Who Is Caring for the Caregiver? The Role of Cybercoping for Dementia Caregivers

Coping with Non-COVID-19 Health Problems Through Communicative Action in Cyberspace

This study investigated how the online health information behaviors of U.S. adults with illnesses unrelated to COVID-19 virus infection affected their coping with health problems and concerns during the COVID-19 pandemic. Guided by the cybercoping model (Kim & Lee, 2014), the study examined associations between these patients' online information behaviors (information seeking and information forwarding) and coping outcomes (health problems and affective states). The study further explored the mediating roles of health coping processes (problem-and emotion-focused) in the associations between these information behaviors and coping outcomes. Survey data from 687 participants were analyzed using structural equation modeling. The results highlighted the significance of information forwarding in enhancing both coping processes and outcomes, while information seeking enhanced problem-focused coping and health-problem coping outcomes alone. These associations were more pronounced among U.S. adults without chronic conditions than among those with chronic illnesses. These findings' implications, the study's limitations, and suggestions for future research were also addressed.

A systematic review of digital access to post-diagnostic health and social care services for dementia

OBJECTIVES

For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed-methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers.

METHODS

Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed-method studies, published in English or German, focused on experiences of using technology-delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included.

RESULTS

From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech-literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes.

CONCLUSIONS

Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery.

Risk Perception and Preventive Behavior During the COVID-19 Pandemic : Testing the Effects of Government Trust and Information Behaviors

Given the absence of COVID-19 treatments, the best way to control the spread of the virus is to break the chain of infection by increasing public participation in preventive behaviors recommended by health authorities. This study proposes a moderated mediation model of information behaviors (e.g. information seeking and information verification) and trust in government that explores the relationship between risk perception and preventive behaviors regarding COVID-19. Using a survey study in South Korea, we conducted the moderated mediation analysis with latent moderated structural equation modeling (LMS). We found serial mediation effects for risk perception, information behaviors, and preventive behaviors, as people both seek out information and verify that information before adopting preventive behaviors. Additionally, trust in government moderated information behaviors in the relationship between risk perception and preventive behaviors, suggesting that trust in government encourages people to adopt more preventive actions via information seeking and information verification. Further implications are discussed to promote public understanding of the health crisis and public participation in preventive measures.

Feasibility and Acceptability of a Novel Online Program for Mental Health Carers

Objective

To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms.

Methods

Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups.

Results

Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control.

Conclusions

The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.

Coping with mental health issues via communicative action in the digital age: testing cybercoping models

BACKGROUND

Mental health issues have become critical social problems around the world. Individuals who are suffering from mental health problems tend to obtain health information and social support in the digital media environment. However, there has been little research on how information-seeking and information-forwarding behaviors affect sufferers' coping processes and outcomes. Based on communicative behaviors of people in online to solve health problmes, this study aims to apply two cybercoping modes proposed by previous reserach to mental health issues.

METHOD

Using anxiety and depression issues, this study conducted an online survey (N = 560) to examine two cybercoping models with data collected from an online crowdsourcing platform (Amazon's Mechanical Turk). Structural equation modeling (SEM) was conducted to test the cybercoping models in the context of mental health issues.

RESULTS

Results of the first cybercoping model showed that information seeking was positively associated with coping outcomes, whereas information forwarding was not significant. While information seeking in the second cybercoping model was significantly associated with other factors, information forwarding was not significant. The second model revealed that coping processes fully mediate between information seeking and cybercoping outcomes.

CONCLUSIONS

This study contributes to the theoretical building of cybercoping models in the context of mental health issues by illustrating the effects of information seeking on cybercoping outcomes. Health care practitioners may use these results to better understand which communicative processes in online mental health communication are positively associated with specific coping processes and outcomes.

Belonging through a communicative lens in dementia caregiving: qualitative study of autobiographical caregivers narratives

This qualitative study examined 23 autobiographical narratives to understand how dementia caregivers discursively construct a sense of belonging through In this study, belonging is understood as an individual feeling valued by a group that is communicatively enacted by both the individual and members of the group. This exploratory study revealed two characteristics of belonging as a communicative concept: (a) two-way street and (b) multi-faceted. Findings suggest that belonging is a more nuanced concept than previously thought.

Family carers of people living with dementia and discussion board engagement in the Understanding Dementia Massive Open Online Course

OBJECTIVES

This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC).

METHODS

A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions.

RESULTS

Family carers were (n = 2320) found to post (p < 0.001) and reply (p = 0.029) significantly more often than non-carers (n = 2392). Of the 32-STM derived-topics, meaningful activities (mean Δ = 0.007, 95% CrI [0.005-0.100]), personal stories of diagnosis (mean Δ = 0.007, 95% CrI [0.005-0.009]), and family history of dementia (mean Δ = 0.006, 95% CrI [0.004-0.008]) were discussed significantly more frequently by family carers compared to non-carers.

CONCLUSION

These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.

Coping strategies and quality of life among Thai family carers of community-dwelling persons living with dementia: A cross-sectional study

AIMS

To examine the association between coping strategies and quality of life (QOL) among Thai family carers of persons living with dementia.

DESIGN

A descriptive correlational quantitative design.

METHODS

Data were collected between January 2021 and April 2021. A multi-pronged approach for recruitment was used. Participants completed measures assessing carer demographic characteristics, coping styles, QOL, perceived stress and perceived social support. Hierarchical multiple regression analysis was used to determine the association between types of coping strategies used and QOL scores, adjusting for carer characteristics and carers' stress and social support.

RESULTS

There were 86 participants (mean age 52.84 years), and the majority were female (87.2%). After adjusting for covariates, hierarchical multiple regression revealed that only positive emotion-focused coping demonstrated a statistically significant association with total QOL scores. Problem-focused coping and negative emotion-focused coping were not significantly associated with total QOL scores of Thai family carers of persons living with dementia.

CONCLUSION

Positive emotion-focused coping was associated with improved QOL scores. This finding supports the use of positive emotion-focused coping in Thai family carers of persons living with dementia, which potentially could improve the QOL of this population.

IMPACT

It is essential to differentiate between positive and negative emotion-focused coping to generate valid estimates of the association between coping and QOL. Nurses should encourage carers to use positive emotion-focused coping strategies as these strategies were found to be helpful in enhancing carers' QOL.

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

AIMS

To examine the accuracy of diagnostic responses and types of information provided on online health forums.

DESIGN

Qualitative descriptive study.

METHODS

This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun & Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not.

RESULTS

The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals.

CONCLUSION

Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial.

IMPACT

This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure.

Predicting Public Support for Government Actions in a Public Health Crisis: Testing Fear, Organization-Public Relationship, and Behavioral Intention in the Framework of the Situational Theory of Problem Solving

This study aimed to examine a theoretical model to predict publics' communicative actions to take and transmit information from the Centers for Disease Control and Prevention (CDC), as well as their behavioral intentions to follow the CDC's instructions in the context of infectious disease outbreaks. Using the framework of the situational theory of problem-solving (STOPS), this study tested the roles of fear and positive organization-public relationship (OPR), linking STOPS and behavioral intentions to follow CDC instructions. The results of this study suggest that fear and positive OPR variables play vital roles in predicting individuals' information acquisition, information transmission, and willingness to follow the CDC's instructions to cope with infectious diseases.

Ashamed Caregivers: Self-Stigma, Information, and Coping among Dementia Patient Families

The number of people living with dementia increases almost every year, and the majority of the care system for these individuals is often made up of close family members. This study investigates the relationship between family caregivers' cross-checking of information with healthcare providers and patient health outcomes. Specifically, we examined whether this relationship was mediated by caregivers' enhanced coping efficacy. We also tested the moderation effect of family caregivers' affiliate stigma on information cross-checking, coping efficacy, and coping outcomes. Using a survey of 226 family caregivers of dementia patients in South Korea, this study tested the moderated mediation model with the PROCESS macro. Results indicate that low affiliate stigma moderates coping efficacy on the relationship between information cross-checking and dementia patients' health outcomes. Further implications for family caregiving and general dementia care are discussed.

Care for carers: A concept analysis of support for carers of ill relatives

The aim of the study is to clarify the concept "care for carers," and enhance our understanding of caring for carers of ill relatives. Healthcare professionals often refer to "care for carers" when discussing methods to support the carers of ill family relatives. These carers do not always receive the support they need. A literature search of electronic databases and search engines, using the keywords carer, caregiver, caring for the carer, caring for the caregiver was done. Peer-reviewed research articles published between 2014 and 2019 and written in the English language were analyzed. Following retrieval, research articles were analyzed to describe the uses, attributes, antecedents, consequences, and empirical referents of the concept "care for carers." Research articles describing borderline, related, contrary, and illegitimate examples were included. "Care for carers" addresses the unique support needs of those taking care of ill family members. Carers may derive a sense of empowerment from receiving individualized and proactively rendered support. Carers should be supported to develop control over their circumstances, to find meaning in their caring, to become resilient when experiencing challenges, and to confirm their identity as carers of their ill relatives.

Adapting the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) in a Sample of Greek and Cypriot Carers of People With Dementia: Reliability and Validation Study

BACKGROUND

As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills.

OBJECTIVE

This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers.

METHODS

The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored.

RESULTS

The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2).

CONCLUSIONS

eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/resprot.8080.

Informal carers' experience of assistive technology use in dementia care at home: a systematic review

BACKGROUND

Dementia is a health and care priority globally. Caring for persons with dementia is a challenge and can lead to negative psychological, physiological and financial consequences for informal carers. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology devices such as electronic medication dispensers, robotic devices trackers and motion detectors. However, little is known about carers' experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use assistive technology.

METHODS

A systematic search in seven databases and manual searches were carried out using pre-defined inclusion and exclusion criteria to identify studies on carers of persons with dementia involving the use of assistive technology. The search identified 56 publications with quantitative, qualitative and mixed-method designs.

RESULTS

The studies reported positive and negative findings and focused on a wide variety of assistive technology devices. There were large differences in the uses of assistive technology, outcome measures used and the quality of studies. Knowledge and acceptance, competence to use and ethical issues when using assistive technology were themes that emerged from the studies. Carers generally appreciated using assistive technology and their experience of use varied.

CONCLUSIONS

The intention of this systematic review is to list and classify the various types of assistive technology used by carers of persons with dementia and explores the positive and negative aspects, knowledge, acceptance and ethical issues in the use of assistive technology by carers of persons with dementia. We recommend the use of a standard and person-centred system of classifying and naming assistive technology devices and systems and for future research efforts in assistive technology to incorporate a family/carer centred model.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO - CRD42017082268 .