The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: a controlled treatment outcome study

Opportunities in Multiple Sclerosis Care Partner Research: An Interview

Guest editor Marcia Finlayson, PhD, OT Reg (Ont), OTR, is a professor in the School of Rehabilitation Therapy at Queen's University in Ontario, Canada. She began her career as a clinical occupational therapist and shifted to a research career focused on generating and sharing knowledge to help people affected by multiple sclerosis (MS) lead healthy, meaningful lives with control over their participation in daily activities, at home and in the community, particularly as they age. For this special issue on caregiving in MS, she chose to interview Kenneth Pakenham, PhD, emeritus professor of clinical and health psychology at the University of Queensland in Brisbane, Australia. For more than 4 decades, he has investigated the psychological well-being welle-eing of caregivers, including coping mechanisms and innovative interventions to improve their quality of life. His work is dedicated to applying positive health frameworks to chronic illnesses and to empowering caregivers and individuals with MS. Together, their expertise illuminates the multifaceted challenges and opportunities in MS caregiving research and understanding.

Do emotional distress and functional problems in persons with traumatic brain injury contribute to perceived sleep-related impairment in caregivers?

OBJECTIVE

The goal of this study was to examine the association between characteristics of persons with traumatic brain injury (PwTBI) and perceived sleep-related impairment of the caregivers.

METHOD

Fifty-two dyads (n = 23 civilians, n = 29 service members/veterans [SMVs]) were enrolled. Caregivers completed the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment computer adaptive test, and PwTBI completed Quality of Life in Neurological Disorders measures of depression, anxiety, anger, cognitive functioning, and upper and lower extremity functioning. Hierarchical linear regression models, stratified by civilian/SMV group, were employed to assess prediction of caregiver-perceived sleep-related impairment from emotional distress of the PwTBI (anxiety, depressed mood, and anger) and perceived functional status of the PwTBI (cognitive, upper extremity, lower extremity functioning).

RESULTS

Compared with caregivers of civilians, caregivers of SMVs reported higher perceived sleep-related impairment. Regression results showed that characteristics of the PwTBI accounted for moderate amounts of variance in the sleep-related impairment of caregivers of both civilians and SMVs. Within-group analyses showed that the strongest predictor of sleep-related impairment of caregivers of civilians was self-reported cognitive function of the PwTBI (β = -0.82, p = .08); the strongest predictor of sleep-related impairment of caregivers of SMVs was self-reported anger of the PwTBI (β = 0.54, p = .07).

CONCLUSIONS

In both caregivers of civilians and SMVs with TBI, characteristics of the PwTBI were related to perceived caregiver sleep-related impairment. These preliminary data can inform future research with larger samples that examine the impact of multiple characteristics of the caregiver and care recipient on caregiver sleep. Findings highlight the potential importance of considering the dynamics of the dyad in rehabilitation programming not only for the PwTBI but for caregivers as well. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evaluating a Dyadic Intervention on Risk Reduction Among People Who Inject Drugs

Among 100 people who inject drugs enrolled in a peer mentorship intervention aiming to promote injection-related risk reduction behavior change, we evaluated the role of participation in a dyad session on reducing sharing of syringes and cookers in the past 6 months. Dyad participants (n = 69) invited an injection, sex partner, or family member to the study site to reinforce learnt behavior change tools by practicing communication skills and risk reduction lessons. In all, 31 participants did not participate in the dyad session. We descriptively assessed changes in sharing injection equipment between the 2 time points of pre- and postintervention using the tests of proportions by dyad participation. Multivariable logistic regression adjusted for sex was used with an interaction term (time points × dyad participation) to evaluate the dyad effect. Dyad participants reported reduced syringe and cooker sharing at postintervention (sharing syringe: 17% versus 39%, P < .05 and cooker: 32% versus 59%, P < .01). There was no difference between the dyad group's sharing injection equipment behavior after the intervention (sharing syringes: adjusted odds ratio [aOR] 0.76; 95% confidence interval [CI] 0.1-3.9 and cookers: aOR 0.72; 95% CI 0.1-3.5). The role of the dyad session alone on risk taking was not effective. With a small sample size, it is important to continue to evaluate the nature of peer-based dyadic experiences in future studies.

Promoting Health and Well-being in Lives of People Living with HIV and AIDS

The highly effective pharmaceutical polytherapies for the treatment of HIV (Human immunodeficiency virus) and AIDS (Acquired immune deficiency syndrome) have practically reduced HIV and AIDS to a chronic condition like any other chronic illness. People living with HIV and AIDS can now have an almost normal life expectancy; the challenge for them is to live a physically and mentally healthy life. These challenges involve avoiding and managing opportunistic infections physically on one hand and taking care of their mental health needs and promoting and sustaining psycho-social well-being on the other hand. Although a torrent of research has studied the psychosocial correlates of slower disease progression and psycho-social well-being among people living with HIV and AIDS, very few sustained approaches have been made to understand and isolate the contribution of different psycho-bio-behavioural parameters for the psycho-immuno-enhancement in people living with HIV and AIDS. Systematic search in different electronic databases as well as different relevant psychological and AIDS care journals have been done to assimilate and review the research studying the effect of different psycho-social, bio-behavioural interventions through randomised control trials on the health promotion, well-being and disease progression parameters in people living with HIV and AIDS. The article makes an attempt to synchronise and consolidate these research efforts, discussing the role of cognitive behavioural stress management, exercise, spiritual practices, hypnosis, relaxation and guided imagery, social support for the psycho-immuno-enhancement in lives of people living with HIV and AIDS, and suggests a comprehensive three-tier intervention model, consisting of intervention at individual, dyadic and community levels, for psychological and immunological improvement in lives of people living with HIV and AIDS.

An integrated review of interventions to improve psychological outcomes in caregivers of patients with heart failure

PURPOSE OF REVIEW

This article examines interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure.

RECENT FINDINGS

Eight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of four to six sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n = 4), depressive symptoms (n = 1), stress mastery (n = 1), caregiver confidence and preparedness (n = 1), and caregiver mastery (n = 1).

SUMMARY

Compared with dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with heart failure. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of heart failure caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance heart failure caregiver support and education.

Recruitment and retention rates in behavioral trials involving patients and a support person: a systematic review

BACKGROUND

Recruitment and retention challenges impede the study of behavioral interventions among patient-support person dyads.

PURPOSE

The aim of the study was to characterize recruitment and retention rates of behavioral interventions involving dyads.

METHODS

Using PRISMA guidelines and with the guidance of a medical librarian, we searched Medline, EMBASE, Cochrane Controlled Trials, PsycInfo, and CINAHL from inception until July 2011. Eligible articles involved RCTs of behavioral interventions targeting adult patients with a non-psychiatric illness and a support person. Sample and study characteristics, recruitment and retention strategies, and recruitment and retention rates were abstracted in duplicate. Quality of reporting was determined on a 5-point scale. Due to the heterogeneity in data reporting and missing data, a narrative synthesis was undertaken.

RESULTS

53 unique studies involving 8081 dyads were included. 9 studies were ascertained to have a "high quality" of reporting. A majority of the studies did not report target sample size, time to complete recruitment, and sample sizes at each follow-up time point. Strategies employed to recruit support persons were rarely reported. 16 studies did not report the number of dyads screened. The mean recruitment rate was 51.2% (range: 4.3%-95.4%), and mean retention rate was 77.5% (range: 36%-100%).

CONCLUSIONS

Details regarding recruitment and retention methodology were sparse in these interventions. Where available, data suggests that resources need to be devoted towards recruitment of sample but that retention rates are generally adequate.

A discussion of HIV/AIDS family interventions: implications for family-focused nursing practice

AIM

This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care.

BACKGROUND

Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention.

DATA SOURCES

The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were 'nurse', or 'nursing', 'HIV/AIDS', 'family interventions', 'family support' and 'family education', and/or 'family subsystems'.

DISCUSSION

The process of theorizing about 'family interventions' and 'HIV/AIDS-family interventions' is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective.

CONCLUSION

Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

A stress and coping model of adjustment to caring for an adult with mental illness

This study investigated the utility of a stress and coping framework for identifying factors associated with adjustment to informal caregiving to adults with mental illness. Relations between stress and coping predictors and negative (distress) and positive (positive affect, life satisfaction, benefit finding, health) carer adjustment outcomes were examined. A total of 114 caregivers completed questionnaires. Predictors included relevant background variables (carer and care recipient characteristics and caregiving context), coping resources (optimism, social support, carer-care recipient relationship quality), appraisal (threat, control, challenge) and coping strategies (problem-focused, avoidance, acceptance, meaning-focused). Results indicated that after controlling for relevant background variables (burden, caregiving frequency, care recipient symptom unpredictability), better caregiver adjustment was related to higher social support and optimism, better quality of carer-care recipient relationship, lower threat and higher challenge appraisals, and less reliance on avoidance coping, as hypothesised. Coping resources emerged as the most consistent predictor of adjustment. Findings support the utility of stress and coping theory in identifying risk and protective factors associated with adaptation to caring for an adult with mental illness.

How a "Special Caring Bond" is Formed Between the Chronically ill Patient and the Family Caregiver

La formación de vínculos en el ser humano tiene su origen en las relaciones de cuidado existentes a lo largo de la vida. Existen teorías que aplican para las situaciones en que el ser humano se encuentra en riesgo o al límite como la situación de enfermedad crónica. Objetivo: describir la forma como se constituye el “vínculo especial” de cuidado entre la díada cuidador familiar-persona con enfermedad crónica. Método: corresponde a la conclusión central de una investigación cualitativa en la que se construyó una teoría sustantiva que describe el proceso por el cual se constituye el “vínculo especial” que surgió con un abordaje de teoría fundamentada. Hallazgos: una estructura teórica que muestra el patrón construido en las díadas frente al significado del cuidado en un diagrama representativo producto de una investigación doctoral. Conclusiones: el esquema construido muestra al inicio una separación entre las dos personas de la díada, y a medida que se comparte la experiencia y van haciéndose más cercanos los intereses, la díada alcanza mayor expansión de su conciencia en el cuidado. En el mismo sentido, la funcionalidad de la persona con enfermedad crónica disminuye y el nivel de habilidad de cuidado aumenta.

Investigation of the benefits of HIV/AIDS caregiving and relations among caregiving adjustment, benefit finding, and stress and coping variables

The present study explored the nature of benefit finding in HIV/AIDS caregiving, and examined relations among caregiver adjustment, benefit finding, and stress and coping variables. A total of 64 HIV/AIDS caregivers and 46 care recipients completed interviews and questionnaires. First, the study aimed to explore the types of benefits associated with HIV/AIDS caregiving. Content analyses of caregiver responses to an interview question inquiring about gains from caregiving revealed eight benefit themes. Second, the study aimed to examine relations between caregiver adjustment and both benefit finding and stress and coping variables. We hypothesized that number of caregiver reported benefits, social support, challenge and control appraisals, and problem focused coping would be inversely related to poorer adjustment, whereas care recipient reported global distress and illness, caregiver threat appraisal and passive-avoidant emotion-focused coping would be positively associated with poorer adjustment. Correlations indicated that poorer adjustment (measured by global distress, depression, caregiving impact, social adjustment and health status) was positively correlated with care-recipient distress, threat appraisals and passive avoidant coping and inversely correlated with social support, and number of reported benefits. Unexpectedly, problem-focused coping, controllability and challenge appraisals, and care recipient illness were unrelated to adjustment. Third, the study aimed to examine relations between benefit finding and stress and coping variables. Correlations indicated that benefit finding was related to social support use, seeking social support coping and problem-solving coping. Findings indicate that the benefit finding and stress/coping frameworks have utility in guiding research into adaptation to HIV/AIDS caregiving. Results also indicate targets for intervention in the provision of services for HIV/AIDS caregivers.

The nature of sense making in caregiving for persons with multiple sclerosis

OBJECTIVE

Sense making refers to the development of explanations for adversity. This study investigated the nature of sense making in multiple sclerosis (MS) carers and relations between it and care recipient illness, caregiving context, carer religious-spiritual beliefs and carer and care recipient adjustment.

SUBJECTS

A total of 232 MS carers and their care recipients completed questionnaires.

METHOD

A questionnaire survey methodology was used to collect qualitative and quantitative data. Variables included: Demographics, caregiving context (caregiving duration, co-residency, carer-care recipient relationship, outside employment), care recipient illness (activities of daily living, number of symptoms, illness duration, course), sense making (anticipated sense making, number of sense making categories), carer and care recipient adjustment (positive states of mind, life satisfaction, anxiety, depression).

RESULTS

Half the carers generated sense making explanations for their caregiving situation and 12 sense making themes emerged from this qualitative data. Over a third of those carers who could not make sense of their situation were able to anticipate comprehending it and the strength of this anticipation was related to greater life satisfaction. Carer sense making was related to having a religious-spiritual belief, fewer care recipient symptoms, marital status and it predicted life satisfaction after controlling for relevant covariates. Carer and care recipient sense making was positively correlated, and the sense making of one partner was positively related to life satisfaction of the other partner.

CONCLUSIONS

Findings chart the nature of sense making in MS caregiving and support the notion of collective sense making within dyads and the proposed beneficial links between sense making and adjustment.

'I felt I have grown up as an adult': caregiving experience of children affected by HIV/AIDS in China

BACKGROUND

The growing global epidemic of HIV/AIDS has a significant impact on the lives of both people living with HIV/AIDS and their family members including children. Children of parents with HIV/AIDS may experience an increased responsibility of caregiving in family. However, limited data are available regarding the caregiving experience and its impact on psychosocial well-being among these children. This study was designed to address these issues by using qualitative data collected from children affected by HIV/AIDS in China.

METHODS

The qualitative data were collected in 2006 in rural central China, where many residents were infected with HIV/AIDS through unhygienic blood collection procedures. In-depth individual interviews were conducted by trained interviewers with 47 children between 8 and 17 years of age who had lost one or both parents to AIDS.

RESULTS

Findings of this study suggest that many children affected by AIDS had experienced increased responsibilities in housework and caregiving for family members. Such caregiving included caring for self and younger siblings, caring for parents with illness and caring for elderly grandparents. Positive impacts from children's participation in family caregiving included personal growth and emotional maturity. Negative consequences included physical fatigue, psychological fear and anxiety and suboptimal schooling (dropping out from school, repeated absence from school and unable to concentrate in class).

CONCLUSION

While the increased caregiving responsibilities among children reflected some cultural beliefs and had some positive effect on personal growth, the caregiving experience generally negatively effected the children's physical and mental health and schooling. The findings in the current study suggest that community-based caregiving support is necessary in areas with high prevalence of HIV and limited resources, especially for the families lacking adult caregivers. In addition, social and psychological support should be made available for children participating in family caregiving.

High 5 for Kids: the impact of a home visiting program on fruit and vegetable intake of parents and their preschool children

OBJECTIVE

The High 5 for Preschool Kids (H5-KIDS) program tested the effectiveness of a home based intervention to teach parents how to ensure a positive fruit-vegetable (FV) environment for their preschool child, and to examine whether changes in parent behavior were associated with improvements in child intake.

METHODS

A group randomized nested cohort design was conducted (2001 to 2006) in rural, southeast Missouri with 1306 parents and their children participating in Parents As Teachers, a national parent education program.

RESULTS

When compared to control parents, H5-KIDS parents reported an increase in FV servings (MN=0.20, p=0.05), knowledge and availability of FV within the home (p=0.01), and decreased their use of noncoercive feeding practices (p=0.02). Among preschoolers, FV servings increased in normal weight (MN=0.35, p=0.02) but not overweight children (MN=-0.10, p=0.48), relative to controls. The parent's change in FV servings was a significant predictor of child's change in FV in the H5-KIDS group (p=0.001).

CONCLUSION

H5-KIDS suggests the need for, and promise of, early home intervention for childhood obesity prevention. It demonstrates the importance of participatory approaches in developing externally valid interventions, with the potential for dissemination across national parent education programs as a means for improving the intake of parents and young children.

A telephone-based intervention for depression in HIV patients: negative results from a randomized clinical trial

To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition.

Caregiver burden and depression among informal caregivers of HIV-infected individuals

BACKGROUND

Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons.

OBJECTIVE

To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals.

DESIGN

Cross-sectional study using baseline data from an ongoing randomized trial of a supportive telephone intervention.

PARTICIPANTS

One hundred seventy-six dyads of HIV patients and their informal caregiver.

MEASUREMENTS

Depression was defined as a Beck Depression Inventory >10. A Caregiver Strain Index >6 identified informal caregivers with a high caregiver burden. We used logistic regression to identify characteristics that were associated with depression in the informal caregiver.

RESULTS

Informal caregivers were 42 years old (SD, 13), 53% female, 59% nonwhite, and 30% had education beyond high school. Forty-seven percent of informal caregivers were the patient's partner, 18% a friend, and 35% a family member. Twenty-seven percent of informal caregivers had a high caregiver burden, and 50% were depressed. We found significantly greater odds of informal caregiver depression with high caregiver burden (OR, 6.08; 95% CI, 2.40 to 15.4), informal caregiver medical comorbidity besides HIV (OR, 2.32; 95% CI, 1.09 to 4.92), spending all day together (OR, 3.92; 95% CI, 1.59 to 9.69), having to help others besides the HIV patient (OR, 2.55; 95% CI, 1.14 to 5.74), and duration of the HIV patient's diagnosis (OR, 1.01 per month; 95% CI, 1.00 to 1.01).

CONCLUSIONS

High caregiver burden was strongly associated with depression among HIV-infected individuals' informal caregivers, who themselves had difficult life circumstances. Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving.