Benefit finding for Chinese family caregivers of community-dwelling stroke survivors: A cross-sectional study

A Holistic Approach to Expressing the Burden of Caregivers for Stroke Survivors: A Systematic Review

This systematic review explores the multifaceted challenges faced by caregivers of stroke survivors, addressing the global impact of strokes and the anticipated rise in survivors over the coming decades. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough literature search identified 34 relevant studies published between 2018 and 2023. The review categorizes caregiver burden into four domains: physical health, social functioning, financial issues, and psychological health. Caregivers often experience a decline in physical health, marked by chronic fatigue, sleep disturbances, and pain. Emotional distress is prevalent, leading to anxiety and depression, especially in cases of high burden. Financial strains arise from medical expenses and employment changes, exacerbating the overall burden. Contextual factors, such as cultural norms and resource availability, influence the caregiver experience. The Newcastle-Ottawa scale assessed the methodological quality of studies. The conclusion emphasizes tailored interventions and support systems for caregivers, with practical recommendations for healthcare professionals, therapists, mental health professionals, financial counselors, and policymakers. This comprehensive review enhances the understanding of caregiver experiences and provides actionable insights to improve stroke care and rehabilitation The study's novelty lies in its holistic examination of caregiver burden in stroke care, its focus on the recent literature, and its emphasis on forecasting caregiver outcomes, contributing valuable insights for proactive intervention strategies.

The mediating effect of stigma between self-perceived burden and loneliness in stroke patients

Introduction

Stroke patients may experience reduced socialization and feelings of isolation due to post-stroke sequelae such as impaired motor function and cognitive deficits. Factors associated with loneliness need to be explored to develop targeted interventions. However, little is known about the impact of self-perceived burden and illness stigma on loneliness in this population.The aim of this study was to explore the mediating effect of stigma on self-perceived burden and loneliness in stroke patients.

Methods

The cluster random sampling method was adopted to select 1028 stroke patients from the neurology department of third-grade A hospitals and second-grade A hospitals in 5 cities of Henan Province from May 2022 to August 2022. A general data questionnaire, self-perceived burden scale, stroke stigma scale, and loneliness scale were used to investigate. The structural equation model was used to analyze the mediating effect of stigma between self-perceived burden and stigma.

Results

The loneliness of stroke patients was positively correlated with self-perceived burden and stigma. The results of the mediation analysis showed that stigma played a complete mediating role between self-perceived burden and loneliness.

Discussion

The results of the study revealed the relationship between self-perceived burden, stigma, and loneliness in stroke patients. Stigma mediated the relationship between self-perceived burden and loneliness in this population.Stigma should be emphasized as an important modifiable psychological factor that affects loneliness of stroke patients.

Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol

INTRODUCTION

In recent years, stroke has become more common among young people. Stroke not only has a profound impact on patients' health but also incurs stress and health threats to their caregivers, especially spousal caregivers. Moreover, the health of stroke survivors and their caregivers is interdependent. To our knowledge, no study has explored dyadic health of young and middle-aged stroke survivors and their spousal caregivers from physiological, psychological and social perspectives. Therefore, this proposed study aims to explore the mechanism of how physiological, psychological and social factors affect dyadic health of young and middle-aged stroke survivors and their spousal caregivers. The findings of this study will provide implications for developing interventions to improve dyadic health of this growing population.

METHODS AND ANALYSES

We will collect data from 57 dyads of young and middle-aged stroke survivors and their spousal caregivers during hospitalisation and at 1, 3, 6, 9 and 12 months after discharge. Questionnaires will be used to collect participants' demographic information, stress, depression, anxiety, benefit finding, social support, mutuality and quality of life. The following physiological reactions will be collected at baseline, including interleukin 6, tumour necrosis factor-alpha and salivary cortisol.

ETHICS AND DISSEMINATION

The study was approved by the ethics review committee of life sciences of Zhengzhou University (No. ZZUIRB2020-53). Prior to being enrolled in the study, participants will be given full and detailed information about the possible risks involved, the informed consent process, confidentiality, the study procedure and secure data storage. Participants will be guaranteed that they can withdraw from the study at any time without providing a reason or leading to any consequences. Both oral and written informed consent will be obtained from all participants. The findings of this proposed study will be disseminated through peer-reviewed journals and academic conferences.

Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level

BACKGROUND

Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China's healthcare system and the lowest out-of-pocket (OOP) expense for insured patients.

METHODS

This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated.

RESULTS

For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals.

CONCLUSION

For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.

Benefit finding in first-ever young and middle-aged patients who had a stroke and their spousal caregivers in China: a longitudinal mixed-methods study protocol

INTRODUCTION

The global burden caused by stroke is shifting to young and middle-aged people. Researchers have emphasised the significance of benefit finding (BF) in psychological health. However, current research has paid little attention to stroke and has discussed BF from only a single perspective, that is, that of either patients or caregivers. Our study aims to understand the changing trajectory, predictors and dyadic interaction of BF in dyads of patient who had a stroke and caregiver.

METHODS AND ANALYSIS

This study is a longitudinal mixed-methods, multicentre study. A total of 142 patients who had a stroke and 142 spousal caregivers will be investigated. Participants will be recruited from four large public hospitals in northern China. Quantitative and qualitative data will be collected at five time points (near discharge and 1, 3, 6 and 12 months following discharge). Validated and reliable questionnaires will be used in quantitative studies. Information on sociodemographic data, BF, functional status, perceived stress, coping styles and mutuality will be collected from the dyads. Qualitative data will be collected via semistructured interviews and observations. The growth mixture model will be used to analyse quantitative data, and Colaizzi's seven-step analysis method will be used to analyse qualitative data. We plan to conduct parallel but separate quantitative and qualitative data analyses and ultimately integrate the data sets to determine confirmation, expansion or discordance.

ETHICS AND DISSEMINATION

All participants will be provided with an informed consent form. This study will encode all identifiable data and store all recorded data on a secure research server. This study has been approved by the Ethics Review Committee of the College of Nursing and Health, Zhengzhou University (ZZUIRB2020-53). The results of the longitudinal study will be published in peer-reviewed journals and presented at national conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2000039509.

Effects of A Benefit-Finding Intervention in Stroke Caregivers in Communities

Objectives: To verify the effectiveness and feasibility of a nine-week benefit-finding intervention on the burden, quality of life, and benefit finding of caregivers, as well as on the quality of life of stroke survivors.Methods: Benefit finding refers to the individual, social, psychological and spiritual benefits perceived by an individual experiencing stress or post-traumatic events. A randomized controlled trial was performed in which 68 stroke survivors and their caregivers were recruited from the Zhengzhou community, China, and randomly split into two groups. The intervention group included those having undergone a nine-week benefit-finding intervention, while the control group included those individuals having undergone a nine-week routine health education. At baseline and one-week post-intervention (after a 9-week intervention), the quality of life of stroke survivors and caregivers and the burden and benefit finding of caregivers were determined.Results: In comparison to the control group, caregiver benefit finding, quality of life, burden, and stroke survivor quality of life were significantly improved (P <.005).Conclusions: The intervention appears to be feasible for stroke patients and caregivers. The intervention is capable of improving the quality of life of caregivers and survivors, increasing the benefit finding of caregivers and reducing the burden of caregivers.Clinical Implications: The benefit-finding intervention is capable of improving the health condition of stroke patients and caregivers.

Dyadic profiles of family resilience among patients with first-episode stroke: A longitudinal study of the first 6 months after stroke

BACKGROUND

The importance of family resilience in the recovery of stroke patients has been demonstrated in numerous studies. However, little is known about post-stroke family resilience.

AIMS

To investigate the family resilience of stroke patients from a patient-caregiver dyadic perspective during the first 6 months after stroke.

METHODS

A total of 288 dyads of patients diagnosed with a first-episode stroke and their principal caregivers were recruited from neurology departments of 7 tertiary hospitals in Shanghai and Shangqiu, China. Family resilience and family function were assessed during hospitalisation and at 1, 3 and 6 months after stroke. K-means cluster analysis was used to identify different clusters of family resilience based on family resilience of patients and caregivers during hospitalisation. The STROBE guidelines for observational studies were followed.

RESULTS

Three clusters of family resilience were identified with distinct trajectories: cluster of high resilience (HR), cluster of low resilience (LR) and cluster of discrepant resilience (DR). The level of family function was consistently highest in cluster HR and lowest in cluster with LR at four time points. Most (69.8%) families fell into the cluster with low resilience and low family function. Characteristics such as the Rankin scores and education level of patients, education level of caregivers, family monthly income and living district were different among the three clusters.

CONCLUSIONS

We concluded that family resilience was linked to the family functioning of patients with a first-episode stroke, however, the levels of resilience in most families were low. Factors, including the education level, family income and stroke severity of patients were revealed to influence the family resilience and its development.

RELEVANCE TO CLINICAL PRACTICE

A resilience-focused approach to family-related treatment is beneficial for families. Therefore, understanding family resilience among stroke survivors is needed to inform the development of interventions for enhancing the recovery of stroke families.

Programs Addressed to Family Caregivers/Informal Caregivers Needs: Systematic Review Protocol

(1) Background: considering the growing increase in informal caregivers or family caregivers, it is critical to identify the unmet care needs of informal caregivers to improve their experiences, health, and well-being, contributing to the achievement of care needs of the elderly or people with adult dependency and promotion of successful transitions from health services to the community/home. (2) Objective: to identify the current state of knowledge about programs addressed to family caregivers/informal caregivers needs. (3) Methods: a systematic review will be undertaken with resource to databases from EBSCOhost Research Platform, Scopus, Web of Science, The Virtual Health Library (VHL). Studies published after January 2011 in English, Spanish, French, Italian and Portuguese will be considered. This review will consider all studies that report on any intervention program targeting family caregivers/informal caregivers who need to improve their experiences, health, and well-being, contributing to the meeting of their needs or those who have dementia and cognitive impairment, mental disorders, impairments in activities of daily living, frailty and/or who need health care and/or promoting successful transitions of community. (4) Discussion: The results of this review could be used to develop an intervention model to meet the needs of the family caregivers/informal caregivers. Furthermore, these findings will help to guide the construction of health policies regarding family caregivers/informal caregivers, as well their needs.

Health care utilization for patients with stroke: a 3-year cross-sectional study of China's two urban health insurance schemes across four cities

Background

Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China.

Methods

A 5% random sample from the 2014–2016 China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data.

Results

We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: − 0.672, − 0.649) fewer outpatient visits, 13.0% (95% CI: − 0.144, − 0.115) fewer inpatient visits, and 34.2% (95% CI: − 0.366, − 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference.

Conclusions

Significant city-specific differences in stroke patients’ healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.

Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis

There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.

Benefits finding among Chinese family caregivers of stroke survivors: a qualitative descriptive study

OBJECTIVES

The caregiving experience includes both caregiver burdens and benefits finding. However, the benefits obtained by family caregivers of stroke survivors in Chinese community dwellings are unknown. The objective of this study was to explore the benefits experienced by family caregivers of stroke survivors in Chinese community dwellings.

DESIGN

A qualitative descriptive design was used, fulfilling the consolidated criteria for the Standards for Reporting Qualitative Research reporting guidelines. Semi-structured interviews were conducted with 20 family caregivers of stroke survivors. The interviews were audiotaped, transcribed and analysed. Thematic analysis was performed to analyse the interview transcripts.

SETTING AND PARTICIPANTS

Home interviews were conducted with family caregivers of stroke survivors in two communities in Zhengzhou, China.

RESULTS

The family caregivers of stroke survivors experienced various benefits from caregiving. There were both internal benefits (increases in knowledge and skills, the development of positive attitudes, and the development of a sense of worthiness and achievement) and external benefits (family growth and gains in social support), which interact to create a healthy lifestyle.

CONCLUSION

Our findings provide a comprehensive perspective in understanding the benefits perceived by family caregivers of stroke survivors. This study provides insights into interventions focused on identifying benefits finding in six domains that may help reduce negative emotions and promote the mental health of caregivers.

Exploring the Moderating Role of Benefit Finding on the Relationship Between Child Problematic Behaviours and Psychological Distress in Caregivers of Children with ASD

Caregivers of children with ASD often find benefits associated with their caregiving role, and benefit finding predicts lower distress. Child problematic behaviours (CPB), which positively predict caregivers' distress, are perceived to be being less problematic, or more manageable, by caregivers who find benefits. Benefit finding therefore might mitigate the negative psychological impact of CPB. A sample of n = 158 caregivers of children with ASD completed an online survey assessing benefit finding, CPB, and psychological distress. CPB positively, and benefit finding negatively, predicted caregivers' distress. Moderation effects however were not observed. Findings implicate increased CPB and lower benefit finding as risk factors for caregivers' psychological distress. Findings provide clearly definable targets for intervention.

Creating a Caregiver Benefit Finding Scale of Family Caregivers of Stroke Survivors: Development and Psychometric Evaluation

In recent years, increased attention has been paid to the benefit finding of family caregivers due to the important role they play. Although some instruments measure benefit finding of caregivers, they do not comprehensively address it in terms specific to the family caregivers of stroke survivors, who require long-term, consistent care. This study is the first effort to develop a comprehensive Caregiver Benefit Finding Scale for the family caregivers of stroke survivors in a Chinese cultural setting. First, 50 items were extracted from a systematic literature review, and a semi-structured interview was conducted with 20 stroke family caregivers to develop the preliminary version of the scale (Version 1). Second, Delphi procedures with 20 experts were used to revise the first version and create Version 2 (37 items). Another six experts were recruited for content validation. Item content validity index (I-CVI) values ranged from 0.83 to 1.00, and the value of the scale CVI was 0.97. Third, 309 family caregivers completed the Version 2 questionnaire and the Chinese version of the Positive Aspects of Caregiving. Two weeks later, 35 family caregivers once again completed the questionnaires. An exploratory factor analysis produced four components (personal growth, health promotion, family growth, and self-sublimation) and 26 items for Version 3 (the cumulative proportion variance was 74.14%). Subsequently, 311 family caregivers completed Version 3. A confirmatory factor analysis confirmed the structure. The goodness of fit index (GFI) = 0.921, adjusted GFI = 0.901, normal fit index = 0.951, incremental fit index = 0.990, comparative FI = 0.990, and the root mean square error of approximation = 0.02 were within the acceptable range. Criterion-related validity was equal to 0.803. The model-based internal consistency index was 0.845 and the values of the Cronbach'α coefficient of the four dimensions were 0.885-0.953. The split-half reliability was 0.92, and the test-retest reliability was 0.994. These findings provide preliminary evidence of the validity and reliability of the Caregiver Benefit Finding Scale. The scale can help researchers and clinicians to achieve a more comprehensive understanding of stroke family caregivers' positive experience. This understanding is necessary for future efforts to address issues in benefit finding by targeting the underlying mechanism and intervention.

Quality of Life in Family Caregivers of Adolescents with Depression in China: A Mixed-Method Study

PURPOSE

In this study, we investigated quantitatively the quality of life (QoL) and its influencing factors among Chinese family caregivers who care for adolescents with depression (AWD) and we explored qualitatively their care-giving experiences.

METHODS

The study was a mixed method with convergent parallel design. The sociodemographic characteristics, QoL, caregivers' burden, family functioning, positive and negative affects were assessed by using questionnaires on 240 family caregivers of AWD in China. Twelve of these family caregivers were interviewed by using a semi-structured guide to explore their care-giving experiences.

RESULTS

The mean score among family caregivers of AWD for physical QoL was 65.18 and 59.42 for mental QoL, which was significantly lower than the Chinese norms for QoL. Multiple regression analysis demonstrated that course of disease of AWD, caregivers' educational qualification, family functioning, positive affect and care-giving burden accounted for 57% of the variance in physical QoL. Suicide history of AWD, caregivers' educational qualification, negative affect, positive affect, care-giving burden and family functioning accounted for 54% of the variance in mental QoL. Four major themes of the care-giving experiences emerged: lack of knowledge about depression, being overwhelmed emotionally with psychological burden, the devastating impact of illness on family, and the perceived benefits of care-giving.

CONCLUSION

The QoL among family caregivers of AWD in China was low. It is necessary for health-care professionals to pay more attention to the QoL of family caregivers who care for AWD.