Effects of bibliotherapy on improving caregiving appraisal and coping among informal caregivers of people with dementia: A pilot randomized controlled trial

Abstract

AbstractBackgroundThe number of people with dementia is increasing worldwide, and the majority are cared for by informal caregivers in home settings. Both positive and negative caregiving outcomes have been found among informal caregivers, the essential determinant was caregiving appraisal. Improving their caregiving appraisal is important for both the caregiver and care‐recipient’s health. However, as professional support for informal caregivers are limited, self‐help approaches are needed. Bibliotherapy, a self‐help intervention requiring minimal professional support, has been proved to be effective on improving caregiving appraisal in other populations, the effect on dementia caregivers is yet to be explored. Objectives: To explore the efficacy of bibliotherapy on improving caregiving appraisal and coping among informal caregivers of people with dementia.MethodA two arm randomized controlled trial was conducted in Zhengzhou, China. Participants were randomized to either the intervention group, receiving 8 weekly bibliotherapy sessions at home without withdrawing from usual care; or the control group, receiving usual care from the community health centers. Assessors were blinded to group allocation. Generalized estimating equation was used for data analysis.ResultsSixty participants were recruited, and 24 out of 30 participants in the intervention group finished the intervention. Bibliotherapy had significant group (Wald χ2=4.98, p=0.026), time (Wald χ 2=15.27, p<0.001) and group‐by‐time interaction effects (Wald χ2=16.51, p<0.001) on the total score of caregiving appraisal. In terms of the subscales, there were significant time effects on subjective burden (Wald χ2=8.81, p=0.003), caregiving impact (Wald χ 2=11.31, p=0.001) and caregiving mastery (Wald χ 2=11.74, p=0.001), and significant group effects on caregiving satisfaction (Wald χ 2=7.39, p=0.007). The group‐by‐time interaction was significant on all the subscales (Wald χ2=5.38‐10.89, p=0.001‐0.020). Bibliotherapy also had significant group (Wald χ2=10.93‐15.24, p<0.001), time (Wald χ 2=10.99‐33.02, p<0.001) and group‐by‐time interaction (Wald χ 2=8.91‐17.80, p=0.001‐0.003) effects on the total score of coping and the positive coping subscale. However, the effects on negative coping were not significant (Wald χ 2=0.53‐3.17, p=0.075‐0.467). No adverse events were found.ConclusionBibliotherapy had significant preliminary effects on improving caregiving appraisal and positive coping. The effect on negative coping is still limited. Future randomized controlled trials with larger sample sizes and long‐term follow‐ups are encouraged.