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Lin CY, Chung ML, Schuman DL, Biddle MJ, Mudd-Martin G, Miller JL, Hammash M, Schooler MP, Rayens MK, Feltner FJ, Moser DK. Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses. Nurs Res 2023; 72:292-300. [PMID: 37011339 PMCID: PMC10330077 DOI: 10.1097/nnr.0000000000000659] [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: 04/05/2023]
Abstract
BACKGROUND The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers. OBJECTIVES This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs. METHODS We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships. RESULTS The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies. DISCUSSION This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs.
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Irani E, Niyomyart A, Zauszniewski JA. Caregiving Stress and Self-Rated Health during the COVID-19 Pandemic: The Mediating Role of Resourcefulness. Issues Ment Health Nurs 2021; 42:982-988. [PMID: 34080954 PMCID: PMC8714403 DOI: 10.1080/01612840.2021.1924324] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Family caregivers faced unprecedented circumstances and experienced increased levels of stress during the COVID-19 pandemic. Resourcefulness can minimize the effect of stress on health outcomes. The purpose of this study was to examine the associations between caregiving stress during the pandemic, resourcefulness, and self-rated health and assess the mediating effect of resourcefulness. A convenience sample of 70 family caregivers of adults with chronic and/or disabling conditions was recruited using social media groups and professional networking platforms. Data were collected using an online survey and analyzed using linear regression. Mediation analysis was conducted using the PROCESS macro. Higher levels of caregiving stress during the pandemic and lower levels of resourcefulness were associated with worse self-rated health, while controlling for age, employment status, and weekly caregiving hours. Resourcefulness mediated the relationship between caregiving stress and self-rated health. Our findings highlight the importance of assessing the psychological impact of the pandemic on family caregivers' outcomes. Resourcefulness skills can be targeted to improve the health and well-being of family caregivers during and beyond the pandemic.
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Affiliation(s)
- Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Atsadaporn Niyomyart
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Rossetti KG, Zlomke KR. Resourcefulness revisited: Further psychometric evaluation of resourcefulness scale. Stress Health 2021; 37:631-639. [PMID: 33426795 DOI: 10.1002/smi.3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 11/09/2022]
Abstract
Resourcefulness, a collection of problem-solving, coping, self-control and emotion regulation skills, has been shown to moderate health outcomes in various caregiver populations. Caregivers of children with neurodevelopmental disorders, such as autism spectrum disorder (ASD), report higher levels of stress, anxiety and depressive symptoms with poorer health-related quality of life. The current study replicated and extended psychometric research on the Resourcefulness Scale (RS) among caregivers of children with ASD (n = 287) and a comparison group of caregivers of non-affected children (n = 207). Results suggest acceptable internal consistency and construct validity when using the RS among caregivers of children with and without ASD. The RS demonstrated poor temporal stability over an average of 4 weeks (r = 0.087, p = 0.434). Caregivers of children with ASD report higher levels of general, social, and personal resourcefulness than non-affected caregivers. Findings validate the use of the RS within caregiving populations with implications for clinical use and future research in the development of interventions to enhance caregiver QoL.
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Affiliation(s)
| | - Kimberly R Zlomke
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
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Bekhet AK, Garnier-Villarreal M. Depression, positive thinking, personal and social resourcefulness among caregivers of persons with autism spectrum disorders. Arch Psychiatr Nurs 2018; 32:823-827. [PMID: 30454623 DOI: 10.1016/j.apnu.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/25/2018] [Accepted: 06/02/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Abir K Bekhet
- Marquette University College of Nursing, United States.
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Musil CM, Rice HM, Singer M, Givens SE, Warner CB, Zauszniewski JA, Burant CJ, Toly VB, Jeanblanc AB. Grandchildren's Depressive Symptoms and Perceptions of Family Functioning: Protective and Influencing Factors. West J Nurs Res 2018; 40:1319-1338. [PMID: 28738731 PMCID: PMC6151252 DOI: 10.1177/0193945917721017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.
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Affiliation(s)
- Carol M Musil
- 1 Case Western Reserve University, Cleveland, OH, USA
| | | | - Mark Singer
- 1 Case Western Reserve University, Cleveland, OH, USA
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Zauszniewski JA, Herbell K, Burant C. Is There More to Resourcefulness Than Personal and Social Skills? West J Nurs Res 2018; 41:372-387. [PMID: 30043688 DOI: 10.1177/0193945918790930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study examined relationships among personal and social resourcefulness and spiritual practices and their associations with perceived stress, depressive symptoms, and self-assessed health in 138 women caregivers of elders with dementia. Caregivers who rated high on personal and social resourcefulness and spiritual practices (by median splits) had the lowest perceived stress, fewest depressive symptoms, and best self-assessed health, followed in sequence by women rating high on two of the three, high on one of the three, and low on all three. Hierarchical regression analyses that introduced spiritual practices after resourcefulness showed significant increases in the R-square change by 3% and 5% for perceived stress and depressive symptoms, respectively, but no significant change for self-assessed health. Strong associations among personal and social resourcefulness and spiritual practices, and similar relationships with two health outcomes, suggest that spiritual practices may be a third dimension of resourcefulness.
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Bekhet AK, Matel-Anderson D. Risk and Protective Factors in the Lives of Caregivers of Persons With Autism: Caregivers' Perspectives. Perspect Psychiatr Care 2017; 53:199-207. [PMID: 27306504 DOI: 10.1111/ppc.12158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/13/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this descriptive exploratory study is to understand the experience of being a caregiver of a person with autism spectrum disorder (ASD) in the light of the resilience theory. METHODS Qualitative data were collected as a part of a larger quantitative study. Ninety-three caregivers completed this qualitative study and responded to the two open-ended questions. In the parent study, subjects were recruited by convenience sampling from the Interactive ASD Network (IAN). FINDINGS The identified categories appeared to reflect three distinct categories consistent with the resilience theory, labeled as follows: risk factors, protective factors, and overlapping factors. PRACTICE IMPLICATIONS These findings help to inform the planning of tailored interventions to enhance caregivers' resilience.
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Affiliation(s)
- Abir K Bekhet
- Abir K. Bekhet, PhD, RN, HSMI, is Associate Professor of Mental Health Nursing, Marquette University College of Nursing, Milwaukee, Wisconsin, USA; and
| | - Denise Matel-Anderson
- Denise Matel-Anderson, APNP, RN, is Nursing Doctoral Student, Marquette University College of Nursing, Milwaukee, Wisconsin, USA
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Benson PR. The impact of child and family stressors on the self-rated health of mothers of children with autism spectrum disorder: Associations with depressed mood over a 12-year period. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017. [DOI: 10.1177/1362361317697656] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Employing a cohort sequential design and multilevel modeling, the effects of child and family stressors and maternal depressed mood on the self-rated health of 110 mothers of children with autism spectrum disorder were assessed over a 12-year period when children in the study were 7–19 years old. Findings indicate a significant decline in self-rated health over time. In addition, child and family stressors, as well as maternal depressed mood, exerted significant between-persons effects on self-rated health such that mothers who reported more stressors and depressed mood across the study period were less likely to rate themselves in better health across that period. In addition, a significant within-person relationship between maternal depressed mood and self-rated health was found, indicating that at times when mothers reported higher levels of depressed mood than usual (their personal average across the study), they were significantly less likely to report better self-rated health. Finally, maternal depressed mood partially mediated the between-persons effects of child and family stressors on self-rated health such that increased stressors led to increased maternal depressed mood which, in turn, led to poorer maternal self-rated health. Findings suggest that chronic stressors erode maternal health over time and that depression may be an important mechanism linking stressors to decreased maternal health.
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Bekhet AK. Online Positive Thinking Training Intervention for Caregivers of Individuals with ASD: Necessity, Acceptability and Feasibility. Issues Ment Health Nurs 2017; 38:443-448. [PMID: 28448225 DOI: 10.1080/01612840.2017.1279247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 3.5 million people in the United States are diagnosed with autism spectrum disorder (ASD). Caring for children with ASD can be stressful and can be detrimental to the well-being of the caregivers (CGs). However, the adverse effects of caregiving on the well-being of CGs may be avoided with appropriate interventions. CGs of persons with ASD might benefit from a positive thinking training (PTT) intervention to help them cope with the stress of caregiving. However, the necessity, acceptability and feasibility for PTT in ASD CGs have not been studied. OBJECTIVE To examine the necessity, acceptability and feasibility of a six-week online PTT intervention designed to improve the well-being of the CGs. DESIGN Random assignment of ASD CGs to one of two conditions: (1) PTT online intervention or (2) Control group. RESULTS The mean score on the depressive cognition scale (DCS) was 20, indicating a high need of PTT to all enrolled CGs. High depressive cognitions in ASD CGs were associated with lower positive thinking (r = -.39; p <.001). Regarding acceptability, CGs indicated that the different strategies and references to real life were the most interesting parts of the intervention. Regarding feasibility, CGs mentioned that listening to the voice-over PowerPoint and visualization was the easiest part of the PTT. CONCLUSIONS Examination of the fidelity and effectiveness of the PTT are the next steps in the refinement of this intervention.
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Affiliation(s)
- Abir K Bekhet
- a Mental Health Nursing, Marquette University College of Nursing , Milwaukee , Wisconsin , USA
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Guo HM, Liu M, Xiang YT, Zhao J, Ungvari GS, Correll CU, Ng CH, Chiu HFK, Duan ZP. Insomnia in Adults With Chronic Hepatitis B, Liver Failure, and Cirrhosis: A Case-Control Study. Perspect Psychiatr Care 2017; 53:67-72. [PMID: 26633859 DOI: 10.1111/ppc.12138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/26/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To determine the frequency and socio-demographic/clinical correlates of insomnia in patients with chronic hepatitis B, hepatitis B virus (HBV)-related liver failure, and cirrhosis. DESIGN AND METHODS Up to 120 patients with HBV-related diseases and 40 matched healthy controls were recruited. Depressive and anxiety symptoms, early, middle, and late insomnia were measured. FINDINGS The frequency of ≥1 type of insomnia was 64.2% in patients and 35.0% in controls; frequencies of early, middle, and late insomnia in patients were 39.2%, 42.5%, and 48.3%, respectively, compared to 22.5%, 10.0%, and 25.0% in controls. Urban residency was independently associated with less insomnia of any type, accounting for 22.6% of the variance. PRACTICE IMPLICATIONS A considerable proportion of patients with HBV-related diseases suffer from insomnia that warrants more attention in clinical practice.
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Affiliation(s)
- Hui-Min Guo
- Artificial Liver Treatment and Training Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Mei Liu
- Artificial Liver Treatment and Training Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao, SAR, China
| | - Jing Zhao
- Artificial Liver Treatment and Training Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, USA
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Zhong-Ping Duan
- Artificial Liver Treatment and Training Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
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Bekhet AK. The Mediating Effects of Positive Cognitions on Autism Caregivers' Depression and Their Children's Challenging Behaviors. Arch Psychiatr Nurs 2016; 30:13-8. [PMID: 26804496 DOI: 10.1016/j.apnu.2015.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/27/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
Caregivers of persons with Autism Spectrum Disorders (ASD) are prone to depression and psychological problems, which have an impact on their children's challenging behaviors. Positive cognitions include specific positive thinking patterns that enhance one's ability to effectively manage daily activities and promote mental health. The purpose of this research is to test the mediating effects of positive cognitions on the relationship between caregivers' depression and their children's challenging behaviors among 117 caregivers of persons with ASD. Positive cognitions were found to have mediating effects on the relationship between caregiver's depression and their children's challenging behaviors in this sample of caregivers of persons with ASD. Nurses are in a strategic position to include in their interventions those strategies that strengthen positive cognitions in order to improve the caregivers' positive cognitions and well-being, which, in turn will have an impact on their children's challenging behaviors.
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Affiliation(s)
- Abir K Bekhet
- Mental Health Nursing, Marquette University College of Nursing, Milwaukee, WI.
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