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Zwar L, König HH, Hajek A. Views of aging and mental health - The role of informal care provision: Longitudinal findings of the health and retirement study in the US. J Affect Disord 2024; 361:472-479. [PMID: 38901694 DOI: 10.1016/j.jad.2024.06.055] [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: 02/05/2024] [Revised: 06/06/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Informal care is a common form of social support, which can vary greatly in its intensity. While views of aging have shown to be relevant to mental health before, we aim to analyze whether the association between views of aging and depressive symptoms is influenced by the provision of informal care and its intensity. METHODS Data of six waves of the Health and Retirement Study in the United States was used. The sample includes up to 41,058 observations pooled over six waves of community-dwelling adults aged ≥50 years. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CESD) and attitudes towards own aging (ATOA) with the Philadelphia Geriatric Center Morale Scale (higher score indicates positive attitudes); informal caregiving (no/yes) and caregiving intensity (moderate, intense) were surveyed. Adjusted fixed effects regression analysis with robust standard errors, and with caregiving as moderator variable were calculated. RESULTS Informal caregiving did not interact with ATOA. However, transitioning into intense caregiving significantly moderated the association between ATOA and depressive symptoms. Lower depressive symptoms were associated with better ATOA and this association was significantly stronger in the intense caregiving condition than in the non-caregiving condition. No significant interaction effects were found between any form of caregiving and subjective age. LIMITATIONS The possibility of reciprocal effects cannot be excluded. CONCLUSION Internalized ageism and depressive symptoms are more strongly related among caregivers who provide intense care. Thus, interventions to reduce internalized ageism could be helpful in particular among this vulnerable group of informal caregivers.
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Affiliation(s)
- Larissa Zwar
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany.
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany
| | - André Hajek
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany
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Huggins M, Puurveen G, Pesut B, Rush K. Competency development for a volunteer navigation program to support caregivers of people living with dementia: A modified e-Delphi method. DEMENTIA 2024; 23:69-90. [PMID: 37976553 PMCID: PMC10797849 DOI: 10.1177/14713012231216768] [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] [Indexed: 11/19/2023]
Abstract
Caregivers of people living with dementia are pillars of the care community. Providing them with adequate support throughout their caregiving journey is essential to their quality of life and may also contribute to improving the care of people living with dementia. Nav-CARE (Navigation - Connecting, Advocating, Resourcing, Engaging) is a volunteer-led navigation program that provides support to older adults with life-limiting illnesses who are living in the community. However, Nav-CARE does not provide support directly to caregivers of people living with dementia. To adapt Nav-CARE to support caregivers, we needed to establish caregivers' needs and the competencies volunteer navigators should be trained in to support caregivers to meet these needs. To do so, a modified e-Delphi method was utilized, which consisted of administering three sequential questionnaires to a panel of 35 individuals with expertise in a variety of dementia related domains. Through this, two final lists of 46 caregivers' needs and 41 volunteer competencies were established to inform the development of volunteer navigator training curriculum. Findings suggest that trained volunteer navigators may be able to support caregivers of people living with dementia throughout the disease trajectory and can be used to inform the development of future dementia navigation programs.
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Affiliation(s)
- Madison Huggins
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Gloria Puurveen
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Barb Pesut
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Kathy Rush
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
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Sideman AB, Merrilees J, Dulaney S, Kiekhofer R, Braley T, Lee K, Chiong W, Miller B, Bonasera SJ, Possin KL. "Out of the clear blue sky she tells me she loves me": Connection experiences between caregivers and people with dementia. J Am Geriatr Soc 2023; 71:2172-2183. [PMID: 36917135 PMCID: PMC10500033 DOI: 10.1111/jgs.18297] [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: 12/02/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dementia can impede the relationship and connection between the person with dementia (PWD) and their caregiver. Yet, caregiving in dementia also offers opportunities for connection, which has implications for caregiver and PWD well-being. In this qualitative study, we describe and characterize ways caregivers felt connected to the person with dementia they care for. METHODS We conducted a telephone-based survey with caregivers of people with dementia. For this paper, we analyzed responses to an open-ended question focused on when caregivers feel most connected to the person they are caring for. Responses were analyzed and coded and themes were identified through an iterative process involving a multidisciplinary team of researchers and clinicians. RESULTS 437 caregivers participated in this study. We identified two domains of connection: activity-based and emotion-based connections. Within activity-based connections, the following themes emerged: everyday activities; reminiscing; activities of caregiving; novel experiences; and time with family and friends. Within emotional connections, the following themes emerged: expressions of love, appreciation, and gratitude; physical affection; sharing an emotion or emotional experience; and times when the PWD seems like "themself" again. CONCLUSIONS Findings provide insights into ways caregivers experience a sense of connection with the person they care for. There is a call to shift away from focusing on reducing stress and toward optimizing positive experiences as a way to better support caregivers' health and well-being. Interventions that leverage these insights to foster caregiver - PWD connection could lead to better health and well-being for both members of the dyad. The amplification of a positive experience may be particularly important for caregivers who are struggling with limited support or respite. Clinicians may be interested in using a question about connection as a way to more fully understand a caregiver's current experience.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Rachel Kiekhofer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, Baystate Health, Springfield, Massachusetts, USA
| | - Katherine L. Possin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
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Wu Q, Yamaguchi Y, Greiner C. Factors associated with the well-being of family caregivers of people with dementia. Psychogeriatrics 2022; 22:218-226. [PMID: 35001457 DOI: 10.1111/psyg.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/28/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Improving the health and well-being of family caregivers of people with dementia has become an increasingly important public health and policy issue in China. The aims of this study were to clarify the factors associated with the well-being of family caregivers of people with dementia in China. METHODS Data were collected from a sample of 132 family caregivers who volunteered to study and live together with people with dementia who had been treated as outpatients in three hospitals in China. The survey included questions on the family caregivers' characteristics, satisfaction with family support, positive aspects of caregiving, preparedness of caregiving, and characteristics of people with dementia. Multiple linear regression analysis was carried out to identify factors associated with the well-being of family caregivers. RESULTS The mean age of the family caregivers (68.2% women) was 46.8 ± 14.9 years. The results of multiple linear regression analysis indicated that positive aspects of caregiving (β = 0.352, P < 0.001), satisfaction with family support (β = 0.219, P < 0.01), activities of daily living of people with dementia (β = 0.265, P < 0.05), and household size (β = -0.184, P < 0.05) were related to the well-being of family caregivers. CONCLUSIONS The findings from this study indicated that positive aspects of caregiving, satisfaction with family support, activities of daily living of people with dementia, and household size were significant factors related to the well-being of family caregivers. These findings could be expected to aid healthcare providers in identifying the optimal solution to enhance the well-being of family caregivers in China.
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Affiliation(s)
- Qian Wu
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yuko Yamaguchi
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Chieko Greiner
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
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5
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OUP accepted manuscript. Br J Surg 2022; 109:898-899. [DOI: 10.1093/bjs/znac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/01/2022] [Accepted: 05/01/2022] [Indexed: 11/14/2022]
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Jiang L, Zhang A, Wang M, Yang L, Ma L. Perceived social support and distress in carers of people with lung cancer: The serial mediation of resilience and positive aspects of caregiving. Eur J Oncol Nurs 2021; 56:102084. [PMID: 34896971 DOI: 10.1016/j.ejon.2021.102084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/27/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the mediating roles of resilience and positive aspects of caregiving (PAC) in the effect of perceived social support (PSS) on distress. METHODS This study, with a cross-sectional design, was conducted in a Chinese hospital. Instruments included the Multidimensional Scale of Perceived Social Support, Chinese version Connor-Davidson Resilience Scale, Positive Aspects of Caregiving, and the Depression, Anxiety, Stress Scales-21. Descriptive analysis and serial mediation analysis were conducted by SPSS 22.0. RESULTS Data from 300 Chinese carers of people with lung cancer was used. The correlation analysis showed that PSS, resilience, and PAC were protective factors of distress. The mediation analysis revealed that resilience and PAC separately and serially mediated the effect of PSS on distress. CONCLUSION Carers of people with lung cancer perceived positive and negative caregiving experiences simultaneously. PSS could alleviate distress by enhancing resilience and promoting PAC. Multicomponent interventions integrating PSS, resilience, and PAC should be designed to alleviate distress among Chinese carers of people with lung cancer.
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Affiliation(s)
- Li Jiang
- Department of Neurosurgery, Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Aiping Zhang
- Department of Cardiovascular Medicine, Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Menxi Wang
- Nursing Department, Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Lixia Yang
- Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Lin Ma
- Nursing Department, Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
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Smith T, Fletcher J, Lister S. Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography. Br J Pain 2020; 15:187-198. [PMID: 34055340 DOI: 10.1177/2049463720925110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain. Methods A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool. Results From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad. Conclusion The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.
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Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jessica Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Department, Connect Health, Milton Keynes, UK
| | - Sarah Lister
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Trajectory of Psychosocial Measures amongst Informal Caregivers: Case-Controlled Study of 1375 Informal Caregivers from the English Longitudinal Study of Ageing. Geriatrics (Basel) 2020; 5:geriatrics5020026. [PMID: 32349243 PMCID: PMC7345989 DOI: 10.3390/geriatrics5020026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/17/2022] Open
Abstract
Informal caregivers provide vital support for older adults living in the community with chronic illnesses. The purpose of this study was to assess the psychosocial status of informal caregivers of community-dwelling adults over an eight-year period. Informal caregivers of adult care-recipients were identified from Wave 1 of the English Longitudinal Study of Ageing (ELSA) cohort. Multivariate regression analysis models were constructed to assess the association between participant's psychosocial characteristics and informal caregiving. Multilevel modelling explored the psychosocial changes between caregivers and non-caregivers over eight years. 1375 informal caregivers and 2750 age-matched non-caregivers were analyzed. Self-reported loneliness (Odd Ratio (OR): 0.26; 95% confidence intervals (CI): 0.01-0.51) and relationship status (OR: 0.36; 95% CI: 0.16-0.46) were independently associated with caregiving. Caregivers were more socially isolated with less holidaying abroad (OR: 0.51; 95% CI: 0.35-0.66), attendance to church (OR: 0.30; 95% CI: 0.11-0.49), or charity groups (OR: 0.35; 95% CI: 0.14-0.55). On multilevel analysis, over time (eight-years), caregivers reported greater loneliness (p < 0.01), change in relationship status (p = 0.01) and reduced control, autonomy, and pleasure (p ≤ 0.01) compared to non-caregivers. Given the deleterious effects caregiving can place on health and wellbeing, further interventions are required to improve these psychosocial factors.
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Psychological Symptomatology in Informal Caregivers of Persons with Dementia: Influences on Health-Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031078. [PMID: 32046272 PMCID: PMC7037057 DOI: 10.3390/ijerph17031078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 01/13/2023]
Abstract
Informal caregivers of persons with dementia often report high levels of anxiety, depression and burden. Nonetheless, other less evaluated psychological symptoms might also influence their health-related quality of life (HRQoL). The aim of this study was to comprehensively analyse other psychological symptoms and their influence on the health-related quality of life of informal caregivers. Fifty-four informal women caregivers and fifty-six women non-caregivers were recruited to participate in the study. Psychological symptoms were assessed using the Symptom Check-List-90-Revised (SCL-90-R) questionnaire and the HRQoL with the EuroQoL-Five Dimensions and Three Levels (EurQoL-5D-3L) questionnaire. Significant between-group differences were found in the majority of scales in the SCL-90-R questionnaire (p < 0.01) and caregivers also reported a worse HRQoL than non-caregivers (p < 0.05). Several psychological symptoms such as obsession-compulsive (β = 0.47), hostility (β = 0.59), and somatization (β = −0.49) had a significant impact on caregivers’ HRQoL (R2 explained between 0.17 and 0.30 of the variance). Caregivers are at a higher risk of suffering other psychological symptoms and show a moderate–high level of psychiatric morbidity, which therefore explains the poorer HRQoL outcomes. Supporting interventions should be provided to mitigate these psychological symptoms in order to improve their general distress and HRQoL.
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Mei YX, Lin BL, Zhang WH, Wang SS, Zhang ZX, Yang DB, Cheung DSK. Creating a Caregiver Benefit Finding Scale of Family Caregivers of Stroke Survivors: Development and Psychometric Evaluation. Front Psychiatry 2020; 11:734. [PMID: 32848914 PMCID: PMC7403500 DOI: 10.3389/fpsyt.2020.00734] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Yong-Xia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,Department of Neurosurgery, The People's Hospital of Hebi, Hebi, China
| | - Bei-Lei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wei-Hong Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Shan-Shan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Dong-Bin Yang
- Department of Neurosurgery, The People's Hospital of Hebi, Hebi, China
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