients, caregivers and their families remains optimal.
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Schwertfeger JL, Thuente L, Hung P, Larson SL. Post-discharge interventions to enhance coping skills for survivors of stroke and their caregivers: a scoping review protocol. JBI Evid Synth 2019; 18:332-340. [DOI: 10.11124/jbisrir-d-18-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shao H, Yang S, Fonseca V, Stoecker C, Shi L. Estimating Quality of Life Decrements Due to Diabetes Complications in the United States: The Health Utility Index (HUI) Diabetes Complication Equation. PHARMACOECONOMICS 2019; 37:921-929. [PMID: 30778865 PMCID: PMC7220804 DOI: 10.1007/s40273-019-00775-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Health utility decrements associated with diabetes mellitus complications are essential for calculating quality-adjusted life-years (QALYs) in patients for use in economic evaluation of diabetes interventions. Previous studies mostly focused on assessing the impact of complications on health utility at event year based on cross-sectional data. This study aimed to separately estimate health utility decrements associated with current and previous diabetes complications. RESEARCH DESIGN AND METHODS The Health Utilities Index Mark 3 (HUI-3) was used to measure heath utility in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 8713). Five macrovascular complications (myocardial infarction [MI], congestive heart failure [CHF], stroke, angina, and revascularization surgery [RS]) and three microvascular complications (nephropathy [renal failure], retinopathy [severe vision loss], and neuropathy [severe pressure sensation loss]) were included in a set of alternative modelling approaches including the ordinary least squares (OLS) model, fixed effects model, and random effects model to estimate the complication-related health utility decrements. RESULTS All macrovascular complications were associated with decrements of HUI-3 scores: MI (event year: - 0.042, successive years: - 0.011), CHF (event year: - 0.089, successive years: - 0.041), stroke (event year: - 0.204, successive years: - 0.101), angina (event year: - 0.010, successive years: - 0.032), and revascularization (event year: - 0.038, successive years: - 0.016) (all p < 0.05). For microvascular complications, severe vision loss (- 0.057), and severe pressure sensation loss (- 0.066) were significantly associated with decrements of HUI-3 scores (both p < 0.05). Hypoglycemia (both severe and symptomatic) was found to be associated with a 0.036 decrement of health utility at event year, and a 0.033 decrement of health utility at successive years. Results from an OLS model are preferred for supporting a microsimulation model while a fixed effects model is preferred to describe direct health impacts from complications. CONCLUSIONS Macrovascular and microvascular complications caused QALY decrements in patients with type 2 diabetes. While only part of the total impaired QALY is experienced during the event year, further QALY decrements for successive years were quite substantial.
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Affiliation(s)
- Hui Shao
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Shuang Yang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Vivian Fonseca
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
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Rohde D, Gaynor E, Large M, Conway O, Bennett K, Williams DJ, Callaly E, Dolan E, Hickey A. Stroke survivor cognitive decline and psychological wellbeing of family caregivers five years post-stroke: a cross-sectional analysis. Top Stroke Rehabil 2019; 26:180-186. [PMID: 30907273 DOI: 10.1080/10749357.2019.1590972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family members frequently provide long-term care for stroke survivors, which can lead to psychological strain, particularly in the presence of cognitive decline. OBJECTIVES To profile anxious and depressive symptoms of family caregivers at 5 years post-stroke, and to explore associations with stroke survivor cognitive decline. METHODS As part of a 5-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of stroke survivors, family members completed a self-report questionnaire. Symptoms of anxiety and depression were assessed using the HADS-A and CES-D. Cognitive decline in stroke survivors was assessed from the caregiver's perspective using the IQCODE, with cognitive performance assessed by the MoCA. Data were analyzed using logistic regression models. RESULTS 78 family members participated; 25.5% exhibited depressive symptoms, 19.4% had symptoms of anxiety. Eleven stroke survivors (16.7%) had evidence of cognitive decline according to both the IQCODE and MoCA. Family members of stroke survivors with cognitive decline were significantly more likely to report symptoms of depression [age-adjusted OR (95% CI): 5.94 (1.14, 30.89)] or anxiety [age-adjusted OR (95% CI): 5.64 (1.24, 25.54)] than family members of stroke survivors without cognitive decline. CONCLUSIONS One-fifth of family caregivers exhibited symptoms of anxiety and one-quarter symptoms of depression at 5 years post-stroke. Stroke survivor cognitive decline was significantly associated with both depressive and anxious symptoms of family caregivers. Family members play a key role in the care and rehabilitation of stroke patients; enhancing their psychological wellbeing and identifying unmet needs are essential to improving outcomes for stroke survivors and families.
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Affiliation(s)
- Daniela Rohde
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Eva Gaynor
- b Department of Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Margaret Large
- c Clinical Research Centre , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Orla Conway
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Kathleen Bennett
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - David J Williams
- d Geriatric and Stroke Medicine , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Elizabeth Callaly
- e Geriatric Medicine , Mater Misercordiae University Hospital , Dublin , Ireland
| | - Eamon Dolan
- f Geriatric Medicine , Connolly Hospital , Dublin , Ireland
| | - Anne Hickey
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
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Vincent-Onabajo G, Puto Gayus P, Masta MA, Ali MU, Gujba FK, Modu A, Hassan SU. Caregiving Appraisal by Family Caregivers of Stroke Survivors in Nigeria. J Caring Sci 2018; 7:183-188. [PMID: 30607358 PMCID: PMC6311622 DOI: 10.15171/jcs.2018.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/22/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction: Attending to caregiving experiences of family caregivers of stroke survivors is important in person-centered stroke rehabilitation. This study explored caregiving appraisals by family caregivers of stroke survivors in Nigeria. Methods: A cross-sectional survey of family caregivers' negative and positive appraisals of caregiving was conducted using the 24-item 4-domain revised Caregiving Appraisal Scale (rCAS). Mann Whitney U and Kruskal-Wallis tests were used to identify differences in caregiving appraisals based on specific caregiver and stroke survivor variables. Results: Seventy-three caregiver and care recipient dyads participated in the study. Mean age of the caregivers was 31.51 (9.82) years. From a score of 5, and higher scores depicting higher appraisal, mean (SD) score for caregiving satisfaction and caregiving mastery (positive appraisal domains) was 4.23 (0.97) and 4.04 (0.92) respectively while 2.29 (0.98) and 2.11 (0.93) were respectively recorded for caregiving burden and environmental impact (negative appraisal). Caregivers' gender, age, and employment status resulted in significantly different appraisals with female caregivers having higher caregiving mastery (U = 446, P<0.05), caregiving satisfaction (U = 384.5, P<0.01), and also caregiving burden (U = 382.5, P<0.01) compared to their male counterparts; while older (U = 330; P<0.05) and employed (U = 437.5, P<0.05) family caregivers reported higher caregiving satisfaction and burden respectively than younger and unemployed family caregivers. Conclusion: Given the comparatively higher positive caregiving appraisal, and the documented benefits of positive caregiving appraisal, efforts should be geared towards identifying effective means of reinforcing positive appraisal, and reducing negative stroke caregiving appraisal, especially for female, older and employed family caregivers.
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Affiliation(s)
- Grace Vincent-Onabajo
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Pwadi Puto Gayus
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Mamman Ali Masta
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Muhammad Usman Ali
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Fatima Kachalla Gujba
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Ali Modu
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Saleh Usman Hassan
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
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Miranda JJ, Moscoso MG, Yan LL, Diez-Canseco F, Málaga G, Garcia HH, Ovbiagele B. Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism. J Neurol Sci 2017; 375:309-315. [PMID: 28320158 DOI: 10.1016/j.jns.2017.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/13/2017] [Indexed: 02/08/2023]
Abstract
Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Miguel G Moscoso
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru.
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